Stedenfeldt Mona, Pirhonen Jouko, Blix Ellen, Wilsgaard Tom, Vonen Barthold, Øian Pål
The National Advisory Unit on Continence and Pelvic Floor Health, University Hospital of North Norway, Tromsø, Norway.
Department of Clinical Medicine, Women's Health and Perinatology Research Group, Faculty of Health Science, University of Tromsø, Tromsø, Norway.
BMC Womens Health. 2014 Dec 16;14:157. doi: 10.1186/s12905-014-0157-y.
Obstetric anal sphincter injuries (OASIS) might cause anal incontinence (AI) and sexual dysfunction, and might be associated with urinary incontinence (UI). Episiotomy has been identified both as a risk and a protective factor of OASIS. Lately, episiotomies with specific characteristics have shown to be protective against the risk of OASIS. However, little is known about episiotomy characteristics and pelvic floor dysfunction. This study investigates AI, UI, and sexual problems in primiparous women with episiotomy, comparing women with and without OASIS. Associations between episiotomy characteristics and AI, UI, and sexual problems were assessed.
This is a matched case-control study investigating 74 women with one vaginal birth, all with an episiotomy. Among these, 37 women sustained OASIS and were compared to 37 women without OASIS. The two groups were matched for vacuum/forceps. AI, UI and sexual problem symptoms were obtained from St. Mark's scoring-tool and self-administered questionnaires. The episiotomy characteristics were investigated and results assessed for the whole group.
The mean time from birth was 34.5 months (range1.3-78.2) for those with OASIS and 25.9 months (range 7.0-57.4) for those without OASIS, respectively. More women with OASIS reported AI: 14 (38%) vs. 3 (8%) p = 0.05 (OR 4.66, 95% CI 1.34-16.33) as well as more problem with sexual desire p = 0.02 (OR 7.62, 95% CI 1.30-44.64) compared to women without OASIS. We found no association between episiotomy with protective characteristics and dysfunctions.
Women with OASIS had more AI and sexual problems than those without OASIS. Episiotomy characteristics varied greatly between the women. Episiotomy with protective characteristics was not associated with increased dysfunctions. OASIS should be avoided, and correct episiotomy used if indicated.
产科肛门括约肌损伤（OASIS）可能导致肛门失禁（AI）和性功能障碍，并且可能与尿失禁（UI）有关。会阴切开术已被确定为OASIS的一个风险因素和保护因素。最近，具有特定特征的会阴切开术已显示出可预防OASIS风险。然而，关于会阴切开术特征与盆底功能障碍的了解甚少。本研究调查了行会阴切开术的初产妇中的肛门失禁、尿失禁和性问题，比较了有和没有OASIS的女性。评估了会阴切开术特征与肛门失禁、尿失禁和性问题之间的关联。
这是一项配对病例对照研究，调查了74名经阴道分娩一次且均行会阴切开术的女性。其中，37名女性发生了OASIS，并与37名未发生OASIS的女性进行比较。两组在真空吸引/产钳使用方面进行了匹配。肛门失禁、尿失禁和性问题症状通过圣马克评分工具和自行填写的问卷获得。调查了会阴切开术的特征，并对整个组的结果进行了评估。
发生OASIS的女性从分娩到调查的平均时间为34.5个月（范围1.3 - 78.2个月），未发生OASIS的女性为25.9个月（范围7.0 - 57.4个月）。与未发生OASIS的女性相比，发生OASIS的女性报告肛门失禁的更多：14例（38%）对3例（8%），p = 0.05（比值比4.66，95%置信区间1.34 - 16.33），并且性欲问题更多，p = 0.02（比值比7.62，95%置信区间1.30 - 44.64）。我们发现具有保护特征的会阴切开术与功能障碍之间没有关联。
发生OASIS的女性比未发生OASIS的女性有更多的肛门失禁和性问题。女性之间会阴切开术的特征差异很大。具有保护特征的会阴切开术与功能障碍增加无关。应避免发生OASIS，如有指征应使用正确的会阴切开术。
