Impact of the Duration of the Second Stage of Labor on Postpartum Pelvic Floor Symptoms.
Impact of the Duration of the Second Stage of Labor on Postpartum Pelvic Floor Symptoms.
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第二产程持续时间对产后盆底症状的影响。
DOI：
10.1097/spv.0000000000001477
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发表时间：
2024
期刊：
影响因子：
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通讯作者：
Cahill,AlisonG
中科院分区：
文献类型：
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作者：
McKenzie,CollinM;Woolfolk,CandiceL;Rieger,MaryM;White,AmandaB;Tuuli,MethodiusG;Srinivas,SindhuK;Caughey,AaronB;Tita,Alan;Gregory,WThomas;Richter,HollyE;Cahill,AlisonG
目的本研究旨在探讨初产妇产后 6 个月 SSL 持续时间与盆底症状之间的关联。研究设计 2014 年至 2018 年间，对一项多中心随机试验进行了计划的二次分析，评估立即与延迟用力对阴道分娩率、孕产妇发病率和新生儿结局的影响。对于盆底臂参与者，收集了产后人口统计学、盆腔检查和经过验证的问卷数据。主要结果是盆底不适量表 20 (PFDI-20) 评分从产后立即到产后 6 个月的变化。次要结果包括产后 6 个月盆底影响问卷、大便失禁严重程度指数、改良曼彻斯特健康问卷评分和盆腔器官脱垂定量测量的变化。根据 SSL 持续时间≤ 60 分钟或> 60 分钟对参与者进行分析。结果 在 2,414 名试验参与者中，767 名 (32%) 在 6 个月时完成了盆底评估。与 > 60 分钟 SSL 组相比，≤ 60 分钟 SSL 组的盆底痛苦量表 20 评分在 6 个月时显着改善（分别为 − 14.3±48.0 和 − 3.2±45.3；P= 0.04）。产后 6 个月时其他问卷的总分和分量表得分的变化在各组之间没有差异。脱垂阶段在各组之间没有差异。 SSL > 60 分钟组的会阴体显着缩短（3.7±0.7、3.5±0.8；P= 0.03）。 结论 SSL > 60 分钟的女性 6 个月时 PFDI-20 评分改善较小。 SSL > 60 分钟的人的组织和神经支配损伤更大可能解释 PFDI-20 分数改善持续较少的原因。
ObjectiveThis study aimed to examine the association between duration of SSL and pelvic floor symptoms at 6 months postpartum among primiparous women.Study DesignA planned secondary analysis of a multicenter randomized trial evaluating the impact of immediate versus delayed pushing on vaginal delivery rates, maternal morbidity, and neonatal outcomes was conducted between 2014 and 2018. For pelvic floor arm participants, demographic, pelvic examination, and validated questionnaire data were collected postpartum. Primary outcome was change in Pelvic Floor Distress Inventory 20 (PFDI-20) score from immediate to 6 months postpartum. Secondary outcomes included changes in the Pelvic Floor Impact Questionnaire, Fecal Incontinence Severity Index, Modified Manchester Health Questionnaire scores, and Pelvic Organ Prolapse Quantification measurements at 6 months postpartum. Participants were analyzed by SSL duration≤ 60 minutes or> 60 minutes.ResultsOf the 2,414 trial participants, 767 (32%) completed pelvic floor assessments at 6 months. Pelvic Floor Distress Inventory 20 scores significantly improved at 6 months in the≤ 60 minutes SSL group compared with> 60 minutes SSL (− 14.3±48.0 and− 3.2±45.3, respectively; P= 0.04). Changes from immediate postpartum in total and subscale scores for other questionnaires at 6 months did not differ between groups. Prolapse stage did not differ between groups. Perineal body was significantly shorter in the> 60 minutes SSL group (3.7±0.7, 3.5±0.8; P= 0.03).ConclusionsWomen with SSL> 60 minutes experience less improvement in PFDI-20 scores at 6 months. Greater tissue and innervation trauma in those with SSL> 60 minutes may explain persistently less improvement in PFDI-20 scores.