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。

Impact of different factors of delivery on early postpartum pelvic floor dysfunction

Objective To investigate the impact of different obstetric factors on early postpartum pelvic floor dysfunction disease(PFD),thus to study the prevention and treatment of pelvic floor dysfunction and provide a theoretical basis for disease.Methods406 primipara who had their childbirth in Zibo Maternal and Child Health Hosptial during Jan.2008 to Dec.2009 were interviewed at 6～8 weeks postpartum and fulfilled questionair survey.A retrospective analysis were made by comparing among obstetric factors in orde to evaluate the risk factors of PFD.ResultsThe occurrence of SUI was 28.33%(115/406)during pregnancy and was 18.47 %(75/406)postpartum,among the postpartum SUI patients,58 had SUI during prengnancy(77.33%),the incidence of POP was 49.51%(201/406)postpartum.The rate of SUI and POP was 7.49% and 37.89% in elective caesarean section group and 64.25%(115/179)and 72.63% in vaginal delivery group,the difference was significant between the two groups﹙P<0.05).Other relevant obstetric factors with SUI during pregnancy were age,the second period of deliver,perineal tear,fetal weight and BMI.ConclusionsThe incidence of SUI during pregnacy was obviously higher than postpartum.Compared with vaginal delivery,selective caesarean section had obvious protective effect which can significantly reduce the occurrence of the early postpartum PFD.Other relevant obstetric factors may increased the risk of the early postpartum PFD.