Guo Jingjing, Liu Lingyan, Hua Min, Han Dong, Tang Xuezhen, Wen Jiying, Zhou Yuheng
Obstetric Department, Guangdong Women and Children Hospital, Guangzhou, China.
Department of Quality Control, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China.
Ann Med. 2025 Dec;57(1):2523556. doi: 10.1080/07853890.2025.2523556. Epub 2025 Jun 26.
Diastasis recti abdominis (DRA) is highly prevalent in the postpartum period and affects women's health. However, the relationship between DRA and prenatal and intrapartum factors is unclear. This study aimed to investigate DRA phenotypes and assess the influence of prenatal and intrapartum factors at 42 days postpartum.
This retrospective study included 1438 singleton primiparous women who delivered between January 2023 and January 2024 at a single institution. The median age was 29 years, and the median gestational age at delivery was 274 days. The exclusion criteria included factors that might affect intra-abdominal pressure during the pre-pregnancy and pregnancy periods. DRA was defined as an inter-rectus distance of ≥20 mm at any of the three measurement sites: 3 cm above/below the umbilicus and at the umbilicus, measured by ultrasound. The Kruskal-Wallis and chi-square tests were used for variance analysis and comparison of variables, respectively. Multivariate logistic regression analysis was performed to explore the relationships between DRA phenotypes and these factors.
The incidence of DRA was 89.4%, 47.8% of which presented as combined upper umbilical and periumbilical separation, 33.7% as isolated periumbilical separation, 6.7% as complete separation, and 10.6% without separation. The combined separation of the upper umbilical and periumbilical areas was associated with increased BMI, neonatal weight, vaginal delivery, episiotomy, and perineal laceration. Complete separation was associated with BMI, neonatal weight, and vaginal delivery. Isolated periumbilical separation was associated with neonatal weight, vaginal delivery, episiotomy, perineal laceration, and cesarean during the first stage of labor. Vaginal delivery was negatively correlated with DRA.
DRA is highly prevalent at 42 days postpartum, with different phenotypes having distinct prenatal and intrapartum risk factors. Careful weight management during pregnancy, promotion of vaginal delivery, and rational use of perineal episiotomies may reduce the incidence of DRA in primiparous women.
腹直肌分离（DRA）在产后时期极为常见，并影响女性健康。然而，DRA与产前及产时因素之间的关系尚不清楚。本研究旨在调查产后42天时的DRA表型，并评估产前和产时因素的影响。
这项回顾性研究纳入了2023年1月至2024年1月在单一机构分娩的1438名单胎初产妇。中位年龄为29岁，中位分娩孕周为274天。排除标准包括可能在孕前和孕期影响腹内压的因素。DRA定义为通过超声测量在脐上/下3厘米处及脐部这三个测量部位中任何一处的腹直肌间距≥20毫米。分别采用Kruskal-Wallis检验和卡方检验进行方差分析和变量比较。进行多因素逻辑回归分析以探讨DRA表型与这些因素之间的关系。
DRA的发生率为89.4%，其中47.8%表现为脐上和脐周联合分离，33.7%为单纯脐周分离，6.7%为完全分离，10.6%无分离。脐上和脐周联合分离与体重指数增加、新生儿体重、阴道分娩、会阴切开术和会阴裂伤有关。完全分离与体重指数、新生儿体重和阴道分娩有关。单纯脐周分离与新生儿体重、阴道分娩、会阴切开术、会阴裂伤以及第一产程剖宫产有关。阴道分娩与DRA呈负相关。
产后42天时DRA极为常见，不同表型具有不同的产前和产时危险因素。孕期谨慎进行体重管理、促进阴道分娩以及合理使用会阴切开术可能会降低初产妇DRA的发生率。
