妊娠和分娩及产科相关因素对产后压力性尿失禁的影响

The influence of pregnancy,delivery and obstetric factors on postpartum stress urinary incontinence

目的：探讨妊娠和分娩及产科相关因素对女性产后压力性尿失禁的影响。方法应用经会阴超声成像技术，测量94例初产妇产后6～8周膀胱颈活动度及尿道旋转角度，与30例未孕妇女行对照研究，分析妊娠和产科相关因素对压力性尿失禁的影响。结果94例入选产妇中阴道分娩组50例，剖宫产组44例，两组年龄、分娩孕周、新生儿出生体重无明显差异（P＞0．05），而产前体重指数有统计学意义（P＜0．05）。产后6周阴道分娩组有15例（30％）发生过压力性尿失禁（SUI），而剖宫产组有4例（9．1％），有统计学差异（P＜0．05）。阴道分娩组、剖宫产组及未孕妇女两两相比，膀胱颈活动度及尿道旋转角度均有统计学差异（P＜0．05）。Logistic回归分析显示阴道分娩、产前有SUI、产钳助产及会阴撕裂是产后压力性尿失禁的危险因素。结论妊娠和分娩是压力性尿失禁的危险因素，与剖宫产相比，阴道分娩增加产后压力性尿失禁的发生率。

Objective This study was conducted to investigate the influence of pregnancy,delivery and associated obstetric factors on fe-male postpartum stress urinary incontinence.Methods Compared the bladder neck mobility and urethral rotation angle of 94 primiparas in 6 to 8 weeks after post partum with those of 30 nulliparas by translabial ultrasound,and analyzed the association of pregnancy,childbirth and related obstetric factors with stress urinary incontinence.Results All 94 primiparas were divided into two groups：50 in the vaginal delivery （VD）group and 44 in the caesarean section （CS ）group.There was no statistically significant difference between the two groups in terms of age,delivery week and birth weight （P〉0.05）,but the antenatal body mass index（BMI）showed statistically signif-icant difference between the two groups （P〈0.05）.The prevalence of SUI in VD group was 15 out of 50（30%）,which is significantly different from the CS group with 4 out of44 （9.1%）（P〈0.05）.The bladder neck mobility and urethral rotation angle are significantly different among VD,CS and nulliparous group（All P〈0.05）.Logistic regression analysis showed that SUI was strongly associated with vaginal delivery,SUI during pregnancy,forceps delivery and perineal lesion（P〈0.05）.Conclusions Pregnancy and delivery are risk factors for stress urinary incontinence.Vaginal delivery increases the risks of postpartum SUI compared with cesarean section.