Obstetric factors associated with levator ani muscle injury after vaginal birth
Obstetric factors associated with levator ani muscle injury after vaginal birth
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DOI：
10.1097/01.aog.0000194063.63206.1c
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发表时间：
2006-01-01
影响因子：
7.2
通讯作者：
DeLancey, JOL
中科院分区：
文献类型：
--
作者：
Kearney, R;Miller, JM;DeLancey, JOL
目的：为了确定产科因素与阴道分娩后肛提肌损伤的发展，方法：磁共振成像采取了160名妇女的骨盆底9至12个月后，第一任期阴道分娩。一半的女性患有新发压力性尿失禁，另一半是大陆对照。在磁共振上确定是否存在耻骨内脏部分的缺失。在每块肌肉中进一步对缺损严重程度进行评分，从0（无缺损）到3（完全肌肉丧失）。分配两侧的总分（0至6）并将其分组为次要（0-3）或主要（4-6）。收集产科详细信息。使用Fisher精确检验和t检验分析产科变量和肌肉损伤之间的关联。结果：发现以下提上睑肌缺损的增加优势比：镊子使用14.7（95%置信区间[CI] 4.9-44.3），肛门括约肌断裂8.1（95% CI 3.3-19.5）和会阴切开术3.1（95% CI 1.4-7.2），但不真空输送0.9（95% CI 0.19-4.3），硬膜外使用0。9（95% CI 0.4-2.0），或催产素使用0.8（95% CI 0.3-1.8）。提肛肌损伤的妇女年龄大3.5岁，第二产程长78分钟。胎龄、出生体重和头围的差异无统计学意义。一个主要的缺陷，在耻骨内脏肌被认为是在22名妇女和一个小的缺陷，在7 women.CONCLUSION：损伤的提肛肌的妇女在第一次阴道分娩后，与几个产科因素表明阴道分娩困难，年龄较大。
OBJECTIVE: To identify obstetric factors associated with development of levator ani injury after vaginal birth.METHODS: Magnetic resonance images were taken of the pelvic floor of 160 women 9 to 12 months after first term vaginal delivery. Half the women had de novo stress incontinence and half were continent controls. Abnormalities of the pubovisceral portion were identified on magnetic resonance as present or absent. Defect severity was further scored in each muscle from 0 (no defect) to 3 (complete muscle loss). A summed score for the 2 sides (0 to 6) was assigned and grouped as minor (0-3) or major (4-6). Obstetric details were collected. The association between obstetric variables and muscle injury were analyzed using Fisher exact test and t tests.RESULTS: The following increased odds ratios for levator defect were found: forceps use 14.7 (95% confidence interval [CI] 4.9-44.3), anal sphincter rupture 8.1 (95% CI 3.3-19.5) and episiotomy 3.1 (95% CI 1.4-7.2) but not vacuum delivery 0.9 (95% CI 0.19-4.3), epidural use 0. 9 (95% CI 0.4-2.0), or oxytocin use 0.8 (95% CI 0.3-1.8). Women with levator injury were 3.5 years older and had a 78-minute longer second stage of labor. Differences in gestational age, birth weight, and head circumference were not statistically significant. A major defect in the pubovisceral muscle was seen in 22 women and a minor defect in 7 women.CONCLUSION: Injuries to the levator ani muscles in women after their first vaginal delivery are associated with several obstetric factors indicating difficult vaginal birth and with older age.