Jia Yang, Liu Qingao, Zeng Lin, Wang Yan
Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China.
Cuigezhuang Community Health Service Center, Beijing, China.
Front Med (Lausanne). 2023 May 2;10:1073073. doi: 10.3389/fmed.2023.1073073. eCollection 2023.
Anal incontinence (AI) is a prevalent postpartum disorder. This study aims to investigate and quantify the risk factors for AI in the Chinese population during the first year following vaginal delivery.
The case control study was conducted at Peking University Third Hospital, including all women who delivered vaginally between January 1, 2014, and June 30, 2018. Participants were followed up by telephone interviews 1 year after delivery. AI was defined as the involuntary loss of flatus or feces using a retrospective Jorge and Wexner score above 0. Clinical data were retrieved from the medical record system. Univariate and multivariate analyses were applied to identify potential risk factors accounting for AI. Based on the logistic regression model, a nomogram was constructed to predict the probability of AI postpartum. Restricted cubic spline was utilized to explore potential non-linear relationships between birth weight and AI postpartum.
Among the 140 AI and 421 none AI cases, we observed antepartum factors like every 100 g of birth weight gain ( 1.39, 1.30-1.49), while intrapartum factors like forceps-assisted vaginal delivery ( 7.11, 2.60-19.45), midline episiotomy ( 13.11, 1.71-100.89), second-degree perineal tear ( 6.51, 1.16-36.68), and third to fourth-degree perineal tear were independent risk factors for postpartum AI. Significantly, infant weighing over 3,400 g at birth increased the risk of AI postpartum. Based on logistic regression model, we constructed a nomogram to estimate the risk of AI 1 year after vaginal delivery.
Our findings indicated that during the first year following vaginal delivery, infant with birth weight of 3,400 g or more, forceps-assisted vaginal delivery, midline episiotomy, and second to fourth-degree perineal tear increased the risk of AI. As a result, it is essential to limit the routine use of forceps and midline episiotomy and to monitor fetal weight during prenatal care.
肛门失禁（AI）是一种常见的产后疾病。本研究旨在调查并量化中国人群阴道分娩后第一年发生AI的风险因素。
病例对照研究在北京大学第三医院进行，纳入2014年1月1日至2018年6月30日期间所有阴道分娩的女性。产后1年通过电话访谈对参与者进行随访。使用回顾性Jorge和Wexner评分大于0将AI定义为气体或粪便的不自主失禁。临床数据从病历系统中获取。采用单因素和多因素分析来确定导致AI的潜在风险因素。基于逻辑回归模型，构建列线图以预测产后AI的概率。使用受限立方样条来探索出生体重与产后AI之间潜在的非线性关系。
在140例AI病例和421例非AI病例中，我们观察到产前因素，如出生体重每增加100 g（1.39，1.30 - 1.49），而产时因素，如产钳辅助阴道分娩（7.11，2.60 - 19.45）、会阴正中切开术（13.11，1.71 - 100.89）、二度会阴撕裂（6.51，1.16 - 36.68）以及三度至四度会阴撕裂是产后AI的独立风险因素。值得注意的是，出生时体重超过3400 g的婴儿会增加产后AI的风险。基于逻辑回归模型，我们构建了列线图以估计阴道分娩后1年发生AI的风险。
我们的研究结果表明，在阴道分娩后的第一年，出生体重3400 g及以上的婴儿、产钳辅助阴道分娩、会阴正中切开术以及二度至四度会阴撕裂会增加AI的风险。因此，必须限制产钳和会阴正中切开术的常规使用，并在产前检查期间监测胎儿体重。
