Department of Obstetrics and Gynecology, Pelvic Floor Disease Diagnosis and Treatment Center, Shengjing Hospital of China Medical University, Shenyang City, Liaoning Province, China.
Nursing Department, Liaoning Maternal and Child Health Hospital, Shenyang City, Liaoning Province, China.
Menopause. 2021 Oct 11;28(11):1279-1286. doi: 10.1097/GME.0000000000001849.
To investigate clinical factors including translabial ultrasound parameters, which are predictive for choosing pessary type (Ring or Gellhorn) in the fitting trial, and to establish a predictive model.
A retrospective study was conducted on symptomatic women with pelvic organ prolapse (POP) at the Pelvic Floor Disease Diagnosis and Treatment Center (Liaoning Province, China) between May 2018 and December 2020 who were successfully fitted with pessaries. This retrospective study was supplemented with a prospective cohort study on women seeking pessary for first-line treatment of POP at the above tertiary center between December 2020 and April 2021 for validation. Enrolled participants were grouped by their fitted type of pessary. Demographic and clinical parameters between groups, including pelvic organ prolapse quantification and translabial ultrasound, were analyzed using logistic regression. A receiver operating characteristic curve was calculated using predictive values obtained by regression as the predictor for choosing pessary type in the pessary fitting trial.
The 181 participants included in the retrospective analysis were randomly divided into the "Development" and "Validation" datasets. In the "Development" set, multivariable logistic regression analyses showed that a younger age (odds ratio [OR]: 0.950; 95% confidence interval [CI]: 0.908-0.995; P = 0.026), a larger hiatal circumference on Valsalva (OR: 1.348; 95% CI: 1.103-1.647; P = 0.004), and a higher POP-Q stage (OR: 2.963; 95% CI: 1.210-7.255; P = 0.017) were independent predictors for successful fitting with the Gellhorn pessary. The predictive model was P = exp(Z)/[1 + exp(Z)], Z = -0.051 × Age (y) + 0.298 × hiatal circumference on Valsalva (cm) + 1.086 × pelvic organ prolapse stage (2, 3, or 4) - 5.490. The area under the receiver operating characteristic curves (AUC) was 0.776 (P < 0.001) and 0.705 (P < 0.001) based on the "Development" dataset and "Validation" datasets, respectively. The AUC was 0.815 (P < 0.001) based on the prospective cohort validation.
For severe POP, women with younger age and larger hiatal circumference, Gellhorn pessaries should be their first choice instead of ring ones in pessary fitting trials.
研究经阴道超声参数等临床因素，这些因素可预测在试配过程中选择子宫托类型（环形或盖尔霍恩型），并建立预测模型。
对 2018 年 5 月至 2020 年 12 月在中国辽宁省盆底疾病诊断与治疗中心（辽宁）成功试配子宫托的盆腔器官脱垂（POP）有症状女性进行回顾性研究。本回顾性研究补充了 2020 年 12 月至 2021 年 4 月间在上述三级中心寻求子宫托一线治疗 POP 的女性的前瞻性队列研究，以验证结果。纳入的参与者根据试配的子宫托类型进行分组。使用逻辑回归分析组间的人口统计学和临床参数，包括盆腔器官脱垂定量和经阴道超声。使用回归得到的预测值计算受试者工作特征曲线，以预测试配试验中子宫托类型的选择。
在回顾性分析中纳入的 181 名参与者被随机分为“发展”和“验证”数据集。在“发展”组中，多变量逻辑回归分析显示，年龄较小（比值比[OR]：0.950；95%置信区间[CI]：0.908-0.995；P=0.026）、Valsalva 时较大的会阴裂孔周长（OR：1.348；95%CI：1.103-1.647；P=0.004）和更高的 POP-Q 分期（OR：2.963；95%CI：1.210-7.255；P=0.017）是成功试配盖尔霍恩子宫托的独立预测因素。预测模型为 P=exp(Z)/[1+exp(Z)]，Z=-0.051×年龄（岁）+0.298×Valsalva 时会阴裂孔周长（cm）+1.086×盆腔器官脱垂分期（2、3 或 4）-5.490。基于“发展”数据集和“验证”数据集的受试者工作特征曲线（AUC）的面积分别为 0.776（P<0.001）和 0.705（P<0.001）。基于前瞻性队列验证的 AUC 为 0.815（P<0.001）。
对于严重的 POP，年龄较小和会阴裂孔周长较大的女性，在子宫托试配试验中，应首选盖尔霍恩子宫托，而不是环形子宫托。
