Ducarme Guillaume, Hamel Jean-François, Brun Stéphanie, Madar Hugo, Merlot Benjamin, Sentilhes Loïc
Department of Obstetrics and Gynecology, Centre Hospitalier Departemental, La Roche sur Yon, France.
Clinical Research Center, Angers University Hospital, Angers, France.
PLoS One. 2017 Jun 7;12(6):e0178915. doi: 10.1371/journal.pone.0178915. eCollection 2017.
To evaluate the effect of the fetal head station at attempted operative vaginal delivery (aOVD), and specifically midpelvic or low aOVD, on female and male sexual function and symptoms of postpartum depression (PPD) at 6 months.
Prospective population-based cohort study.
1,941 women with singleton term fetuses in vertex presentation with midpelvic or low aOVD between 2008 and 2013 in a tertiary care university hospital.
Symptoms of female sexual dysfunction using the Pelvic Organ Prolapse/Urinary Incontinence/Sexual Function Short Form Questionnaire (PISQ-12), symptoms of PPD using the Edinburgh Postnatal Depression Scale (EPDS) score, symptoms of male sexual dysfunction using the International Index of Erectile Function (IIEF-15) and perineal pain were assessed 6 months after aOVD. We measured the association between midpelvic or low aOVD and symptoms of female and male sexual function and symptoms of PPD at 6 months using multiple regression and adjusting for demographics, and risk factors of sexual dysfunction, symptoms of PPD and perineal pain with adjusted odds ratios (aORs) and 95% confidence intervals (95% CI).
The study included 907 women (46.7%) who responded to the questionnaire; 18.4% (167/907) had midpelvic aOVD, and 81.6% (740/907) low. Most women (873/907 [96.3%]) of those with partners reported sexual activity at 6 months. No significant difference was observed for PISQ-12, EPDS, IIEF-15 scores and perineal pain between mid and low pelvic groups. Compared with low pelvic aOVD, midpelvic aOVD was not significantly associated with either female or male sexual dysfunction (p = 0.89 and p = 0.76, respectively), or maternal symptoms of PPD (p = 0.83). Perineal pain significantly increased the risk of male and female sexual dysfunction and maternal symptoms of PPD at 6 months (p = 0.02, p = 0.006, and p = 0.02, respectively).
Midpelvic compared with low pelvic aOVD was not associated with an increase in sexual dysfunction, nor with symptoms of PPD at 6 months.
评估试产时胎头位置（尤其是中骨盆或低位试产）对产后6个月时男女性功能及产后抑郁（PPD）症状的影响。
基于人群的前瞻性队列研究。
2008年至2013年期间，在一家三级护理大学医院中，1941名单胎足月胎儿、头先露且进行中骨盆或低位试产的女性。
使用盆腔器官脱垂/尿失禁/性功能简短问卷（PISQ - 12）评估女性性功能症状，使用爱丁堡产后抑郁量表（EPDS）评分评估PPD症状，使用国际勃起功能指数（IIEF - 15）评估男性性功能症状，并在试产后6个月评估会阴疼痛情况。我们采用多元回归分析，在调整人口统计学因素以及性功能障碍、PPD症状和会阴疼痛的风险因素后，测量中骨盆或低位试产与产后6个月时男女性功能症状及PPD症状之间的关联，并计算调整后的优势比（aORs）和95%置信区间（95%CI）。
该研究纳入了907名回复问卷的女性（46.7%）；其中18.4%（167/907）为中骨盆试产，81.6%（740/907）为低位试产。大多数有伴侣的女性（873/907 [96.3%]）在产后6个月有性行为。中骨盆组和低位骨盆组在PISQ - 12、EPDS、IIEF - 15评分及会阴疼痛方面未观察到显著差异。与低位骨盆试产相比，中骨盆试产与男女性功能障碍（分别为p = 0.89和p = 0.76）或产妇PPD症状（p = 0.83）均无显著关联。会阴疼痛在产后6个月时显著增加了男女性功能障碍及产妇PPD症状的风险（分别为p = 0.02、p = 0.006和p = 0.02）。
与低位骨盆试产相比，中骨盆试产与性功能障碍增加无关，也与产后6个月时的PPD症状无关。
