产科因素对盆底功能障碍性疾病发生的影响

目的 研究产科相关因素对女性盆底功能障碍性疾病( pelvic floor dysfunction,PFD)发生的影响,旨在为其预防治疗提供理论依据。方法 选择2013年1—12月足月初产妇423例,根据分娩方式分为阴道分娩组221例,剖宫产组202例。行盆底结构功能障碍性疾病(PFD)临床问卷调查,采用一般问卷调查和盆腔器官脱垂定量(POP-Q)分期法评分了解产后早期压力性尿失禁(stress urinary incontinence, SUI)和盆腔脏器脱垂(pelvic organ prolapse,POP)发生情况及相关影响因素；比较与妊娠、分娩相关的不同产科因素对盆底功能的影响,调取产科住院病历统计分析产科相关因素。结果 选择性剖宫产组产后SUI、POP的发生率为8.9%(18/202)、27.2%(55/202),阴道分娩组为15.4%(34/221)、37.6%(83/221),两组SUI、POP的发生率比较,差异有统计学意义(P<0.05)。在产后SUI、POP发生的其他产科因素中,年龄、分娩前BMI、新生儿出生体质量、第二产程时间与对照组比较,差异有统计学意义(P<0.05),且与SUI、POP的发生有一定相关性(P<0.05),而孕次无统计学意义(P＞0.05)。结论 年龄、阴道分娩、分娩前BMI、第二产程时间、新生儿出生体质量是产后早期女性PFD的发生的相关危险因素。

The impact of obstetric factors on pelvic floor function

Objective To investigate the impact of different obstetric factors on pelvic floor dysfunction disease(PFD),thus to study the prevention and treatment of pelvic floor dysfunction and provide a theoretical basis for prophylaxis.Methods 423 full-term primipara admitted from January 2013 to December 2013 were selected.According to the delivery mode, they were divided into 2 groups:vaginal delivery group (n=221) and elective cesarean section group (n=202).Questionnaire of pelvic floor dysfunction and score based on pelvic organ prolapse (POP-Q) staging method were used to understand the incidence and related influencing factors of early postpartum stress urinary incontinence and pelvic organ prolapse, and to compare the effect of different obstetrical factors on pelvic floor muscle strength.Case analysis was also carried out to investigate relevant factors of obstetrics.Results The incidence of SUI and POP in the elective cesarean section group were 9.4%(19/202),and 27.2%(55/202), respectively, while they were 15.4% (34/221) and 37.6% (83/221) in the vaginal delivery group(P<0.05).Compared with control group, other factors of SUI and POP in postpartum have significant difference in the age, BMI, neonatal birth weight, and the second labor time (P < 0.05), showing a certain correlation (P<0.05).But there was no statistical significance in gravidity (P>0.05).Conclusion It demonstrated that age, BMI, neonatal birth weight, the second labor time and vaginal delivery would affect the incidence of the early postpartum period of SUI and POP.