初产妇产后早期盆腔器官脱垂的高危因素分析

目的:探讨初产妇足月阴道分娩后产后早期盆腔器官脱垂(POP)发生的高危因素。方法:选取2017年1—4月在上海交通大学医学院附属国际和平妇幼保健院产后6~8周复诊的经阴道足月分娩的初产妇1 216例。同时行盆腔器官脱垂定量分度法(POP-Q)评分,按评分结果分为POP组(644例)和对照组(572例),采用单因素和多因素Logistic回归分析各种产科因素与产后早期发生POP的相关性。结果:在1 216例阴道分娩的初产妇中,POP的发生率为52.96%(644/1 216);POP组的年龄、分娩孕周、新生儿出生体质量以及产钳助产率显著高于对照组,差异有统计学意义(均P0.05);而2组产妇孕前体质量指数(BMI)、孕期体质量增加量、产时BMI、第二产程时间、是否会阴裂伤和是否会阴侧切比较,差异均无统计学意义(均P0.05)。多因素Logistic回归分析显示,与年龄28岁的产妇相比,年龄≥36岁的产妇产后早期POP的发生风险显著升高(OR=2.352,P=0.010,95%CI:1.222~4.526);与新生儿出生体质量3 000 g的产妇相比,新生儿出生体质量为3 500~3 999 g和≥4 000g的产妇产后POP的发生风险均显著增加(OR=2.039,P=0.000,95%CI:1.385~3.003;OR=2.676,P=0.007,95%CI:1.303~5.495);与自然分娩的产妇相比,行产钳助产的产妇产后POP发生风险显著升高(OR=1.760,P=0.019,95%CI:1.097~2.823)。结论:初产妇阴道分娩产后POP的发生与年龄、新生儿出生体质量以及产钳助产有关。阴道分娩产后POP发生率高,应加强产妇盆底疾病的预防及重视产后康复训练,尤其是有高危因素的产妇。     

产后压力性尿失禁发生的影响因素研究

目的探讨产后压力性尿失禁(SUI)发生的影响因素。方法回顾性分析2016年12月至2017年12月于北京大学人民医院产科定期产前检查住院分娩,并于产后6～14周复查的1 027例产妇的临床资料,其中SUI组303例,无SUI者724例,统计分析妊娠及产后SUI发生率及其影响因素。结果①1 027例产妇SUI的发生率为29.50%(303/1 027);②SUI高危因素分析显示,不同分娩方式对产后SUI的发生产生不同影响(χ2=31.757,P 0.001),阴道分娩者相对于选择性剖宫产者发生产后SUI的风险增加(OR=3.001,95%CI:1.964～4.585),阴道分娩转剖宫产者产后SUI的发生率与选择性剖宫产者比较,差异无统计学意义(P 0.05)。产妇的母亲有SUI者相对于无家族史者发生SUI的风险增加(OR=15.563,95%CI:5.769～41.982)。第二产程时间、会阴裂伤、产钳助产、会阴侧切、手取胎盘、无痛分娩对产后SUI无明显影响(P0.05);③经阴道分娩组中,SUI者的平均年龄、产前体质指数较无SUI者升高(P 0.05),母亲有SUI的产妇相对于无家族史者发生SUI的风险增加(OR=15.251,95%CI:4.511～51.560)。经产妇相对于初产妇发生SUI的风险增加(OR=1.498,95%CI:1.051～2.136)。结论经阴道分娩、母亲患SUI、肥胖及高龄是产后SUI的高危因素;第二产程时间、会阴裂伤、产钳助产、会阴侧切、手取胎盘、无痛分娩等产科因素对SUI的发生未产生明显影响。     

阴道分娩97例初产妇产后尿潴留危险因素临床分析

目的：探讨经阴道分娩产后尿潴留（postpartum urinary retention,PUR）的危险因素,为降低PUR发生率、减少产后并发症提供理论依据。方法：选择天津医科大学宝坻临床学院（我院）2016年1-12月经阴道分娩PUR患者97例为观察组[A组,其中分娩镇痛者83例（A1组）,无分娩镇痛者14例（A2组）],随机选择同期经阴道分娩无尿潴留者88例为对照组[B组,其中分娩镇痛者59例（B1组）,无分娩镇痛者29例（B2组）]。记录2组患者一般信息、妊娠期合并症及妊娠期并发症、产时情况、产后出血情况及新生儿体质量,进行回顾性分析。结果：2组产妇妊娠期合并症及并发症、孕次、胎膜早破、枕左前（LOA）胎位、第三产程时间和新生儿体质量比较,差异无统计学意义（均P＞0.05）。孕周、分娩镇痛、产钳助娩、侧切、第一产程时间、第二产程时间和产后出血比较,差异有统计学意义（均P＜0.05）。发生PUR的危险因素有孕周增大（OR=1.619,95%CI：1.121～2.339）、产钳助娩（OR=4.981,95%CI：2.184～11.361）、产后出血（OR=3.429,95%CI：1.024～11.488）和侧切（OR=2.419,95%CI：1.058～5.531）。PUR危险因素的ROC曲线分析：年龄最佳临界值为26.50岁,孕周最佳临界值为40.36周,新生儿体质量最佳临界值为3 372.50 g,分娩镇痛第一产程最佳临界值为402.50 min,分娩镇痛第二产程最佳临界值为61.50 min,无分娩镇痛第一产程最佳临界值为230.00 min,无分娩镇痛第二产程最佳临界值为34.50 min。结论：对孕周、分娩镇痛、产钳助娩、侧切、第一产程时间、第二产程时间、产后出血诸因素适当干预,可减少PUR的发生。     

分娩方式对产后妇女粪失禁及尿失禁的影响

目的 调查女性产后粪失禁和尿失禁的发生率及其相关因素.方法 电话随访2006年10月1日至2007年9月30日在北京大学第一医院妇产科分娩的产妇,共纳入2012例妇女,收集其产后6个月内粪失禁和尿失禁的症状.采用Logistic回归法分析分娩方式与尿失禁和粪失禁的关系.结果 (1)参与调查的2012例产后妇女,14例(0.70％)有粪失禁症状.Logistic回归分析显示,粪失禁与阴道产钳助产(OR=20.09,95％ CI:3.64～110.90,P=0.000)和会阴侧切术分娩相关(OR=6.11,95％ CI:1.29～28.80,P=0.024).(2)2012例妇女中产后尿失禁、压力性尿失禁(stress urinary incontinence,SUI)、急迫性尿失禁(urge urinary incontinence,UUI)、混合性尿失禁(mixed urinary incontinence,MUI)的发病率分别为10.04％(202例)、8.15％ (164例)、0.94％(19例)和0.94％(19例).Logistic回归分析显示,与SUI相关的因素有:母亲年龄(OR=1.07,95％ CI:1.04～1.11,P=0.000)、母亲分娩前体重(OR=1.04,95％CI:1.02～1.06,P=0.001)、新生儿头围(OR=1.20,95％ CI:1.05～1.39,P=0.010)、会阴侧切术分娩(OR=4.96,95％ CI:3.05～8.07,P=0.0005)、阴道自然分娩(OR=5.22,95％ CI:2.53～10.76,P=0.000)和阴道产钳助产(OR=9.20,95％ CI:4.07～20.79,P=0.000).与UUI相关的因素有:产妇分娩前体重(OR=1.51,95％CI:1.12～2.05,P=0.008).与MUI相关的因素有:产妇分娩前体重(OR=1.06,95％ CI:1.00～1.11,P=0.049)、第二产程时限(OR=1.01,95％ CI:1.00～1.03,P=0.010)、会阴侧切术分娩(OR=7.76,95％ CI:1.42～42.52,P=0.017)和阴道产钳助产(OR=15.21,95％ CI:1.61～143.44,P=0.018).(3)产后4d和产后42 d SUI的发病率较高分别为7.95％和9.10％.结论 (1)本院产后妇女粪失禁和尿失禁的发病率较先前报道的其他地区的发病率低.(2)阴道分娩是妇女产后粪失禁和尿失禁发生的高危因素,特别是阴道产钳助产和会阴侧切术分娩.(3)母亲的年龄、分娩前体重、新生儿出生时头围、阴道自然分娩、产钳助产、会阴侧切术是发生尿失禁的高危因素.     

产后腹直肌分离发生的影响因素研究

目的:探讨产后发生腹直肌分离(DRA)的影响因素。方法:横断面选取2018年8月至2018年10月于北京大学人民医院产科定期产检并分娩,并于产后6～8周复查的产妇。统计分析产后DRA发生率及其影响因素。结果:符合入组标准的产妇共310例,其中DRA者108例,无DRA者202例,DRA发生率为34.84%(108/310)。阴道分娩者相对于剖宫产者,发生产后DRA的风险较小(OR=0.459,95%CI为0.261～0.807)。产后高BMI是DRA分离发生的保护因素(OR=0.796,95%CI为0.717～0.883),新生儿出生体重大是DRA的危险因素(OR=1.001,95%CI为1.000～1.002)。结论:经剖宫产分娩、新生儿出生体重过大及产后低BMI是产后DRA的高危因素。     

产妇盆底功能情况调查及产科因素对盆底功能的近期影响分析研究

目的:探讨产后盆底功能情况及产科因素对盆底功能的近期影响。方法:调查2014年1~12月同仁医院分娩并于产后6~8周来院做检查的2023例妇女,出院小结和产后检查记录提取产科相关信息,进行盆底电生理评估,对产妇盆底功能与产科因素进行单因素及多因素分析。结果:2023例产妇产后6~8周盆底功能评估异常率为89.67%。单因素分析结果表明,产次≥2次、会阴切开、足月分娩和新生儿出生体质量≥3500 g的产妇盆底功能更差。多因素分析结果显示,产次≥2次的产妇(OR=2.529,95%CI 1.763~3.628)、新生儿出生体质量≥3500 g(OR=1.636,95%CI 1.184~2.262)、阴道分娩(OR=1.440,95%CI 1.068~1.941)是影响产妇盆底功能的高危因素。对于阴道分娩产妇,产次≥2次(OR=3.460,95%CI 2.059~5.828)、会阴切开(OR=2.297,95%CI 1.484~3.557)和足月分娩(OR=6.248,95%CI 1.824~21.399)是影响盆底功能的高危因素。结论:分娩后6~8周的产妇盆底功能损伤较严重;多产次、新生儿体质量较大和阴道分娩是影响产后6~8周产妇盆底功能的因素。对于阴道分娩者,多产次、足月分娩、会阴切开是另一个影响盆底功能的因素。产科医生应指导孕妇合理控制孕期体重,临近预产期指导孕妇进行kegel训练,降低会阴切开率,以降低盆底功能障碍性疾病发生率。     

阴道分娩97例初产妇产后尿潴留危险因素临床分析

目的:探讨经阴道分娩产后尿潴留(postpartum urinary retention,PUR)的危险因素,为降低PUR发生率、减少产后并发症提供理论依据。方法:选择天津医科大学宝坻临床学院(我院)2016年1—12月经阴道分娩PUR患者97例为观察组[A组,其中分娩镇痛者83例(A1组),无分娩镇痛者14例(A2组)],随机选择同期经阴道分娩无尿潴留者88例为对照组[B组,其中分娩镇痛者59例(B1组),无分娩镇痛者29例(B2组)]。记录2组患者一般信息、妊娠期合并症及妊娠期并发症、产时情况、产后出血情况及新生儿体质量,进行回顾性分析。结果:2组产妇妊娠期合并症及并发症、孕次、胎膜早破、枕左前(LOA)胎位、第三产程时间和新生儿体质量比较,差异无统计学意义(均P0.05)。孕周、分娩镇痛、产钳助娩、侧切、第一产程时间、第二产程时间和产后出血比较,差异有统计学意义(均P0.05)。发生PUR的危险因素有孕周增大(OR=1.619,95%CI:1.121～2.339)、产钳助娩(OR=4.981,95%CI:2.184～11.361)、产后出血(OR=3.429,95%CI:1.024～11.488)和侧切(OR=2.419,95%CI:1.058～5.531)。PUR危险因素的ROC曲线分析:年龄最佳临界值为26.50岁,孕周最佳临界值为40.36周,新生儿体质量最佳临界值为3 372.50 g,分娩镇痛第一产程最佳临界值为402.50 min,分娩镇痛第二产程最佳临界值为61.50 min,无分娩镇痛第一产程最佳临界值为230.00 min,无分娩镇痛第二产程最佳临界值为34.50 min。结论:对孕周、分娩镇痛、产钳助娩、侧切、第一产程时间、第二产程时间、产后出血诸因素适当干预,可减少PUR的发生。     

孕期及产后妇女发生尿失禁的影响因素

目的 探讨不同分娩方式对孕产妇发生尿失禁的影响和阴道分娩后发生产后压力性尿失禁(SUI)的相关因素.方法 选择2008年1-12月在首都医科大学附属北京妇产医院行产前检查并于分娩后6～8周复查的孕产妇788例.根据分娩方式不同分为剖宫产组212例、阴道顺产组534例、产钳助产组42例,将阴道顺产组和产钳助产组孕产妇合计后统计尿失禁发生情况.采用问卷调查方式了解各组孕产妇分娩方式及其与分娩有关的产科因素对产后SUI发生的影响.并使用盆底肌电图检测各组孕产妇盆底肌强度,了解产后SUI发生与盆底肌肉强度的关系.结果 (1)尿失禁发生率:孕期尿失禁总的发生率为15.4%(121/788),其中阴道顺产组为15.9%(85/534),产钳助产组为11.9%(5/42),剖宫产组为14.6%(31/212),3组比较,差异无统计学意义(P>0.05).产后6～8周SUI总的发生率为17.1%(135/788),其中阴道顺产组为19.1%(102/534),产钳助产组为26.2%(11/42),剖宫产组为10.4%(22/212).阴道顺产组产后SUI发生率明显低于产钳助产组,两组比较,差异有统计学意义(P<0.01);剖宫产组产后SUI发生率明显低于阴道顺产组,两组比较,差异有统计学意义(P<0.01).(2)不同产科因素对产后SUI的影响:阴道顺产组和产钳助产组孕产妇共发生尿失禁113例,未发生尿失禁463例,将尿失禁发生与否两类孕产妇的一般情况和产科因素进行单因素分析和logistic多元回归分析,了解其对产后SUI的影响.结果显示,分娩方式、新生儿出生体质量、孕期发生尿失禁是产后SUI的主要影响因素.剖宫产术可使产后SUI发病率降低(P<0.01),新生儿出生体质量增加、孕期发生尿失禁可使产后SUI的发生风险加大.对阴道分娩组和产钳助产组孕产妇分析发现,新生儿出生体质量增加、产钳助产、孕期发生尿失禁与产后SUI发病率升高有关(P均<0.01);而与分娩镇痛、产程时间、会阴侧切、产后哺乳、产后出血量、分娩孕周、引产与否、孕前体质量等无明显相关(P均>0.05).(3)盆底肌电图检测结果:剖宫产组孕产妇盆底肌活力值为(19.7±9.9)μv,做功值为(84.5±37.2)μv,峰值为(25.5±12.5)μv,均高于阴道顺产组和产钳助产组[两组均值为:活力值(14.8±8.4)μv、做功值(78.8±28.2)μv、峰值(19.7±11.8)μv].两者比较,差异有统计学意义(P均<0.01).阴道顺产组和产钳助产组中尿失禁孕产妇盆底肌放松值[均值为(1.7±1.8)μv]较非尿失禁孕产妇[均值为(3.0±3.9)μv]低,两者比较,差异有统计学意义(P<0.01).尿失禁孕产妇放松值与活力值(r/a)比值为0.2±0.2,非尿失禁孕产妇r/a比值为0.3±0.5,差异有统计学意义(P<0.01).阴道顺产组和产钳助产组孕产妇r/a比值为0.2±3.5,虽高于剖宫产组(0.2±0.2),但差异无统计学意义(P>0.05).结论 产钳助产及阴道顺产产妇的产后SUI发生率高于剖宫产.孕期发生尿失禁、产钳助产、新生儿出生体质量增加是产后SUI发生的高危因素.     

产科因素对产后早期盆底功能障碍性疾病发生的影响

目的探讨不同产科因素对产后早期盆底功能障碍性疾病（PFD）发生的影响,旨在为其预防和治疗提供理论依据。方法对2008年1月至2009年12月406例单胎初产妇产前及产后6～8周进行问卷调查,同时行POPQ评分,分析产科相关因素与PFD发生的相关性。结果孕期压力性尿失禁（SUI）的发生率为28.33%（115/406）;产后SUI的发生率为18.47%（75/406）,其中58例孕妇SUI症状由分娩前持续至分娩后,占产后SUI的77.33%（58/75）;产后盆腔器官脱垂（POP）发生率为49.51%（201/406）。其中选择性剖宫产组SUI和POP的发生率为7.49%（27/227）和37.89%（86/227）,阴道分娩组为32.40%（58/179）和64.25%（115/179）,剖宫产组与阴道分娩组比较,差异有统计学意义（P〈0.05）。Logistic回归分析显示,产后SUI的发生与妊娠期SUI、年龄、第二产程时间、会阴撕裂、产钳助产、新生儿出生体重和分娩前BMI有关（P〈0.05）。结论孕期SUI的发病率高于产后;选择性剖宫产可能对盆底功能具有保护作用,与产后早期PFD的发生降低有关;产时及其他相关因素可使产后早期PFD发生的风险增加。     

初产妇盆腔器官脱垂影响因素分析及防治措施

目的探讨初产妇盆腔器官脱垂的影响因素。方法选取2013年1月至2014年6月就诊于湘潭市妇幼保健院行常规产后检查的单胎足月初产妇共1086例,进行问卷调查及盆底功能障碍性疾病筛查。结果产后42d至3个月随访发现:分娩方式对阴道前壁脱垂有影响(P0.05):择期剖宫产者较阴道分娩者更不容易出现阴道前壁脱垂(P0.05,OR=0.063,95%CI 0.031~0.128);试产后剖宫产者较阴道分娩者更不容易出现阴道前壁脱垂,(P0.05,OR=0.170,95%CI 0.062~0.469)。分娩方式对阴道后壁脱垂有影响(P0.05):择期剖宫产者较阴道分娩者更不容易出现阴道后壁脱垂(P0.05,OR=0.091,95%CI 0.046~0.181);试产后剖宫产者较阴道分娩者更不容易出现阴道后壁脱垂(P0.05,OR=0.371,95%CI 0.175~0.787)。分娩方式(P0.05)、年龄(P=0.042)对子宫脱垂有影响:择期剖宫产者较阴道分娩者更不容易出现子宫脱垂(P0.05,OR=0.385,95%CI 0.294~0.505);年龄越大者越容易出现子宫脱垂(P=0.042,OR=1.039,95%CI 1.001~1.078)。结论初产妇阴道前、后壁脱垂的主要影响因素为分娩方式,子宫脱垂的主要影响因素为分娩方式及年龄。择期剖宫产、试产后剖宫产相比于阴道分娩,是盆腔器官脱垂的保护因素,年龄为子宫脱垂的危险因素。     

产后妇女盆底器官脱垂情况调查及影响因素分析

目的:调查产后妇女盆底器官脱垂的情况并探讨人口学特征、运动习惯和产科等因素对盆底器官脱垂的影响。方法:纳入2015年10月至2016年4月产后6~8周到上海交通大学附属同仁医院产后门诊做常规体检的产妇852例。采用自填问卷方式收集研究对象人口学特征、产科信息、孕前参加体育锻炼情况等信息,并由妇科医生进行盆底器官脱垂的检查。结果:852例产后6~8周产妇中84.25%有阴道脱垂,55.61%的产妇为Ⅰ度脱垂,28.64%的产妇为Ⅱ度脱垂,未发现Ⅲ度或Ⅳ度阴道脱垂。仅有5例有Ⅰ度子宫脱垂。多分类有序Logistic回归显示,巨大儿(OR 2.469,95%CI 1.029~5.927)、产次≥2次(OR 2.730,95%CI 1.929~3.864)、阴道分娩(OR 43.257,95%CI25.505~73.353)、紧急剖宫产(OR 2.139,95%CI 1.266~3.615)是影响产妇阴道脱垂的高危因素。结论:产后6~8周的产妇轻度阴道脱垂的比例较高。阴道分娩、巨大儿和多产次对阴道脱垂的影响较大。     

产后早期盆腔器官脱垂发生的预测模型构建及验证

目的:分析产后早期发生盆腔器官脱垂（POP）的高危因素并构建预测模型。方法:横断面调查北京大学人民医院2018年12月至2019年10月期间产后6周妇女（2 247例）的临床资料和POP现状并采用logistic回归分析产后POP发生的相关影响因素,构建产后早期POP发生的预测模型并进行内部验证;另采集2019年11—...     

Risk factors for vaginal prolapse after hysterectomy

Objective

To identify risk factors for pelvic organ prolapse (POP) and their influence on the occurrence of vaginal prolapse after hysterectomy.

Methods

Medical records from 2 groups of women who had undergone hysterectomy were reviewed retrospectively. The study group was 82 women who had undergone surgery for vaginal prolapse after hysterectomy; the control group was 124 women who had undergone hysterectomy with no diagnosis of vaginal prolapse by the time of the study. All hysterectomy procedures had been performed for benign gynecological disease, including POP. Both groups of women completed a self-administered questionnaire to obtain additional information on the occurrence of POP.

Results

The incidence of vaginal prolapse after hysterectomy was significantly higher in women with a higher number of vaginal deliveries, more difficult deliveries, fewer cesareans, complications after hysterectomy, heavy physical work, neurological disease, hysterectomy for pelvic organ prolapse, and/or a family history of pelvic organ prolapse. Premenopausal women had vaginal prolapse corrected an average of 16 years after hysterectomy, and postmenopausal women 7 years post hysterectomy.

Conclusion

Before deciding on hysterectomy as the approach to treat a woman with pelvic floor dysfunction, the surgeon should evaluate these risk factors and discuss them with the patient.     

盆腔器官脱垂的危险因素研究进展

盆腔器官脱垂(pelvic organ prolapse,POP)是由多因素导致盆底支持组织损伤而引发的复杂疾病,临床表现为盆腔器官位置下移及功能异常。POP现已严重影响广大女性尤其是中老年女性的生活质量,增加了家庭经济负担。因此,减少POP的发生、发展是当下亟需解决的问题。已有研究表明,高龄、肥胖、种族、阴道分娩、产钳助产、第二产程延长、巨大儿、家族史、遗传史等可能是POP发生的危险因素;产次、重体力劳动、慢性咳嗽、便秘、高血压、糖尿病等对POP造成的影响目前尚存在争议。综述POP的危险因素,以期为相关干预措施及卫生政策的制定提供科学依据。     

Urinary incontinence in the 12-month postpartum period

OBJECTIVE: To describe the prevalence and severity of urinary incontinence in the 12-month postpartum period and to relate this incontinence to several potential risk factors including body mass index, smoking, oral contraceptives, breast-feeding, and pelvic floor muscle exercise. METHODS: Participants were 523 women, aged 14 to 42 years, who had obstetrical deliveries. The women were interviewed in their rooms on postpartum day 2 or 3 and by telephone 6 weeks, 3 months, 6 months, and 12 months postpartum. Chart abstraction was conducted to obtain obstetrical data from the index delivery. RESULTS: At 6 weeks postpartum, 11.36% of women reported some degree of urinary incontinence since the index delivery. Although the rate of incontinence did not change significantly over the postpartum year, frequency of accidents decreased over time. In the generalized estimating equation, postpartum incontinence was significantly associated with seven variables: baseline report of smoking (odds ratio [OR] 2.934; P =.002), incontinence during pregnancy (OR 2.002; P =.007), length of breast-feeding (OR 1.169; P =.023), vaginal delivery (OR 2.360; P =.002), use of forceps (OR 1.870; P =.024), and two time-varying covariates: frequency of urination (OR 1.123; P = <.001) and body mass index (OR 1.055; P =.005). Factors not associated with postpartum incontinence included age, race, education, episiotomy, number of vaginal deliveries, attendance at childbirth preparation classes, and performing pelvic floor muscle exercises during the postpartum period. CONCLUSION: Postpartum incontinence is associated with several risk factors, some of which are potentially modifiable and others that can help target at-risk women for early intervention.     

Reproductive factors, family history, occupation and risk of urogenital prolapse

OBJECTIVE: We conducted a case-control study to analyze risk factors for urogenital prolapse requiring surgery. METHODS: Cases were 108 women with a diagnosis of II or III degree uterovaginal prolapse and/or third degree cystocele. Controls were 100 women admitted to the same hospitals as the cases, for acute, non-gynecological, non-neoplastic conditions. RESULTS: Occupation showed an association with urogenital prolapse: in comparison with professional/managerial women, housewives had an odds ratios (OR) of urogenital prolapse of 3.1 (95% confidence interval (CI), 1.6-8.8). Compared with nulliparae, parous women tended to have a higher risk of genital prolapse (OR 2.6, 95% CI 0.9-7.8). In comparison with women reporting no vaginal delivery, the ORs were 3.0 for women reporting one vaginal delivery (95% CI 1.0-9.5), and 4.5 (95% CI 1.6-13.1) for women with two or more vaginal deliveries. Forceps delivery and birthweight were not associated with risk of prolapse after taking into account the effect of number of vaginal deliveries. The risk of urogenital prolapse was higher in women with mother or sisters reporting the condition: the ORs were, respectively, 3.2 (95% CI 1.1-7.6) and 2.4 (95% CI 1.0-5.6) in comparison with women whose mother or sisters reported no prolapse. CONCLUSIONS: Our data support the clinical suggestion that parous women are at a higher risk of prolapse and the risk increases with number of vaginal deliveries. First-degree family history of prolapse seems to increase the risk of prolapse.     

Prolapse severity, symptoms and impact on quality of life among women planning sacrocolpopexy.

OBJECTIVES: To explore the relationship between severity of pelvic organ prolapse (POP), symptoms of pelvic dysfunction and quality of life using validated measures. METHOD: Baseline data from 314 participants in the Colpopexy And Urinary Reduction Efforts (CARE) trial were analyzed. Pelvic symptoms and impact were assessed using the Pelvic Floor Distress Inventory (PFDI) and the Pelvic Floor Impact Questionnaire (PFIQ). PFDI and PFIQ scores were compared by prolapse stage and history of incontinence or POP surgery. Regression analyses were performed to identify other predictors of symptoms and impact. RESULTS: Women were predominantly (90%) Caucasian and had mean age of 61 years. Women with stage II POP, especially those with prior surgery, reported more symptoms and impact than women with more advanced POP. There were no other significant predictors of symptoms or life impact. CONCLUSIONS: Women planning sacrocolpopexy with stage II prolapse and prior pelvic surgery reported more symptoms and quality of life impact than those with more advanced prolapse.     

Malpresentations--impact on mode of delivery

Fetal malpresentation, including persistent occipitoposterior position, is a major cause of dystocia resulting in obstetric interventions. We studied malpresentation among 11 957 consecutive singleton deliveries from 1995 to 2004. There were 1 030 deliveries with a malpresentation (8.6%). Cephalic malpresentations occurred in 5.4% of deliveries (persistent occipitoposterior 5.2%, face 0.1%, brow 0.14%), and 3.1% had breech presentation and 0.12% a transverse lie. The odds ratios (OR) for cesarean section were 14.89 (95%CI 11.91-18.63) in breech presentation and 4.57 (95% CI 3.85-5.42) in persistent occipitoposterior presentation. With persistent occipitoposterior position, the OR for instrumental vaginal delivery was 3.84 (95%CI 3.14-4.70). Primiparity was associated with increased malpresentation risks, as 54.6% of those with malpresentations were primiparous compared with 41.7% of those without (OR 1.68, 95%CI 1.48-1.91, p < 0.001). Primiparous women required more cesarean sections (OR 1.92, 95%CI 1.50-2.47) and instrumental deliveries (OR 2.89, 95%CI 1.50-2.47). Malpresentation frequently leads to cesarean section or instrumental delivery, especially among primiparous women.     

Risk of new-onset urinary incontinence after forceps and vacuum delivery in primiparous women

OBJECTIVE: We sought to determine the incidence of new-onset urinary incontinence after forceps and vacuum delivery compared with spontaneous vaginal delivery. STUDY DESIGN: We performed a prospective study in primiparous women delivered by forceps (n = 90), vacuum (n = 75), or spontaneous vaginal delivery (n = 150). Follow-up for urinary incontinence was at 2 weeks, 3 months, and 1 year after delivery. RESULTS: The incidence of urinary incontinence was similar in the 3 groups at 2 weeks after delivery. The proportion of women developing new-onset urinary incontinence decreased significantly over time in the spontaneous vaginal (P =.003) and vacuum delivery groups (P =.009) but not in the forceps group (P =.2). No relationship of urinary incontinence with vaginal lacerations, epidural anesthesia, length of second stage of labor, or infant birth weight was seen. CONCLUSIONS: In primiparous women, urinary incontinence after forceps delivery is more likely to persist compared with spontaneous vaginal or vacuum delivery.