Influence of the subpubic arch angle on anal sphincter trauma and anal incontinence following childbirth
Influence of the subpubic arch angle on anal sphincter trauma and anal incontinence following childbirth
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DOI：
10.1046/j.1471-0528.2002.01466.x
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发表时间：
2002-11-01
影响因子：
5.8
通讯作者：
Winter, R
中科院分区：
文献类型：
--
作者：
Frudinger, A;Halligan, S;Winter, R
目的评估耻骨下弓角、肛门括约肌和会阴创伤与未产妇产后肛门失禁的关系。设计前瞻性队列研究。设置大学教学医院。样本134例低风险未产妇。方法测量骨盆骨性出口以计算耻骨下弓角。在分娩前后进行会阴和肛门括约肌的超声内镜评估。一个特定的肠功能问卷调查完成之前和之后deliver.Main结果措施会阴和肛门括约肌创伤，恶化后deliver.Results 32名妇女的耻骨下弓角度小于90度有显着延长的第一和第二阶段的劳动力相比，102名妇女的耻骨下弓更广泛。分娩后，肛门狭窄恶化，更多的妇女与一个狭窄的耻骨下角（69%比21%，P < 0.001），但这是不相关的发病率肛门括约肌和会阴traums.Conclusions一个狭窄的耻骨下弓是密切相关的分娩时间延长和产后肛门失禁的初产妇。然而，会阴和肛门括约肌损伤，超声评估，并不能解释产后肛门失禁的比例较高的妇女与耻骨下弓角狭窄。
Objective To assess the relationship between the subpubic arch angle, anal sphincter and perineal trauma, and anal incontinence after childbirth in nulliparous women.Design Prospective cohort study.Setting University teaching hospital.Sample One hundred thirty-four low risk nulliparous women.Methods Measurements of the bony pelvic outlet were made to calculate the subpubic arch angle. Endosonographic assessment of the perineum and anal sphincter was made before and after delivery. A specific bowel function questionnaire was completed before and after delivery.Main outcome measures Perineal and anal sphincter trauma, and deteriorating anal continence after delivery.Results Thirty-two women with a subpubic arch angle of less than 90degrees had significantly prolonged first and second stages of labour when compared with 102 women whose subpubic arch was wider. Following delivery, anal continence deteriorated in more women with a narrow subpubic angle (69% vs 21%, P < 0.001) but this was unrelated to the incidence of anal sphincter and perineal trauma.Conclusions A narrow subpubic arch is strongly associated with prolonged labour and postpartum anal incontinence in nulliparous women. However, perineal and anal sphincter trauma, assessed by ultrasound, does not account for the higher rate of postpartum anal incontinence in women with a narrow subpubic arch angle.