Sydney Medical School Nepean, University of Sydney, Sydney, NSW, Australia; Kaplan Medical Center, Rehovot, Affiliated to the Hebrew University and Hadassah School of Medicine in Jerusalem, Israel.
Hospital Carlos Van Buren, Universidad de Valparaíso, Chile, Affiliated to Universidad de Valparaíso, Chile.
Eur J Obstet Gynecol Reprod Biol. 2021 Jun;261:25-28. doi: 10.1016/j.ejogrb.2021.04.006. Epub 2021 Apr 12.
Our objective was to identify non-obstetric risk factors for pelvic organ prolapse in women attending a urogynecology clinic.
A retrospective study of 662 women referred for pelvic floor dysfunction between January 2017 and August 2018. Participants underwent a standardized interview, clinical exam including Pelvic Organ Prolapse Qualification (POP-Q) assessment, and four-dimensional transperineal ultrasound. They were questioned about smoking, asthma, heavy lifting and family history of pelvic organ prolapse, as well as prolapse symptoms. Significant clinical prolapse was defined as POP-Q stage ≥2 for anterior and posterior compartments and stage ≥1 for apical prolapse. Offline analysis of volume data was performed blinded against all other data. Statistical analysis included logistic regression with multivariable models adjusted for age, body mass index, vaginal parity, levator hiatal area and levator avulsion.
Participating women were assessed at a mean age of 58 (SD 13.3) years with a mean body mass index of 28.93 kg/m (standard deviation 5.98). The vast majority were vaginally parous (88.2 %) with a median of two vaginal deliveries (range 0-7). Previous hysterectomy was reported by 29.3 % of women (n = 194) and previous prolapse repair by 17.2 % (n = 114). Past or current smoking was reported by 300 (45.6 %) women, 113 (17.2 %) reported asthma, 246 (37.6 %) heavy lifting and 186 (28.6 %) a family history of pelvic organ prolapse. Heavy lifting was associated with sonographic prolapse (odds ratio 1.71, 95 % confidence interval 1.2-2.4), confirmed on multivariable analysis (P = 0.046). Heavy lifting was positively associated with symptoms (P = 0.053) and clinical signs of pelvic organ prolapse (P = 0.056) on univariate analysis; however, this became non-significant on multivariable analysis. No associations were found for individual compartments except for a trend towards more posterior compartment prolapse with heavy lifting.
Smoking, asthma and family history of prolapse were not found to be a significant risk factor for prolapse in our study population. Heavy lifting may be a potential risk factor, in particular for posterior compartment prolapse.
本研究旨在确定就诊于泌尿科门诊的女性发生盆腔器官脱垂的非产科危险因素。
本研究为回顾性队列研究，纳入 2017 年 1 月至 2018 年 8 月期间因盆底功能障碍就诊的 662 例女性。参与者接受了标准化访谈、包括盆腔器官脱垂定量（POP-Q）评估在内的临床检查，以及经会阴四维超声检查。她们被问及吸烟、哮喘、重物搬运和盆腔器官脱垂家族史以及脱垂症状。有明显临床脱垂定义为前、后盆腔 POP-Q 分期≥2 级和/或中盆腔脱垂≥1 级。离线分析容量数据时对所有其他数据进行了盲法处理。统计分析包括多变量模型的逻辑回归分析，调整因素包括年龄、体重指数、阴道分娩次数、肛提肌裂孔面积和肛提肌撕裂。
参与研究的女性平均年龄为 58 岁（标准差 13.3 岁），平均体重指数为 28.93kg/m²（标准差 5.98kg/m²）。绝大多数为经阴道分娩（88.2%），中位分娩次数为 2 次（范围 0-7 次）。29.3%（n=194）的女性曾行子宫切除术，17.2%（n=114）曾行脱垂修补术。300 名（45.6%）女性报告有吸烟史，113 名（17.2%）报告有哮喘，246 名（37.6%）有重物搬运史，186 名（28.6%）有盆腔器官脱垂家族史。重物搬运与超声脱垂（比值比 1.71，95%置信区间 1.2-2.4）相关，多变量分析结果一致（P=0.046）。重物搬运与症状（P=0.053）和盆腔器官脱垂的临床体征（P=0.056）呈单变量分析相关；然而，多变量分析结果无统计学意义。除了与后盆腔脱垂有趋势性关联外，各解剖部位之间未发现其他关联。
在本研究人群中，吸烟、哮喘和盆腔器官脱垂家族史并非脱垂的显著危险因素。重物搬运可能是一个潜在的危险因素，特别是与后盆腔脱垂有关。
