Pennycuff Jon F, Karp Deborah R, Shinnick Julia, Hudson Catherine O, Northington Gina M
From the Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA.
Women's Services, Wellstar Health, Atlanta, GA.
Female Pelvic Med Reconstr Surg. 2019 Sep/Oct;25(5):383-387. doi: 10.1097/SPV.0000000000000583.
Obstetric anal sphincter injury (OASIS) is a potentially serious complication of vaginal delivery and can lead to both short-term and long-term sequelae. This study sought to identify health care seeking patterns of women who developed pelvic floor symptoms including pelvic pain after OASIS. It also identified demographic and clinical factors associated with seeking subspecialty care from a pelvic floor specialist and demographic and clinical factors associated with seeking care for pelvic pain after OASIS.
This study is a retrospective cohort study of 69 women who developed pelvic floor disorders after OASIS.
For women diagnosed with a pelvic floor symptom, the mean time to follow-up was 2.4 years, the mean number of visits until diagnosis was 2.2 visits, and 2.9 visits were needed for treatment. The most common diagnoses were pelvic pain, lower urinary tract symptoms including incontinence, and defecatory dysfunction. Twenty-five percent of the cohort received treatment from a pelvic floor specialist. These women were more likely to be older and have urinary incontinence. Women with pain were more likely to be seen by a primary care provider and have longer time to diagnosis.
The study showed that multiple visits were needed to both diagnose and treat pelvic floor disorders (PFD) after OASIS. Pelvic pain was the most common primary PFD after OASIS. There should be a high level of suspicion for pelvic floor disorders, especially pain disorders, in women who have sustained a third- or fourth-degree laceration.
产科肛门括约肌损伤（OASIS）是阴道分娩的一种潜在严重并发症，可导致短期和长期后遗症。本研究旨在确定出现盆底症状（包括OASIS后盆腔疼痛）的女性的就医模式。它还确定了与寻求盆底专科医生的亚专科护理相关的人口统计学和临床因素，以及与OASIS后盆腔疼痛寻求护理相关的人口统计学和临床因素。
本研究是一项对69例OASIS后出现盆底功能障碍的女性进行的回顾性队列研究。
对于被诊断为盆底症状的女性，平均随访时间为2.4年，诊断前的平均就诊次数为2.2次，治疗需要2.9次就诊。最常见的诊断是盆腔疼痛、包括尿失禁在内的下尿路症状以及排便功能障碍。该队列中有25%的女性接受了盆底专科医生的治疗。这些女性更有可能年龄较大且患有尿失禁。有疼痛的女性更有可能由初级保健提供者诊治，且诊断时间更长。
该研究表明，OASIS后诊断和治疗盆底功能障碍（PFD）需要多次就诊。盆腔疼痛是OASIS后最常见的原发性PFD。对于有三度或四度裂伤的女性，应高度怀疑其存在盆底功能障碍，尤其是疼痛性疾病。
