Comparison of levator ani muscle avulsion injury after forceps-assisted and vacuum-assisted vaginal childbirth.
Comparison of levator ani muscle avulsion injury after forceps-assisted and vacuum-assisted vaginal childbirth.
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DOI：
10.1097/aog.0000000000000825
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发表时间：
2015-05
影响因子：
7.2
通讯作者：
Handa VL
中科院分区：
文献类型：
--
作者：
Memon HU;Blomquist JL;Dietz HP;Pierce CB;Weinstein MM;Handa VL
利用三维经会阴超声，我们比较了产钳与真空辅助阴道分娩后肛提肌损伤的发生率。这是一项回顾性队列研究。将至少经历过一次产钳分娩的妇女（在所有分娩中）与至少经历过一次真空分娩的妇女进行比较。平均而言，参与者距离指数交付还有10年。三维经会阴超声体积被捕获为静止、Valsalva和盆底肌肉收缩时的电影循环。主要结局为肛提肌撕脱。次要结局包括食管裂孔直径和面积。还比较了两个分娩组的盆底疾病患病率。在产钳组的45名参与者和真空组的28名参与者中，两组之间在第一次分娩时的母亲年龄、产次、体重指数、出生体重、会阴切开术和第二阶段持续时间方面没有差异。肛门括约肌撕裂的病史在产钳组中更常见。产钳术后肛提肌撕脱的患病率显著高于真空分娩术后[22/45（49%）vs 5/28（18%），p=0.012，患病率比= 2.74（95% CI：1.17，6.40），比值比= 4.40（95%置信区间：1.42，13.62）]。控制分娩类型，肛提肌撕脱与脱垂症状相关（p=0.036），尽管两组脱垂的客观证据无显著差异（p=0.20）。分娩后10年，产钳术后提上睑肌撕脱的发生率几乎是真空辅助阴道分娩的三倍。
Using three-dimensional transperineal ultrasound, we compared the prevalence of levator ani muscle injury after forceps with vacuum-assisted vaginal delivery. This was a retrospective cohort study. Women who experienced at least one forceps delivery (across all deliveries) were compared to women who had at least one vacuum birth. On average, participants were 10 years from the index delivery. Three-dimensional transperineal ultrasound volumes were captured as cine loops at rest, with Valsalva and with pelvic floor muscle contraction. The primary outcome was levator ani muscle avulsion. Secondary outcomes included hiatal diameter and area. Prevalence of pelvic floor disorders was also compared between the two delivery groups. Among 45 participants in the forceps group and 28 participants in the vacuum group, there were no differences between groups in maternal age at first delivery, parity, body mass index, birth weight, episiotomy, and duration of second stage. History of anal sphincter laceration was more common in the forceps group. The prevalence of levator ani muscle avulsion was significantly higher after forceps compared with vacuum delivery {22/45 (49%) versus 5/28 (18%), p=0.012, prevalence ratio = 2.74 (95% CI: 1.17, 6.40), odds ratio = 4.40 (95% confidence interval: 1.42, 13.62)}. Controlling for delivery type, levator ani muscle avulsion was associated with symptoms of prolapse (p=0.036), although objective evidence of prolapse was not significantly different between groups (p=0.20). Ten years after delivery, the prevalence of levator avulsion is almost tripled after forceps compared with vacuum-assisted vaginal delivery.