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分娩过程中膀胱膨出和直肠膨出对母婴的影响。

Maternal and neonatal consequences of cystocele and rectocele in the delivery process.

机构信息

Yuzuncu Yil University, Faculty of Medicine, Gynecology and Obstetrics Clinic Van, Van, Turkey.

Yuzuncu Yil University, Faculty of Medicine, Public Health Van, Van, Turkey.

出版信息

Medicine (Baltimore). 2023 Dec 22;102(51):e36720. doi: 10.1097/MD.0000000000036720.

Abstract

The study aimed to investigate the effects of cystocele and rectocele on the stages of vaginal birth and maternal and newborn outcomes. A total of 672 multiparous pregnant women between the ages of 18 to 40 who underwent normal vaginal delivery in our tertiary center between November 2022 and February 2023, were included in this prospective study. Among the participants, 348 (51.8%) had no abnormalities, 78 (11.6%) had rectocele only, 112 (16.7%) had cystocele only, and 134 (19.9) had both cystocele and rectocele. Patients with the coexistence of cystocele and rectocele experienced a notably extended duration for both the first stage and second stage of labor, although the extension in the second stage was not statistically significant. Among the maternal complications, the development of maternal laceration and chorioamnionitis was significantly more common in the patient group with cystocele and rectocele compared to the other groups. When the groups were assessed for postpartum bleeding, while the bleeding risk increased from the normal group to the rectocele + cystocele group, this increase was not statistically significant. There was no difference between the groups in terms of neonatal outcomes. The delivery time of pregnant women with cystocele and rectocele, in the absence of additional risk factors, was determined to be significantly longer than that of the control group. We think that these patients should receive more vigilant monitoring, and this criterion should be kept in mind when assessing the indication for a cesarean section.

摘要

本研究旨在探讨膀胱膨出和直肠膨出对阴道分娩阶段以及母婴结局的影响。我们在 2023 年 11 月至 2 月期间对我院三级中心的 672 名 18 至 40 岁之间的经阴道分娩的多产妇进行了前瞻性研究,所有参与者均无异常,78 例(11.6%)仅有直肠膨出,112 例(16.7%)仅有膀胱膨出,134 例(19.9%)同时存在膀胱膨出和直肠膨出。患有膀胱膨出和直肠膨出的患者的第一产程和第二产程均显著延长,尽管第二产程的延长无统计学意义。在母亲并发症方面,与其他组相比,同时患有膀胱膨出和直肠膨出的患者发生会阴裂伤和绒毛膜羊膜炎的风险显著增加。评估产后出血风险时,虽然从正常组到膀胱膨出+直肠膨出组的出血风险增加,但无统计学意义。在新生儿结局方面,各组之间无差异。我们认为,在不存在其他危险因素的情况下,患有膀胱膨出和直肠膨出的孕妇的分娩时间明显延长,因此在评估剖宫产指征时应牢记这一标准。

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