Carley M E, Turner R J, Scott D E, Alexander J M
Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas 75235-9032, USA.
J Am Assoc Gynecol Laparosc. 1999 Feb;6(1):85-9. doi: 10.1016/s1074-3804(99)80047-4.
To compare obstetric histories of women who had surgical correction of urinary incontinence or pelvic organ prolapse with a similar group who did not.
Case control study (Canadian Task Force classification II-2).
Urban, community-based, private practice teaching hospital.
Four hundred eighty women (age 51.4 +/- 13.0 yrs) who underwent corrective surgery for urinary incontinence, pelvic organ prolapse, or both, and whose obstetric history was obtainable through chart review. The control group was composed of 150 women (age 50.7 +/- 9.6 yrs) having routine screening mammography who completed a questionnaire regarding obstetric, gynecologic, and urologic history.
Patients and controls did not differ significantly in terms of age, race, height, weight, body mass index, or smoking history. Women who underwent surgery were of greater parity (2.5 +/- 1.2 vs 2.0 +/- 1.2, p <0.001), less often nulliparous (3% vs 18%, p <0.001), less likely to have had a cesarean delivery (4% vs 15%, p <0.001), and more likely to have had a vaginal delivery (94% vs 77%, p <0.001) than those with no surgery. The odds ratio of patients who had a vaginal delivery compared with controls was 4.7 (2.3-8.3), and that for cesarean delivery was 0.22 (0.11-0.43). Analysis of specific delivery information found that, compared with controls, patients were older by 4 years at time of their first delivery (28.9 +/- 4.9 vs 24.9 +/- 4.9 yrs, p <0.001) and more commonly received epidural analgesia intrapartum (87% vs 40%, p = 0.004). Comparisons within the patient group, categorized by indication for surgery, revealed that women who had surgery for either prolapse alone or for both prolapse and incontinence were most likely to have had vaginal deliveries (85% incontinence alone vs 94% prolapse alone vs 97% both, p <0.001).
Increased parity, vaginal childbirth, maternal age at time of delivery, and use of epidural analgesia are associated with need for operative correction of pelvic organ prolapse or adult urinary incontinence. Conversely, cesarean delivery is associated with less need for surgical correction of incontinence or pelvic organ prolapse.
比较接受尿失禁或盆腔器官脱垂手术矫正的女性与未接受手术的类似女性群体的产科病史。
病例对照研究（加拿大工作组分类II-2）。
城市社区私立教学医院。
480名女性（年龄51.4±13.0岁），她们接受了尿失禁、盆腔器官脱垂或两者的矫正手术，且其产科病史可通过病历回顾获得。对照组由150名女性（年龄50.7±9.6岁）组成，她们接受常规乳腺钼靶筛查，并完成了一份关于产科、妇科和泌尿科病史的问卷。
患者和对照组在年龄、种族、身高、体重、体重指数或吸烟史方面无显著差异。接受手术的女性产次更多（2.5±1.2 vs 2.0±1.2，p<0.001），初产妇较少（3% vs 18%，p<0.001），剖宫产的可能性较小（4% vs 15%，p<0.001），阴道分娩的可能性较大（94% vs 77%，p<0.001）。与对照组相比，接受阴道分娩的患者的优势比为4.7（2.3-8.3），剖宫产的优势比为0.22（0.11-0.43）。对具体分娩信息的分析发现，与对照组相比，患者首次分娩时年龄大4岁（28.9±4.9 vs 24.9±4.9岁，p<0.001），产时更常接受硬膜外镇痛（87% vs 40%，p=0.004）。在按手术指征分类的患者组内进行比较，结果显示，仅因脱垂或因脱垂和尿失禁两者而接受手术的女性最有可能经阴道分娩（仅尿失禁为85%，仅脱垂为94%，两者皆有为97%，p<0.001）。
产次增加、阴道分娩、分娩时产妇年龄以及硬膜外镇痛的使用与盆腔器官脱垂或成人尿失禁的手术矫正需求相关。相反，剖宫产与尿失禁或盆腔器官脱垂的手术矫正需求较少相关。
