Gyhagen Maria, Åkervall Sigvard, Milsom Ian
Department of Obstetrics and Gynecology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden,
Int Urogynecol J. 2015 Aug;26(8):1115-21. doi: 10.1007/s00192-015-2663-3. Epub 2015 Feb 24.
The objective was to assess the prevalence and risk factors for co-occurring pelvic floor disorders (PFDs): urinary incontinence (UI), symptomatic pelvic organ prolapse (sPOP), and fecal incontinence (FI), 20 years after one vaginal (VD) or one cesarean (CS) delivery.
We carried out a registry-based national cohort study of primiparae who delivered during the period 1985-1988 and had no further deliveries. Medical Birth Registry data were linked to data from postal questionnaires distributed 20 years post-partum (response rate 65.2%, n = 5,236). Main outcome measures were prevalence and risk factors for combined and isolated PFDs.
The prevalence of any PFD was 46.5; 31.7% had one symptom and 14.8% had two or more. Co-occurring symptoms doubled after VD (17.1%) compared with CS (8.4%) (adjOR 2.26; 95% CI 1.84-2.79). The strongest association was observed between VD and having all three symptoms (adjOR 5.20; 95% CI 2.73-9.91), followed by the combination of sPOP and UI (adjOR 3.38; 95% CI 2.24-5.10). The degree of frustration perceived by the women because of pelvic floor dysfunction increased with each additional co-occurring PFD (p < 0.001). The strongest risk factors for clustering of PFDs were: VD (OR 2.19; 95% CI 1.75-2.73), family history (OR 2.03; 95% CI 1.73-2.34), and ≥2 degree tear (OR 1.78; 95% CI 1.24-2.55). Vacuum extraction and episiotomy were not risk factors.
The prevalence of co-occurring PFDs was high and was doubled in women after VD compared with CS. Women with UI most likely had it as an isolated symptom, whereas FI and sPOP more often occurred in combination.
目的是评估在经一次阴道分娩（VD）或一次剖宫产（CS）20年后，同时存在的盆底功能障碍（PFDs）的患病率及危险因素，这些障碍包括尿失禁（UI）、有症状的盆腔器官脱垂（sPOP）和大便失禁（FI）。
我们对1985 - 1988年期间分娩且无后续分娩的初产妇进行了一项基于登记处的全国队列研究。医疗出生登记数据与产后20年发放的邮政调查问卷数据相关联（回复率65.2%，n = 5236）。主要结局指标是合并及单独的PFDs的患病率和危险因素。
任何PFD的患病率为46.5%；31.7%有一项症状，14.8%有两项或更多症状。与剖宫产（8.4%）相比，阴道分娩后同时出现症状的比例增加了一倍（17.1%）（校正比值比2.26；95%可信区间1.84 - 2.79）。在阴道分娩与出现所有三种症状之间观察到最强的关联（校正比值比5.20；95%可信区间2.73 - 9.91），其次是sPOP和UI的组合（校正比值比3.38；95%可信区间2.24 - 5.10）。因盆底功能障碍而感到沮丧的女性程度随着同时出现的PFD数量增加而增加（p < 0.001）。PFDs聚集的最强危险因素是：阴道分娩（比值比2.19；95%可信区间1.75 - 2.73）、家族史（比值比2.03；95%可信区间1.73 - 2.34）和≥Ⅱ度裂伤（比值比1.78；95%可信区间1.24 - 2.55）。真空吸引和会阴切开术不是危险因素。
同时存在的PFDs患病率很高，与剖宫产相比，阴道分娩后的女性患病率增加了一倍。尿失禁女性最可能仅有这一单独症状，而大便失禁和有症状的盆腔器官脱垂更常合并出现。
