Volløyhaug I, Mørkved S, Salvesen Ø, Salvesen K Å
Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway.
Department of Obstetrics and Gynecology, Trondheim University Hospital, Trondheim, Norway.
Ultrasound Obstet Gynecol. 2015 Oct;46(4):487-95. doi: 10.1002/uog.14891. Epub 2015 Aug 25.
To study possible associations between mode of delivery and pelvic organ prolapse (POP) and pelvic floor muscle trauma 16-24 years after first delivery and, in particular, to identify differences between forceps and vacuum delivery.
This was a cross-sectional study including 608 women who delivered their first child in 1990-1997 and were examined with POP quantification (POP-Q) and pelvic floor ultrasound in 2013-2014. Outcome measures were POP ≥ Stage 2 or previous prolapse surgery, levator avulsion and levator hiatal area on Valsalva. Univariable and multivariable logistic regression analyses and ANCOVA were applied to identify outcome variables associated with mode of delivery.
Comparing forceps to vacuum delivery, the adjusted odds ratios (aOR) were 1.72 (95% CI, 1.06-2.79; P = 0.03) for POP ≥ Stage 2 or previous prolapse surgery and 4.16 (95% CI, 2.28-7.59; P < 0.01) for levator avulsion. Hiatal area on Valsalva was larger, with adjusted mean difference (aMD) of 4.75 cm(2) (95% CI, 2.46-7.03; P < 0.01). Comparing forceps with normal vaginal delivery, the adjusted odds ratio (aOR) was 1.74 (95% CI, 1.12-2.68; P = 0.01) for POP ≥ Stage 2 or surgery and 4.35 (95% CI, 2.56-7.40; P < 0.01) for levator avulsion; hiatal area on Valsalva was larger, with an aMD of 3.84 cm(2) (95% CI, 1.78-5.90; P < 0.01). Comparing Cesarean delivery with normal vaginal delivery, aOR was 0.06 (95% CI, 0.02-0.14; P < 0.01) for POP ≥ Stage 2 or surgery and crude OR was 0.00 (95% CI, 0.00-0.30; P < 0.01) for levator avulsion; hiatal area on Valsalva was smaller, with an aMD of -8.35 cm(2) (95% CI, -10.87 to -5.84; P < 0.01). No differences were found between vacuum and normal vaginal delivery.
We found that mode of delivery was associated with POP and pelvic floor muscle trauma in women from a general population, 16-24 years after their first delivery. Forceps was associated with significantly more POP, levator avulsion and larger hiatal areas than were vacuum and normal vaginal deliveries. There were no statistically significant differences between vacuum and normal vaginal deliveries. Cesarean delivery was associated with significantly less POP and pelvic floor muscle trauma than were normal or operative vaginal delivery.
研究首次分娩后16至24年分娩方式与盆腔器官脱垂（POP）及盆底肌肉损伤之间可能存在的关联，尤其要明确产钳助产和真空吸引助产之间的差异。
这是一项横断面研究，纳入了608名在1990年至1997年首次分娩的女性，并于2013年至2014年对她们进行了盆腔器官脱垂量化（POP-Q）检查和盆底超声检查。观察指标包括POP≥2期或既往有脱垂手术史、肛提肌撕裂以及用力屏气时的肛提肌裂孔面积。采用单变量和多变量逻辑回归分析以及协方差分析来确定与分娩方式相关的观察变量。
将产钳助产与真空吸引助产相比较，POP≥2期或既往有脱垂手术史的校正比值比（aOR）为1.72（95%置信区间，1.06 - 2.79；P = 0.03），肛提肌撕裂的校正比值比为4.16（95%置信区间，2.28 - 7.59；P < 0.01）。用力屏气时的裂孔面积更大，校正平均差（aMD）为4.75 cm²（95%置信区间，2.46 - 7.03；P < 0.01）。将产钳助产与正常阴道分娩相比较，POP≥2期或手术史的校正比值比（aOR）为1.74（95%置信区间，1.12 - 2.68；P = 0.01），肛提肌撕裂的校正比值比为4.35（95%置信区间，2.56 - 7.40；P < 0.01）；用力屏气时的裂孔面积更大，校正平均差为3.84 cm²（95%置信区间，1.78 - 5.90；P < 0.01）。将剖宫产与正常阴道分娩相比较，POP≥2期或手术史的校正比值比为0.06（95%置信区间，0.02 - 0.14；P < 0.01），肛提肌撕裂的粗比值比为0.00（95%置信区间，0.00 - 0.30；P < 0.01）；用力屏气时的裂孔面积更小，校正平均差为 - 8.35 cm²（95%置信区间， - 10.87至 - 5.84；P < 0.01）。真空吸引助产与正常阴道分娩之间未发现差异。
我们发现，在首次分娩后16至24年的普通人群女性中，分娩方式与盆腔器官脱垂及盆底肌肉损伤有关。与真空吸引助产和正常阴道分娩相比，产钳助产与更多的盆腔器官脱垂、肛提肌撕裂以及更大的裂孔面积显著相关。真空吸引助产与正常阴道分娩之间无统计学显著差异。剖宫产与正常或手术阴道分娩相比，与更少的盆腔器官脱垂和盆底肌肉损伤显著相关。
