From the Departments of Obstetrics and Gynecology.
Family and Preventive Medicine.
Female Pelvic Med Reconstr Surg. 2021 May 1;27(5):289-296. doi: 10.1097/SPV.0000000000000848.
The aim of the study was to determine whether oxytocin for induction or augmentation of labor impacts the incidence or persistence of pelvic floor symptoms and support 5 to 10 weeks after first vaginal delivery.
Participants in this prospective cohort study were nulliparous women 18 years or older that delivered vaginally at 37 weeks gestation or more and completed the Epidemiology of Prolapse and Incontinence Questionnaire (EPIQ) and the Pelvic Organ Prolapse Quantification examination in third trimester and 5 to 10 weeks postpartum. We compared the incidence and persistence of symptomatic EPIQ domains and worse vaginal support (maximal vaginal descent ≥0 cm) between women who received oxytocin with those that did not (with or without prostaglandin or mechanical methods in both groups). We performed modified binomial regression to calculate adjusted relative risks of each outcome with 95% confidence intervals.
The mean (SD) age of the 722 participants was 28.3 (5.2) years; 20% were Hispanic. There were no significant differences according to oxytocin exposure in either incidence or persistence of symptomatic EPIQ domains or worse vaginal support. We found similar results in sensitivity analyses comparing women who received oxytocin as the sole pharmacologic agent to women who received no pharmacologic agent. After adjusting for demographic and obstetric factors associated with incidence and persistence of symptoms and support, oxytocin exposure continued to have no effect.
Oxytocin during labor does not significantly increase the risks for the incidence or persistence of pelvic floor symptoms or worse vaginal support in the early postpartum period, although power for less frequent outcomes was limited.
本研究旨在确定催产素用于引产或催产是否会影响初产妇产后 5 至 10 周时盆底症状的发生或持续存在及其对盆底支持的影响。
本前瞻性队列研究的参与者为年龄在 18 岁及以上、孕 37 周及以上经阴道分娩的初产妇，且在孕晚期和产后 5 至 10 周完成了脱垂和尿失禁的流行病学问卷（EPIQ）和盆腔器官脱垂量化检查。我们比较了使用催产素与未使用催产素（两组均使用或不使用前列腺素或机械方法）的产妇在出现 EPIQ 症状域和阴道支持恶化（最大阴道下降≥0cm）方面的发生率和持续性。我们采用校正二项式回归计算每个结局的调整后相对风险，置信区间为 95%。
722 名参与者的平均（SD）年龄为 28.3（5.2）岁，20%为西班牙裔。根据催产素暴露情况，在 EPIQ 症状域的发生率或持续性或阴道支持恶化方面，无显著差异。我们在敏感性分析中比较了仅使用催产素作为单一药物的产妇与未使用任何药物的产妇，发现了类似的结果。在校正与症状和支持的发生和持续性相关的人口统计学和产科因素后，催产素暴露仍然没有影响。
尽管对不太常见结局的效能有限，但分娩时使用催产素并不会显著增加产妇在产后早期出现盆底症状或阴道支持恶化的风险。
