阴道分娩后盆底肌力受损高危因素分析

目的:分析阴道分娩产妇的产后盆底肌力改变及盆腔脏器脱垂情况,探讨盆底肌力受损的高危因素。方法:选择2015年4月至6月复旦大学附属妇产科医院门诊进行产后复查的阴道分娩产妇288例,回顾性分析其产后6周盆底功能检查结果。通过调阅住院病历获取其临床数据,对影响产后盆底肌力的因素进行Logistic回归分析。结果:288例产妇中,252例(87.5%)产后出现盆底肌力受损。其中,149例(51.7%)阴道前壁膨出,29例(10.1%)阴道后壁膨出,7例(2.4%)产妇子宫脱垂。单因素与多因素Logistic回归分析均显示,仅新生儿体质量与盆底肌力受损相关(P0.05),而产妇年龄、产次、分娩孕周、体质指数、产钳助产、第一产程时间、第二产程时间及侧切等产科因素与盆底肌力受损无相关性。结论:妊娠和分娩易导致盆底肌力异常及盆腔脏器脱垂;在各产科因素中,新生儿体质量与盆底肌力受损明显相关。

Analysis of risk factors for pelvic muscle damage after vaginal delivery

Objective To analyze the maternal pelvic muscle strength changes after vaginal delivery and to explore the risk factors for pelvic muscle damage. Methods 288 postpartum women, who all vaginal delivered in Obstetrics and Gynecology Hospital of Fudan University, were enrolled in our study between April and June in 2015. We retrospectively summarized their pelvic floor screening results, and retrieved their medical records to obtain their obstetrical characteristics, and then analyzed the potential influencing factors of postpartum pelvic muscle damage via Logistic regression analysis. Results Abnormal pelvic muscle strength presented in all women at 6 weeks of postpartum. 252/288 cases (87.5%) encountered postpartum pelvic muscle damage. 149/288 cases(51.7%) were diagnosed with anterior vaginal wall prolapse, 29/288 cases (10.1%) with posterior vaginal wall prolapse, and 7/288 cases (2.4%) with uterine prolapse. Totally, 162/288 women (56.3%) underwent different types of pelvic organ prolapse. Univariate analysis showed that only newborn birth weight was associated with pelvic muscle damage (OR2.579,95% CI 1.096-6.071, P = 0.03), but other obstetric factors such as maternal age, parity, gestational age, body mass index, whether forceps delivery, the time of first/second stage of labor and whether episiotomy were not associated with pelvic muscle damage. Conclusion Pregnancy and childbirth are important factors leading to pelvic muscle abnormalities and pelvic organ prolapse. Pelvic muscle damage were significantly correlated with newborn birth weight.