产后腹直肌分离的相关危险因素分析

Risk Factors Analysis of Diastasis Recti Abdominis during Postpartum

【目的】探讨产后腹直肌分离的相关危险因素。【方法】回顾性分析2019年6月至2020年10月在中山大学附属第三医院岭南医院产检并分娩,且产后3个月内使用高频超声探头测量腹直肌的孕妇共2394例,根据腹直肌是否分离,分为非DRA组321例和DRA组2073例。收集两组孕期的一般临床特点和分娩结局,包括:年龄、身高、产次、体质量指数、是否合并糖尿病、分娩孕周、分娩方式和新生儿出生体质量等。对比分析两组之间的临床特点差异,通过Logistic回归分析方法分析DRA发生的危险因素。【结果】①产后3个月内DRA以脐部分离为主,发生率为86.6%。其中轻度DRA发生率32.1%,中度DRA发生率48.2%,重度DRA发生率6.3%。②与非DRA组相比较,DRA组的产妇年龄、孕前BMI、分娩前BMI和新生儿出生体质量更大(P<0.001),DRA组中多产和剖宫产的比例更高(48.2%vs.26.8%和41.3%vs.19.6%,P<0.001)。③高龄、多产和剖宫产均为产后DRA发生的独立危险因素[OR=4.137,95%CI为(2.655,6.448);OR=2.892,95%CI为(2.198,3.805)和OR=3.217,95%CI为(2.379,4.350),P<0.05]。【结论】高龄、多产和剖宫产均为产妇产后DRA发生的独立危险因素。

【Objective】To explore the risk factors of diastasis recti abdominis(DRA)during postpartum.【Methods】Retrospective analysis was performed on 2394 deliveries who received regular prenatal tests and delivered in the Third Affiliated Hospital of Sun Yat-sen University during June 2019 to October 2020.The inter-rectus distance were measured by high-frequency ultrasound during 3 months postpartum.According to the width of inter-rectus distance,321 cases in non-DRA group and 2073 cases in DRA group were included.The clinical characteristics and delivery outcomes of the subjects were collected,including age,height,parity,body mass index(BMI),diabetes mellitus or not,gestational age at delivery,delivery modes and neonatal birth weight.The differences of clinical characteristics between the two groups were compared,and the risk factors of DRA were explored by Logistic analysis.【Results】DRA mainly occurred at umbilicus,the incidence of DRA after postpartum 3 months was 86.6%,the incidence of mild DRA was 32.1%,moderate DRA was 48.2%and severe DRA was 6.3%.Compared with non-DRA group,the average age,pre-pregnancy BMI,BMI at delivery and the neonatal birth weight were bigger in DRA group(P<0.001),the proportion of multiple parturitions and cesarean section were higher in DRA group(48.2%vs.26.8%and 41.3%vs.19.6%,P<0.001).Elderly women,multiple parturitions and cesarean section were all independent risk factors of DRA after postpartum.[OR=4.137,95%CI(2.655,6.448);OR=2.892,95%CI(2.198,3.805)and OR=3.217,95%CI(2.379,4.350),all P<0.05].【Conclusion】Elderly maternal,multiple parturitions and cesarean section were independent risk factors of DRA during postpartum.