Du Jingran, Ye Juntong, Fei Hui, Li Mengxiong, He Juan, Liu Lixiang, Liu Yun, Li Tian
Department of Obstetrics and Gynecology, Pelvic Floor Disorder Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China.
Department of Obstetrics and Gynecology, Pelvic Floor Disorder Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China.
Sex Med. 2021 Oct;9(5):100417. doi: 10.1016/j.esxm.2021.100417. Epub 2021 Aug 19.
Epidural analgesia has become a universal intervention for relieving labor pain, and its effect on the pelvic floor is controversial.
To investigate the effect of epidural analgesia on pelvic floor dysfunction (PFD) in primiparous women at 6 months postpartum.
We performed a prospective cohort study involving 150 primiparous women in preparation for vaginal delivery, with 74 (49.3%) receiving epidural analgesia. Baseline demographic and intrapartum data were collected. At 6 months postpartum, PFD symptoms, including stress urinary incontinence, overactive bladder, defecation disorder, pelvic organ prolapse, and 4 kinds of sexual dysfunction (arousal disorder, low sexual desire, dyspareunia, and orgasm disorder), were evaluated. Pelvic floor muscle (PFM) function and postpartum depression were also assessed. Multivariate logistic regression was applied to identify factors associated with the PFD symptoms affected by epidural analgesia.
PFD symptoms and sexual dysfunction were evaluated through Pelvic Floor Distress Inventory-20 (PFDI-20) and Female Sexual Function Index (FSFI-12). PFM function was examined with palpation and surface electromyography (sEMG). Postpartum depression was assessed using Self-Rating Depression Scale (SDS).
At 6 months postpartum, women who delivered with epidural analgesia had a higher incidence of dyspareunia (43.2% vs 26.3%, P <0.05) and longer first, second, and total stage of labor durations (P <0.01) than those who without. No significant difference in other PFD symptoms or PFM function was found between the 2 groups (P >0.05). Multivariate logistic regression revealed that epidural analgesia (OR = 3.056, 95% CI = 1.217-7.671) and SDS scores (OR = 1.066, 95% CI = 1.009-1.127) were independent risk factors for dyspareunia.
At 6 months postpartum in primiparous women, epidural analgesia was associated with an increased risk of postpartum dyspareunia and longer labor durations, which deserves attention for rehabilitation after delivery. Future studies with a larger sample size are needed to evaluate the impact of epidural analgesia on other PFD symptoms. Du J, Ye J, Fei H, et al. Effect of Epidural Analgesia on Pelvic Floor Dysfunction at 6 Months Postpartum in Primiparous Women: A Prospective Cohort Study. Sex Med 2021;9:100417.
硬膜外镇痛已成为缓解分娩疼痛的普遍干预措施，其对盆底的影响存在争议。
探讨硬膜外镇痛对初产妇产后6个月盆底功能障碍（PFD）的影响。
我们进行了一项前瞻性队列研究，纳入150名准备经阴道分娩的初产妇，其中74名（49.3%）接受硬膜外镇痛。收集基线人口统计学和产时数据。在产后6个月时，评估PFD症状，包括压力性尿失禁、膀胱过度活动症、排便障碍、盆腔器官脱垂以及4种性功能障碍（性唤起障碍、性欲低下、性交困难和性高潮障碍）。还评估了盆底肌肉（PFM）功能和产后抑郁情况。采用多因素逻辑回归分析确定受硬膜外镇痛影响的与PFD症状相关的因素。
通过盆底功能障碍指数-20（PFDI-20）和女性性功能指数（FSFI-12）评估PFD症状和性功能障碍。通过触诊和表面肌电图（sEMG）检查PFM功能。使用自评抑郁量表（SDS）评估产后抑郁情况。
产后6个月时，接受硬膜外镇痛分娩的女性性交困难发生率较高（43.2%对26.3%，P<0.05），第一产程、第二产程和总产程持续时间更长（P<0.01），高于未接受硬膜外镇痛的女性。两组在其他PFD症状或PFM功能方面未发现显著差异（P>0.05）。多因素逻辑回归显示，硬膜外镇痛（OR = 3.056，95%CI = 1.217 - 7.671）和SDS评分（OR = 1.066，95%CI = 1.009 - 1.127）是性交困难的独立危险因素。
在初产妇产后6个月时，硬膜外镇痛与产后性交困难风险增加和产程延长有关，这在分娩后康复中值得关注。需要进一步开展更大样本量的研究来评估硬膜外镇痛对其他PFD症状的影响。杜J，叶J，费H等。初产妇产后6个月硬膜外镇痛对盆底功能障碍的影响：一项前瞻性队列研究。性医学2021；9：100417。
