La Verde Marco, Torella Marco, Fordellone Mario, Pace Luciana, Troìa Libera, Remorgida Valentino
Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania Luigi Vanvitelli, Naples, Italy.
Medical Statistics Unit, University of Campania Luigi Vanvitelli, Naples, Italy.
Int Urogynecol J. 2025 Jan;36(1):101-106. doi: 10.1007/s00192-024-05966-2. Epub 2024 Nov 4.
Obstetric anal sphincter injuries (OASIs), third- and fourth-degree lacerations, represent a severe obstetric complication. Previous studies reported a higher incidence of OASIs in Asian women in non-Asian countries. This study was aimed at establishing a different OASIs prevalence among the racial/ethnic groups in Southern European centers.
A multicenter retrospective study that included pregnant women who had vaginal singleton delivery between January 2019 and September 2022 in two Italian University hospitals, Naples and Novara, was conducted. We excluded cesarean sections, nonvertex presentation, preterm delivery, multiple pregnancies, congenital malformations, or stillbirths. Statistical analysis with an independent association of ethnicity to the risk of OASIs using clinical characteristics-adjusted multivariate logistic regression was performed.
A total of 3,049 pregnant women were included. 2.33% (71 patients) had an OASI. The median age was 31 years (IQR 7.00) and median gestational age was 39 weeks (IQR 1.40). Mean birth weight was 3,300 g (IQR 580.00). 1' and 5' Apgar scores were 9 and 9. The univariate logistic regression was not statistically significant. Multivariate logistic regression model adjusted for baseline clinical characteristics showed an OR 2.540 (p value 0.01) for OASIs in Asian women. Primiparous and secondiparous were protective factors for OASIs with OR 0.224 (p value < 0.001) and OR 0.209 (p value 0.01).
Our results confirm racial/ethnic disparities regarding OASIs, with an elevated risk for Asian women in Southern Europe. Prevention strategies and obstetric care in developed countries should be modulated to offset the risk of OASIs in this population. Additional research is needed to explain the specific mechanisms of these disparities.
产科肛门括约肌损伤（OASIs），即三度和四度裂伤，是一种严重的产科并发症。以往研究报告称，在非亚洲国家的亚洲女性中，OASIs的发病率较高。本研究旨在确定南欧中心不同种族/族裔群体中OASIs的患病率。
进行了一项多中心回顾性研究，纳入了2019年1月至2022年9月期间在那不勒斯和诺瓦拉的两家意大利大学医院进行单胎阴道分娩的孕妇。我们排除了剖宫产、非头位分娩、早产、多胎妊娠、先天性畸形或死产。使用临床特征调整的多变量逻辑回归对种族与OASIs风险的独立关联进行了统计分析。
共纳入3049名孕妇。2.33%（71例患者）发生了OASI。中位年龄为31岁（四分位间距7.00），中位孕周为39周（四分位间距1.40）。平均出生体重为3300g（四分位间距580.00）。1分钟和5分钟阿氏评分分别为9分和9分。单变量逻辑回归无统计学意义。调整基线临床特征的多变量逻辑回归模型显示，亚洲女性发生OASIs的比值比为2.540（p值0.01）。初产妇和经产妇是OASIs的保护因素，比值比分别为0.224（p值<0.001）和0.209（p值0.01）。
我们的结果证实了OASIs存在种族/族裔差异，南欧的亚洲女性风险较高。发达国家的预防策略和产科护理应进行调整，以抵消该人群发生OASIs的风险。需要进一步研究来解释这些差异的具体机制。
