Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Obstet Gynecol. 2011 Oct;118(4):777-84. doi: 10.1097/AOG.0b013e3182267f2f.
To estimate differences in pelvic floor disorders by mode of delivery.
We recruited 1,011 women for a longitudinal cohort study 5-10 years after first delivery. Using hospital records, we classified each birth as: cesarean without labor, cesarean during active labor, cesarean after complete cervical dilation, spontaneous vaginal birth, or operative vaginal birth. At enrollment, stress incontinence, overactive bladder, anal incontinence, and prolapse symptoms were assessed with a validated questionnaire. Pelvic organ support was assessed using the Pelvic Organ Prolapse Quantification system. Logistic regression analysis was used to estimate the relative odds of each pelvic floor disorder by obstetric history, adjusting for relevant confounders.
Compared with cesarean without labor, spontaneous vaginal birth was associated with a significantly greater odds of stress incontinence (odds ratio [OR] 2.9, 95% confidence interval [CI] 1.5-5.5) and prolapse to or beyond the hymen (OR 5.6, 95% CI 2.2-14.7). Operative vaginal birth significantly increased the odds for all pelvic floor disorders, especially prolapse (OR 7.5, 95% CI 2.7-20.9). These results suggest that 6.8 additional operative births or 8.9 spontaneous vaginal births, relative to cesarean births, would lead to one additional case of prolapse. Among women delivering exclusively by cesarean, neither active labor nor complete cervical dilation increased the odds for any pelvic floor disorder considered, although the study had less than 80% power to detect a doubling of the odds with these exposures.
Although spontaneous vaginal delivery was significantly associated with stress incontinence and prolapse, the most dramatic risk was associated with operative vaginal birth.
II.
评估不同分娩方式对盆底功能障碍的影响。
我们招募了 1011 名女性进行一项纵向队列研究，随访时间为首次分娩后 5-10 年。根据医院记录，我们将每次分娩分为：无活跃期剖宫产、活跃期剖宫产、完全宫颈扩张后剖宫产、自然阴道分娩或经阴道助产分娩。在入组时，使用经过验证的问卷评估压力性尿失禁、膀胱过度活动症、肛门失禁和脱垂症状。使用盆腔器官脱垂定量系统评估盆腔器官支持情况。使用逻辑回归分析，在调整相关混杂因素后，根据产科史估计每种盆底功能障碍的相对比值比。
与无活跃期剖宫产相比，自然阴道分娩与压力性尿失禁的比值比显著增加（比值比 [OR] 2.9，95%置信区间 [CI] 1.5-5.5）和处女膜后或超出的脱垂（OR 5.6，95% CI 2.2-14.7）显著增加。经阴道助产分娩显著增加了所有盆底功能障碍的发生风险，尤其是脱垂（OR 7.5，95% CI 2.7-20.9）。这些结果表明，相对于剖宫产，每增加 6.8 次经阴道助产分娩或 8.9 次自然阴道分娩，就会导致 1 例额外的脱垂病例。在完全行剖宫产分娩的女性中，虽然研究的效力不足以检测到这些暴露因素使比值比增加一倍，但活跃期分娩或完全宫颈扩张均不会增加任何考虑的盆底功能障碍的发生风险。
尽管自然阴道分娩与压力性尿失禁和脱垂显著相关，但最显著的风险与经阴道助产分娩相关。
II 级。
