School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
Department of Obstetrics and Gynecology, Soroka University Medical Center, P.O. Box 151, 84101, Beer Sheva, Israel.
Arch Gynecol Obstet. 2022 Oct;306(4):1053-1061. doi: 10.1007/s00404-022-06555-8. Epub 2022 Apr 18.
Preliminary evidence suggests that women with cervical oss insufficiency may have an increased risk to develop pelvic organ prolapse later in life, suggesting a common underlying collagen-oriented mechanism.
The objective of this study was to determine the association between cervical oss insufficiency and the subsequent development of pelvic organ prolapse.
A matched, case-control study, including women who delivered at the Soroka University Medical Center. Cases were women diagnosed or treated with pelvic organ prolapse (n = 1463), and controls were a representative sample of women of the same age group without pelvic organ prolapse (n = 5637). The association between pelvic organ prolapse and prior preterm birth was tested. Univariate analysis was performed using a conditional logistic regression to assess the association between preterm labor and pelvic organ prolapse. Statistically and clinically significant variables in the univariate analysis were included in the multivariable regression.
The rate of spontaneous preterm birth did not differ between the study groups [pelvic organ prolapse - 4.0% (59/1463) vs. non- pelvic organ prolapse - 4.9% (276/5637), p = 0.16]. The median number of preterm births was higher among women without pelvic organ prolapse (controls) than in those with pelvic organ prolapse (cases) (p = 0.004). Among those who delivered preterm, the individual proportion of preterm deliveries was higher among the controls' group (p = 0.03). Similarly, the rate of cesarean deliveries was also higher among the controls group (p = 0.003). The rate of small for gestational age neonates was higher in the controls group (p = 0.0007), while that of large for gestational age neonates was higher in the case group (p = 0.02). In the univariate analysis, birthweight, vaginal delivery, and prior surgery were associated with subsequent development of pelvic organ prolapse. The multivariable analysis exhibited the same association- having birthweight, vaginal delivery, and all types of prior surgery independently associated with subsequent development of pelvic organ prolapse.
Obstetrics characteristics associated with pelvic organ prolapse included vaginal delivery and birthweight along with non-obstetrical factors such as prior surgery. There was no association between preterm birth and subsequent development of pelvic organ prolapse. Our findings suggest that the effort during labor at term required for the delivery of appropriate for gestational age or large for gestational age newborns affects the pelvic floor and is a major contributor for the subsequent development of pelvic organ prolapse.
初步证据表明，宫颈机能不全的女性日后发生盆腔器官脱垂的风险可能会增加，这表明存在共同的潜在胶原定向机制。
本研究旨在确定宫颈机能不全与随后发生盆腔器官脱垂之间的关联。
这是一项匹配的病例对照研究，包括在索罗卡大学医学中心分娩的女性。病例组为被诊断为或接受盆腔器官脱垂治疗的女性（n=1463），对照组为同年龄组无盆腔器官脱垂的女性（n=5637）。研究测试了盆腔器官脱垂与先前早产之间的关联。使用条件逻辑回归进行单变量分析，以评估早产与盆腔器官脱垂之间的关联。单变量分析中具有统计学和临床意义的变量被纳入多变量回归。
研究组间自发性早产的发生率无差异[盆腔器官脱垂组-4.0%（59/1463）与非盆腔器官脱垂组-4.9%（276/5637），p=0.16]。无盆腔器官脱垂（对照组）的女性中位早产次数高于有盆腔器官脱垂（病例组）的女性（p=0.004）。在早产的女性中，对照组的个体早产比例更高（p=0.03）。同样，剖宫产率在对照组中也更高（p=0.003）。对照组中小于胎龄儿的发生率更高（p=0.0007），而病例组中大于胎龄儿的发生率更高（p=0.02）。在单变量分析中，出生体重、阴道分娩和既往手术与随后发生的盆腔器官脱垂相关。多变量分析显示，出生体重、阴道分娩和所有类型的既往手术均与随后发生的盆腔器官脱垂独立相关。
与盆腔器官脱垂相关的产科特征包括阴道分娩和出生体重，以及非产科因素如既往手术。早产与随后发生的盆腔器官脱垂之间无关联。我们的研究结果表明，在足月分娩过程中，为分娩适当胎龄或大于胎龄的新生儿而付出的努力会影响盆底，并成为随后发生盆腔器官脱垂的主要因素。
