阴道分娩后盆底障碍：会阴切开术、会阴裂伤和剖宫产的影响。
Pelvic floor disorders after vaginal birth: effect of episiotomy, perineal laceration, and operative birth.
机构信息
Department Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
出版信息
Obstet Gynecol. 2012 Feb;119(2 Pt 1):233-9. doi: 10.1097/AOG.0b013e318240df4f.
OBJECTIVE
To investigate whether episiotomy, perineal laceration, and operative delivery are associated with pelvic floor disorders after vaginal childbirth.
METHODS
This is a planned analysis of data for a cohort study of pelvic floor disorders. Participants who had experienced at least one vaginal birth were recruited 5-10 years after delivery of their first child. Obstetric exposures were classified by review of hospital records. At enrollment, pelvic floor outcomes, including 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.
RESULTS
Of 449 participants, 71 (16%) had stress incontinence, 45 (10%) had overactive bladder, 56 (12%) had anal incontinence, 19 (4%) had prolapse symptoms, and 64 (14%) had prolapse to or beyond the hymen on examination. Forceps delivery increased the odds of each pelvic floor disorder considered, especially overactive bladder (odds ratio [OR] 2.92, 95% confidence interval [CI] 1.44-5.93), and prolapse (OR 1.95, 95% CI 1.03-3.70). Episiotomy was not associated with any of these pelvic floor disorders. In contrast, women with a history of more than one spontaneous perineal laceration were significantly more likely to have prolapse to or beyond the hymen (OR 2.34, 95% CI 1.13-4.86). Our multivariable results suggest that one additional woman would have development of prolapse for every eight women who experienced at least one forceps birth (compared with delivering all her children by spontaneous vaginal birth).
CONCLUSION
Forceps deliveries and perineal lacerations, but not episiotomies, were associated with pelvic floor disorders 5-10 years after a first delivery.
LEVEL OF EVIDENCE
II.
目的
探讨会阴切开术、会阴裂伤和剖宫产是否与阴道分娩后盆底功能障碍有关。
方法
这是一项对盆底功能障碍队列研究数据的计划分析。研究对象在分娩后 5-10 年招募，至少经历过一次阴道分娩。通过回顾病历记录对产科暴露情况进行分类。在入组时，采用经过验证的问卷评估盆底功能障碍结局，包括压力性尿失禁、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。采用 logistic 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。
结果
在 449 名参与者中，71 名（16%）患有压力性尿失禁，45 名（10%）患有膀胱过度活动症，56 名（12%）患有肛门失禁，19 名（4%）患有脱垂症状，64 名（14%）在检查时发现脱垂至处女膜或更深处。产钳分娩增加了每种考虑的盆底功能障碍的几率，尤其是膀胱过度活动症（比值比 [OR] 2.92，95%置信区间 [CI] 1.44-5.93）和脱垂（OR 1.95，95% CI 1.03-3.70）。会阴切开术与这些盆底功能障碍均无关。相比之下，有多次自发性会阴裂伤史的女性发生处女膜或更深处脱垂的可能性显著更高（OR 2.34，95% CI 1.13-4.86）。我们的多变量结果表明，每有 8 名女性经历至少一次产钳分娩，就会有 1 名女性发生脱垂（与所有孩子经阴道自然分娩相比）。
结论
在首次分娩后 5-10 年，产钳分娩和会阴裂伤与盆底功能障碍有关，而会阴切开术与盆底功能障碍无关。
证据等级
II 级。
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