不同产科因素对产后妇女盆底功能障碍的影响

Impact of different obstetric factors on pelvic floor dysfunction among postpartum women

目的探讨不同分娩方式及相关产科因素对盆底功能障碍的影响。方法选择四川省妇幼保健院产后42 d进行产后复查的妇女1 381例为研究对象,其中经阴道分娩712例,剖宫产669例,专人询问并填写孕期及产后尿失禁(urinary incontinence,UI)问卷调查表,并进行盆底肌力筛查,观察不同分娩方式及产科影响因素与盆底肌力的相关性。结果Ⅰ类肌纤维肌力异常检出率阴道分娩组(69.38%)与剖宫产组(67.71%)比较差异无统计学意义(P>0.05);Ⅱ类肌纤维肌力异常检出率阴道分娩组(67.56%)高于剖宫产组(61.73%)(P<0.05)。孕期压力性尿失禁(stress urinary incontinence,SUI)293例(21.22%),其中阴道分娩组157例(22.05%),剖宫产组136例(20.33%);产后SUI 133例(9.63%),其中阴道分娩组114例(16.01%),剖宫产组19例(2.84%),阴道分娩组产后SUI发病率明显高于剖宫产组(P<0.05)。结论分娩前体质量指数是I类、Ⅱ类肌纤维肌力异常的高危因素;剖宫产为Ⅱ类肌纤维肌力异常、产后发生SUI的保护性因素;年龄为产后SUI发生的高危因素。应严格控制孕期体重,给予孕产妇保护盆底功能充分的宣教,指导其进行盆底肌锻炼。

Objective To investigate the impact of different delivery modes and obstetric factors on dysfunction of the pelvic floor. Methods A total of 1 381 women in Maternal and Child Health Hospital of Sichuan Province at 6 weeks postpartum were surveyed, with 712 women in the vaginal delivery group and 669 women in the elective cesarean section group, the survey included questionnaire on stress urinary incontinence performed by special staff and the pelvic floor muscle screening, the correlation between different modes of delivery and related factors of obstetric and pelvic floor muscle strength were observed. Results There was no significant difference statistically in detection rate of type Ⅰ muscle fiber between vaginal delivery group （69.38 % ） and cesareansection group （67.71% ） （P 〉0. 05）. The detection rate of type Ⅱmuscle fiber of vaginal delivery group （61.73 % ） was higher than cesarean section group （67.56 % ） （P 〈0. 05）. Total number of stress urinary incontinence （SUI） during pregnancy was 293 （21.22 % ）. Among them 135 cases were in cesarean section group accounting for 20. 33 %, 159 cases were in vaginal delivery group accounting for 22.05 %. Total number of postpartum urinary incontinence was 133 （9. 63 % ）. Among them 114 cases were in vaginal delivery group accounting for 16.01%, 19 cases were in elective cesarean section group accounting for 2. 84 %, the incidence of SUI of vaginal delivery was higher than that of cesarean section group （ P 〈 0. 05 ）. Conclusion Body mass index before the delivery is a risk factor for type Ⅰ, typⅡ muscle fiber （ P 〈 0.05 ）. Cesarean section is a protective factor for type Ⅱ muscle fiber and postpartum SUI （P 〈 0. 05 ）. Maternal age is a risk factor for postpartum urinary incontinence. We should strictly control the weight during pregnancy, give pregnant women education about how to protect pelvic floor and guide them to do muscle exercise.