Childbirth and prolapse: long-term associations with the symptoms and objective measurement of pelvic organ prolapse
Childbirth and prolapse: long-term associations with the symptoms and objective measurement of pelvic organ prolapse
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DOI：
10.1111/1471-0528.12075
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发表时间：
2013-01-01
影响因子：
5.8
通讯作者：
Wilson, D.
中科院分区：
文献类型：
--
作者：
Glazener, C.;Elders, A.;Wilson, D.
目的 调查产后 12 年的脱垂症状和客观测量的盆腔器官脱垂情况，以及与分娩方式史的关系。设计十二年纵向研究。在阿伯丁、伯明翰和但尼丁设立产科单位。人口 居住在社区的妇女。方法 收集指标出生后 12 年的女性数据，并邀请女性进行检查。逻辑回归研究了危险因素与脱垂症状和体征之间的关联。主要结果测量脱垂症状评分（POP-SS）；客观测量的脱垂（POP-Q）。结果 在 7725 名持续女性中，3763 名 (49%) 在 12 岁时返回了调查问卷。 POP-SS 评分中位数为 2 (IQR 04)。一次或多次产钳分娩（OR 1.20，95% CI 1.041.38）和体重指数（BMI）超过 25 与较高（较差）的 POP-SS 评分相关，但首次分娩时年龄超过 25 岁与较低（较好）的评分相关。如果所有分娩均通过剖腹产，则没有保护作用（OR 0.84，95% CI 0.691.02）。 182/762 (24%) 名女性发现客观脱垂。 30 岁以上女性生育第一胎和产次与脱垂显着相关。与全部阴道自然分娩的女性相比，全部剖腹产的女性发生脱垂的可能性最低（OR 0.11，95% CI 0.030.38），产钳或自然阴道分娩和剖腹产混合后的风险降低。结论 这些发现相互矛盾，表明脱垂症状和客观脱垂可能不一致，或者与不同的先行因素相关。计划进一步跟进。
Objectives To investigate prolapse symptoms and objectively measured pelvic organ prolapse, 12 years after childbirth, and association with delivery mode history. Design Twelve-year longitudinal study. Setting Maternity units in Aberdeen, Birmingham and Dunedin. Population Women dwelling in the community. Methods Data from women were collected 12 years after an index birth and women were invited for examination. Logistic regression investigated associations between risk factors and prolapse symptoms and signs. Main outcome measures Prolapse symptom score (POP-SS); objectively measured prolapse (POP-Q). Results Of 7725 continuing women, 3763 (49%) returned questionnaires at 12 years. The median POP-SS score was 2 (IQR 04). One or more forceps deliveries (OR 1.20, 95% CI 1.041.38) and a body mass index (BMI) over 25 were associated with higher (worse) POP-SS scores, but age over 25 years at first delivery was associated with lower (better) scores. There was no protective effect if all deliveries were by caesarean section (OR 0.84, 95% CI 0.691.02). Objective prolapse was found in 182/762 (24%) women. Women aged over 30 years when having their first baby and parity were significantly associated with prolapse. Compared with women whose births were all spontaneous vaginal deliveries, women who had all births by caesarean section were the least likely to have prolapse (OR 0.11, 95% CI 0.030.38), and there was a reduced risk after forceps or a mixture of spontaneous vaginal delivery and caesarean section. Conclusions These findings are at odds with each other, suggesting that prolapse symptoms and objective prolapse may not be in concordance, or are associated with different antecedent factors. Further follow-up is planned.