Department of Obstetrics and Gynaecology, Vrinnevi Hospital, Norrköping, Sweden.
Department of Obstetrics and Gynaecology, University Hospital, 587 50, Linköping, Sweden.
Int Urogynecol J. 2024 Jan;35(1):77-84. doi: 10.1007/s00192-023-05609-y. Epub 2023 Aug 16.
How body mass index (BMI) affects pelvic floor function after a second-degree perineal laceration is unknown. The hypothesis of this study is that pelvic floor dysfunction and complications after an obstetric second-degree perineal laceration are more common in women with a higher BMI 8 weeks postpartum.
This register-based cohort study includes 10,876 primiparous women with an obstetric second-degree perineal laceration between 2014 and 2021. Data were retrieved from the Swedish Perineal Laceration Registry. Outcomes in relation to maternal BMI were urinary incontinence (UI), anal incontinence (AI) and common complications attributable to the laceration. Uni- and multivariate logistic regressions were used for comparison between normal weight (BMI < 24.9, reference), overweight (25.0-29.9) and obese (≥ 30) women.
Multivariate analyses showed an increased risk for UI in both overweight and obese women compared to normal-weight women 8 weeks after a second-degree perineal laceration with an adjusted odds ratio (aOR) of 1.21 (CI 1.02-1.44) and 1.27 (CI 1.13-1.58) respectively. Overweight and obese women had a decreased risk for AI (aOR 0.81, CI 0.68-0.96; aOR 0.72, CI 0.57-0.90 respectively) compared with normal-weight women. No significant differences were found in the univariate analyses over BMI strata concerning complications after perineal laceration.
Primiparous overweight and obese women report less AI and more UI than normal-weight women 8 weeks after a second-degree perineal laceration. No differences were found regarding complications. These findings are new and merit further study to find potential preventive factors and interventions after a second-degree perineal laceration.
目前尚不清楚体重指数（BMI）如何影响二度会阴裂伤后的盆底功能。本研究的假设是，在经历产科二度会阴裂伤 8 周后，BMI 较高的女性更容易出现盆底功能障碍和并发症。
这是一项基于登记的队列研究，纳入了 2014 年至 2021 年间 10876 名初次分娩的二度会阴裂伤产妇。数据来自瑞典会阴裂伤登记处。与产妇 BMI 相关的结局包括尿失禁（UI）、肛门失禁（AI）和与裂伤相关的常见并发症。采用单因素和多因素逻辑回归比较正常体重（BMI<24.9，参考）、超重（25.0-29.9）和肥胖（≥30）女性之间的差异。
多因素分析显示，与正常体重女性相比，超重和肥胖女性在二度会阴裂伤 8 周后发生 UI 的风险增加，调整后的优势比（aOR）分别为 1.21（95%CI 1.02-1.44）和 1.27（95%CI 1.13-1.58）。超重和肥胖女性发生 AI 的风险降低（aOR 0.81，95%CI 0.68-0.96；aOR 0.72，95%CI 0.57-0.90），与正常体重女性相比。在单因素分析中，未发现 BMI 分层与会阴裂伤后并发症之间存在显著差异。
初次分娩的超重和肥胖女性在经历二度会阴裂伤 8 周后报告的 AI 较少，UI 较多，而正常体重女性则没有差异。对于并发症，未发现差异。这些发现是新的，值得进一步研究，以寻找二度会阴裂伤后的潜在预防因素和干预措施。
