Magee-Womens Hospital University of Pittsburgh Medical Center, 300 Halket Street, Pittsburgh, PA, 15232, USA.
Magee-Womens Research Institute (MWRI), 204 Craft Street, Pittsburgh, PA, 15232, USA.
Int Urogynecol J. 2022 Dec;33(12):3355-3364. doi: 10.1007/s00192-022-05296-1. Epub 2022 Aug 17.
We hypothesized that elective induction of labor (eIOL) at 39 weeks is protective of levator ani muscle injury (LAMI) and is associated with decreased pelvic symptoms at 6 weeks postpartum compared to expectant management of labor.
Prospective cohort pilot study of uncomplicated, primiparous women with a singleton, vertex gestation enrolled immediately post-vaginal delivery (VD). Subjects were dichotomized into two groups based on labor management: eIOL without complication defined by the ARRIVE trial versus spontaneous VD between 39 weeks and 42 weeks or no indication for IOL prior to 40 weeks. The primary outcome was LAMI at 6 weeks postpartum as evidenced by any of the following ultrasound measures: (1) increased levator hiatal area (LHA) > 2500 mm, (2) increased elasticity index (EI, > 75th quartile) or (3) levator enthesis avulsion.
Analysis represents 45/102 consented women from July 2019-October 2020 (eIOL n = 22 and spontaneous VD, n = 23). Neither maternal, clinical, sociodemographic characteristics nor pelvic symptoms differed between groups. Fewer women had LAMI as defined by the primary outcome with eIOL (n = 5, 23.8%) compared to spontaneous VD (n = 15, 65.2%), p = 0.008. Levator enthesis was more deformable (increased EI) with spontaneous VD as compared to the eIOL [10.66 (8.99) vs. 5.68 (2.93), p = 0.046]. On univariate logistic regression women undergoing spontaneous VD had unadjusted OR of 6.0 (1.6-22.5, p = 0.008) of sustaining LAMI compared to those undergoing eIOL.
Composite measures of LAMI though not pelvic floor symptoms were markedly increased in women undergoing spontaneous VD compared to those undergoing eIOL at 39 weeks.
我们假设选择性诱导分娩（eIOL）在 39 周时可以保护肛提肌损伤（LAMI），并与期待分娩管理相比，在产后 6 周时减少骨盆症状。
对无并发症的初产妇进行前瞻性队列研究，研究对象为单胎、头位妊娠，在阴道分娩（VD）后立即入组。根据分娩管理，将受试者分为两组：ARRIVE 试验定义的无并发症的 eIOL 与 39 周至 42 周之间的自然 VD 或 40 周之前无 IOL 指征。主要结局是产后 6 周时的 LAMI，其证据为以下任何超声测量结果：（1）增加的肛提肌裂孔面积（LHA）>2500mm，（2）增加的弹性指数（EI，>第 75 四分位数）或（3）肛提肌止点撕裂。
分析代表了 2019 年 7 月至 2020 年 10 月期间同意的 102 名产妇中的 45 名（eIOL 组 n=22，自然 VD 组 n=23）。两组之间的产妇、临床、社会人口统计学特征或骨盆症状均无差异。与自然 VD 组（n=15，65.2%）相比，eIOL 组发生定义为主要结局的 LAMI 的女性更少（n=5，23.8%），p=0.008。与 eIOL 相比，自然 VD 组的肛提肌止点更具变形性（增加 EI）[10.66（8.99）比 5.68（2.93），p=0.046]。在单变量逻辑回归中，与接受 eIOL 的女性相比，接受自然 VD 的女性发生 LAMI 的未经调整 OR 为 6.0（1.6-22.5，p=0.008）。
与接受 eIOL 的女性相比，接受自然 VD 的女性的 LAMI 复合测量值（而非盆底症状）明显增加。
