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P＜0.05）；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P＞0.05）。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。

Risk Factors of Pelvic Organ Prolapse for Unipara after Vaginal Delivery in Early Postpartum

Objective：To investigate risk factors of pelvic organ prolapse(POP) in early postpartum period among unipara women after vaginal delivery. Methods: From January to April 2017，a total of 1 216 primiparous women after vaginal delivery were recruited． Pelvic organ prolapse was assessed at 6-8 weeks postpartum，using the Pelvic Organ Prolapse Quantification(POP-Q) system. Logistic regression analysis was used to estimate the relative odds of each factor. Results: Of 1 216 participants, 52.96%(644/1 216) had prolapse to or beyond the hymen as POP group. There were significant difference at age, delivery pregnancy week, infant birth weight and forceps delivery between the two groups(P＜0.05). There were no significant difference at BMI before pregnancy, BMI when delivery, ponderal growth during pregnancy ,the second period of delivery, perineal tear and episiotomy between the two groups(P＞0.05). The results of nonconditional multivariate Logistic regression analysis showed that compared with the maternal age under 28, the incidence of early postpartum POP with older maternal age(≥36 years) was significantly higher(OR=2.352，P=0.010，95%CI：1.222-4.526); Compared with the infant birthweight under 3 000 g, women with infant birthweight 3 500-3 999 g and over 4 000 g had higher risk of early POP postpartum(OR=2.039，P＜0.001，95%CI：1.385-3.003；OR=2.676，P=0.007，95%CI：1.303-5.495, respectively). Women who had forceps deliveries were more likely to have POP than women who had natural deliveries(OR=1.760，P=0.019，95%CI：1.097-2.034). Conclusions: Postpartum POP is relevant to a variety of factors including theage, infant birthweight and forceps delivery. The incidence of postpartum POP among primiparous women after vaginal delivery was high. Early prevention for POP and training should be strengthened，specially for those who were at risk of POP.