Rogers R G, Leeman L M, Borders N, Qualls C, Fullilove A M, Teaf D, Hall R J, Bedrick E, Albers L L
Departments of Obstetrics and Gynecology and Surgery, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
BJOG. 2014 Aug;121(9):1145-53; discussion 1154. doi: 10.1111/1471-0528.12571. Epub 2014 Feb 19.
Maternal expulsive efforts are thought to damage the pelvic floor. We aimed to compare pelvic floor function and anatomy between women who delivered vaginally (VB) versus those with caesarean delivery (CD) prior to the second stage of labour.
Prospective cohort.
University Hospital Midwifery practice.
Nulliparas.
Pregnant nulliparas were recruited during pregnancy and women who underwent CD prior to the 2nd stage of labour at birth were recruited immediately postpartum. Both groups were followed prospectively to 6 months postpartum.
POPQ, perineal ultrasound (U/S) and Paper Towel Test (PTT), an objective measure of stress incontinence; Incontinence Severity Index (ISI), Pelvic Floor Impact Questionnaire (PFIQ-7), Wexner Fecal Incontinence Scale (W) and Female Sexual Function Index (FSFI).
336/448 (75%) VB and 138/224 (62%) CD followed up. The VB group was younger (23.9 ± 4.9 versus 26.6 ± 6.1 years, P < 0.001) and less overweight/obese (38 versus 56%, P < 0.001); baseline functional measures were similar (all P > 0.05). At follow-up, urinary incontinence (UI) (55 versus 46% ISI > 0, P = 0.10), fecal incontinence (FI) (8 versus 13% FI on W, P = 0.12), sexual activity rates (88 versus 92%, P = 0.18) and PFIQ-seven scores were similar. Positive PTT tests (17 versus 6%, P = 0.002) and ≥ Stage 2 prolapse (22 versus 15%, P = 0.03) were higher with VB; differences were limited to points Aa and Ba. U/S findings were not different between groups. Stepwise multivariate analyses controlling for age, body mass index, and non-Hispanic White race for prolapse of points Aa and Ba did not alter conclusions (all P < 0.004).
VB resulted in prolapse changes and objective UI but not in increased self-report pelvic floor dysfunction at 6 months postpartum compared with women who delivered by CD prior to the second stage of labour. The second stage of labour had a modest effect on postpartum pelvic floor function.
产妇的用力分娩被认为会损伤盆底。我们旨在比较分娩第二产程前经阴道分娩（VB）的女性与剖宫产（CD）的女性之间的盆底功能和解剖结构。
前瞻性队列研究。
大学医院助产实践。
初产妇。
在孕期招募初产妇，在产后立即招募分娩第二产程前接受剖宫产的女性。两组均进行前瞻性随访至产后6个月。
盆腔器官脱垂定量分期系统（POPQ）、会阴超声（U/S）和纸巾试验（PTT），一种压力性尿失禁的客观测量方法；尿失禁严重程度指数（ISI）、盆底影响问卷（PFIQ - 7）、韦克斯纳大便失禁量表（W）和女性性功能指数（FSFI）。
336/448（75%）例经阴道分娩者和138/224（62%）例剖宫产者完成随访。经阴道分娩组年龄更小（23.9±4.9岁对26.6±6.1岁，P<0.001）且超重/肥胖者更少（38%对56%，P<0.001）；基线功能指标相似（所有P>0.05）。随访时，尿失禁（UI）（ISI>0者55%对46%，P = 0.10）、大便失禁（FI）（W量表上大便失禁者8%对13%，P = 0.12）、性活动率（88%对92%，P = 0.18）和PFIQ - 7评分相似。经阴道分娩者阳性纸巾试验（17%对6%，P = 0.002）和≥II度脱垂（22%对15%，P = 0.03）更高；差异仅限于Aa点和Ba点。两组间超声检查结果无差异。对Aa点和Ba点脱垂控制年龄、体重指数和非西班牙裔白人种族进行逐步多变量分析未改变结论（所有P<0.004）。
与分娩第二产程前剖宫产的女性相比，经阴道分娩在产后6个月导致脱垂改变和客观尿失禁，但自我报告的盆底功能障碍未增加。第二产程对产后盆底功能有适度影响。
