Persson Lisa K G, Sakse Abelone, Langhoff-Roos Jens, Jangö Hanna
Department of Obstetrics and Gynecology, Hvidovre University Hospital , Kettegaard Alle 30, 2650, Hvidovre, Denmark.
Department of Obstetrics and Gynecology, Juliane Marie Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Arch Gynecol Obstet. 2017 Jun;295(6):1399-1406. doi: 10.1007/s00404-017-4368-y. Epub 2017 Apr 13.
To evaluate prevalence and risk factors for long-term anal incontinence in women with two prior vaginal deliveries without obstetric anal sphincter injury (OASIS) and to assess the impact of anal incontinence-related symptoms on quality of life.
This is a nation-wide cross-sectional survey study. One thousand women who had a first vaginal delivery and a subsequent delivery, both without OASIS, between 1997 and 2008 in Denmark were identified in the Danish Medical Birth Registry. Women with more than two deliveries in total till 2012 were excluded at this stage. Of the 1000 women randomly identified, 763 were eligible and received a questionnaire. Maternal and obstetric data were retrieved from the national registry.
The response rate was 58.3%. In total, 394 women were included for analysis after reviewing responses according to previously defined exclusion criteria. Median follow-up time was 9.8 years after the first delivery and 6.4 years after the second. The prevalence of flatal incontinence, fecal incontinence and fecal urgency were 11.7, 4.1, and 12.3%, respectively. Overall, 20.1% had any degree of anal incontinence and/or fecal urgency. In 6.3% these symptoms affected their quality of life. No maternal or obstetric factors including episiotomy and vacuum extraction were consistently associated with altered risk of anal incontinence in the multivariable analyses.
Anal incontinence and fecal urgency is reported by one fifth of women with two vaginal deliveries without OASIS at long-term follow-up. Episiotomy or vacuum extraction did not alter the risk of long-term anal incontinence.
评估无产科肛门括约肌损伤（OASIS）的经两次阴道分娩的女性长期肛门失禁的患病率和危险因素，并评估肛门失禁相关症状对生活质量的影响。
这是一项全国性横断面调查研究。在丹麦医疗出生登记处识别出1997年至2008年期间在丹麦首次阴道分娩且随后再次分娩均无OASIS的1000名女性。在此阶段排除截至2012年总共分娩次数超过两次的女性。在随机识别出的1000名女性中，763名符合条件并收到问卷。从国家登记处获取产妇和产科数据。
回复率为58.3%。根据先前定义的排除标准审查回复后，总共纳入394名女性进行分析。首次分娩后的中位随访时间为9.8年，第二次分娩后的中位随访时间为6.4年。排气失禁、大便失禁和便急的患病率分别为11.7%、4.1%和12.3%。总体而言，20.1%的女性有任何程度的肛门失禁和/或便急。其中6.3%的这些症状影响了她们的生活质量。在多变量分析中没有包括会阴切开术和真空吸引术在内的产妇或产科因素与肛门失禁风险改变始终相关。
在长期随访中，五分之一经两次阴道分娩且无OASIS的女性报告有肛门失禁和便急。会阴切开术或真空吸引术未改变长期肛门失禁的风险。
