不同产科因素对产后尿失禁的影响

Effect of different factors of delivery on postpartum urinary incontinence

目的探讨妊娠和分娩方式以及与分娩有关的不同产科因素对产后尿失禁发生率的影响。方法采用国际尿失禁咨询委员会尿失禁问卷表，对产后6～8周复查的初产妇400例进行问卷调查，询问产妇孕前、妊娠期及产后42天尿失禁的发病情况和产后下尿路症状。分析不同分娩方式与产后尿失禁的关系，探讨与尿失禁发生率有关的产科因素。结果①368例产妇中有51人（13．86％）在产后42天内至少一次出现尿失禁症状；②剖宫产、阴道顺产、产钳助产的尿失禁发生率分别为4．22％（7／166）、19．34％（35／181）、42．86％（9／21），产钳助产分别与其它两组之间有极显著性差异（P〈0．01），阴道顺产组的产后尿失禁发生率也明显高于刮宫产组（P〈0．05）；③阴道分娩组中与产后尿失禁有明显关系的因素有孕期发生尿失禁、孕前体重指数、产钳助产和产后尿急尿频等症状，而与硬膜外镇痛、第一产程时间、第二产程时间、会阴裂伤、会阴侧切术、新生儿体重、产后哺乳均无明显相关性；④剖宫产中影响产后尿失禁的因素只有孕前尿失禁的发生，而与是否临产后剖宫产和新生儿体重无明显相关性。结论①剖宫产与产钳助产和阴道顺产相比具有明显的保护作用，可以显著降低产后42天内尿失禁的发生率；②产钳助产、孕期发生尿失禁、孕前高体重指数和产后出现下尿路症状可增加自娩后尿失禁发生的机率；③产后尿失禁以轻度为主，加强孕期和产后盆底肌肉训练可以预防和治疗产后尿失禁。

Objective To investigate the effect of different delivery modes and the risk factors in pregnancy and delivery to postpartum urinary incontinence. Methods Four hundred primipara, delivered from July to November 2004 in our hospital and were followed up 42 days after delivery, were recruited and their symptoms of urinary incontinence before, after and during pregnancy, along with low urinary tract symptoms after delivery were investigated. The questionnaire was designed according to International Consultant Incontinence. The electromyogram of pelvic floor muscles was then evaluated and the information of delivery was recorded. As many as 368 questionnaires were valid and their data were analyzed in order to evaluate the risk factors of postpartum urinary incontinence. Results ①51 of 368 （13.86%） women complained of urinary leakage at least once after delivery. ②The incidence of urinary incontinence in spontaneous vaginal delivery, forceps and cesarean section was 4.22% （7/166）, 19.34% （35/181）, and 42.86% （9/21）, respectively. The incidence of urinary incontinence in forceps delivery was higher than that of the other two types of delivery （ P 〈 0.01 ）, and the incidence of urinary incontinence in spontaneous vaginal delivery was also higher than that of the cesarean section group. ③The risk factors to postpartum urinary incontinence in vaginal delivery was the occurrence of urinary incontinence during pregnancy, BMI before pregnancy, foreeps and lower urinary tract symptoms after delivery.But the other events, such as pudendal block, pudendal tears, episiotomy, the duration of the first or second peried of delivery, fetal weight, length and lactation, were not correlated.④The only factor that associated with postpartum urinary incontinence in cesarean section was the urinary incontinence before delivery, but not the weight of newborn and the cesarean section itself. Conclusion ①Cesarean section is obviously protective to postpartum urinary incontinence than vaginal and forceps delivery. ②The usage of forceps, occurrence of urinary incontinence during pregnancy and lower urinary tract symptoms after delivery are significant risk factors of postpartum urinary incontinence. ③The symptoms of the most women with postpartum urinary incontinence are mild. Pelvic floor exercise during pregnancy and after delivery is valid to prevent postpartum urinary incontinence.