Department of Obstetrics and Gynaecology, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190-2º andar, Belo Horizonte, 30130-100, Brazil.
Department of Surgery, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190-sala 203, Belo Horizonte, 30130-100, Brazil.
Arch Gynecol Obstet. 2018 Aug;298(2):345-352. doi: 10.1007/s00404-018-4811-8. Epub 2018 Jun 14.
Disorders related to pelvic floor include urinary incontinence (UI), anal incontinence, pelvic organ prolapse, sexual dysfunction and pelvic pain. Because pelvic floor dysfunctions (PFD) can be diagnosed clinically, imaging techniques serve as auxiliary tools for establishing an accurate diagnosis. The objective is to evaluate the PFD in primiparous women after vaginal delivery and the association between clinical examination and three-dimensional ultrasonography (3DUS).
A cross-sectional study was conducted in a in tertiary maternity. All primiparous women with vaginal deliveries that occurred between January 2013 and December 2015 were invited. Women who attended the invitation underwent detailed anamnesis, questionnaire application, physical examination and endovaginal and endoanal 3DUS. Crude and adjusted predictor factors for PFD were analyzed.
Fifty women were evaluated. Sexual dysfunction was the most prevalent PFD (64.6%). When associated with clinical features and PFD, oxytocin use increased by approximately four times the odds of UI (crude OR 4.182, 95% CI 1.149-15.219). During the multivariate analysis, the odds of UI were increased in forceps use by approximately 11 times (adjusted OR 11.552, 95% CI 11.155-115.577). When the clinical and obstetrical predictors for PFD were associated with 3DUS, forceps increased the odds of lesion of the pubovisceral muscle and anal sphincter diagnosed by 3DUS by sixfold (crude OR 6.000, 95% CI 1.172-30.725), and in multivariate analysis forceps again increased the odds of injury by approximately 7 times (adjusted OR 7.778, 95% CI 1.380-43.846).
Sexual dysfunction was the most frequent PFD. The use of forceps in primiparous women was associated with a greater chance of UI and pelvic floor muscle damage diagnosed by 3DUS.
与骨盆底相关的疾病包括尿失禁（UI）、肛门失禁、盆腔器官脱垂、性功能障碍和盆腔疼痛。由于骨盆底功能障碍（PFD）可以通过临床诊断，影像学技术则作为建立准确诊断的辅助手段。本研究旨在评估阴道分娩后初产妇的 PFD 情况，以及临床检查与三维超声（3DUS）的关联。
这是一项在一家三级产科医院进行的横断面研究。邀请了所有 2013 年 1 月至 2015 年 12 月期间进行阴道分娩的初产妇。参加邀请的女性接受了详细的病史、问卷调查、体格检查以及阴道内和肛门内 3DUS 检查。分析了 PFD 的粗预测因子和调整预测因子。
共评估了 50 名女性。性功能障碍是最常见的 PFD（64.6%）。当与临床特征和 PFD 相关联时，催产素的使用使 UI 的几率增加了约四倍（粗 OR 4.182，95%CI 1.149-15.219）。在多变量分析中，产钳的使用使 UI 的几率增加了约 11 倍（调整 OR 11.552，95%CI 11.155-115.577）。当将 PFD 的临床和产科预测因子与 3DUS 相关联时，产钳使 3DUS 诊断的耻骨直肠肌和肛门括约肌损伤的几率增加了 6 倍（粗 OR 6.000，95%CI 1.172-30.725），并且在多变量分析中，产钳再次使损伤的几率增加了约 7 倍（调整 OR 7.778，95%CI 1.380-43.846）。
性功能障碍是最常见的 PFD。初产妇使用产钳与 UI 和 3DUS 诊断的骨盆底肌肉损伤的几率增加有关。
