产后女性阴道前壁脱垂情况及影响因素研究

Analysis on prevalence and factors related to anterior vaginal prolapse among postpartum women

目的了解产后女性阴道前壁脱垂情况并探讨其影响因素,为促进产后女性盆底康复提供基础资料。方法选取2020年6—10月在某保健院进行产后体检的产妇3 368例,对其一般情况、盆底功能检测结果等资料进行分析。结果产后女性深层、浅层Ⅰ类和Ⅱ类肌肌力1级占比最多;阴道前壁、后壁、子宫脱垂发生率分别为61.5%、9.3%、9.9%;阴道前壁脱垂组年龄、孕期体重增长、妊娠次数、生产次数高于未脱垂组;不同年龄、文化程度、体质指数(body mass index,BMI)、孕期体重增长、妊娠次数、生产次数、是否有巨大儿史、腹直肌是否分离、咳嗽和打喷嚏时是否漏尿、放松和无约束时是否漏尿的阴道脱垂发生率比较,差异均有统计学意义(P<0.05);logistic回归分析显示,超重(OR=28.066,95%CI=20.663~38.121)、肥胖(OR=161.208,95%CI=46.991~553.049)、妊娠2次(OR=8.513,95%CI=6.174~11.739)、妊娠≥3次(OR=9.31,95%CI=6.353~13.643)、生产2次(OR=1.76,95%CI=1.297~2.388)、生产≥3次(OR=2.765,95%CI=1.584~4.827)、有巨大儿史(OR=33.408,95%CI=15.218~73.337)、腹直肌分离(OR=11.374,95%CI=9.080~14.248)为阴道前壁脱垂的危险因素(P<0.05)。结论产后女性盆底肌力较弱,阴道前壁脱垂发生率较高;腹直肌分离、超重、肥胖、妊娠≥2次、生产≥2次、巨大儿史在阴道前壁脱垂的发生中起到重要作用。

Objective To investigate prevalence and the factors related to anterior vaginal prolapse among postpartum women, so as to provide basic data for promoting rehabilitation of pelvic floor function.Methods Totally 3 368 postpartum women were selected at a maternity and child health care hospital from June to October 2020. Data of general health condition and pelvic floor function were analyzed.Results Most women’s class Ⅰ and class Ⅱ pelvic floor muscle strength were Level 1. The percentage of anterior, posterior vaginal and uterus prolapse were 61. 5%, 9. 3%, and 9. 9%, respectively. Women with anterior vaginal prolapse was older and had more weight gain during pregnancy, more times of pregnancy and childbirth than women without this problem. There were significant differences about the incidence of anterior vaginal prolapse between different age, degree of education, BMI, weight gain during pregnancy, times of pregnancy and childbirth, history of macrosomia, diastasis recti abdominis, urinary incontinence during coughing and sneezing, relaxation and unconstrained body posture(P< 0. 05). Logistic regression analysis showed that overweight(OR=28. 066, 95%CI= 20. 663-38. 121), obesity(OR= 161. 208, 95%CI= 46. 991-553. 049), twice of pregnancy(OR= 8. 513,95%CI=6. 174-11. 739), 3 times of pregnancy and above(OR= 9. 310, 95%CI= 6. 353-13. 643), history of macrosomia(OR= 33. 408,95%CI= 15. 218-73. 337), diastasis recti abdominis(OR= 11. 374, 95%CI= 9. 080-14. 248) were risk factors of anterior vaginal prolapse(P< 0. 05).Conclusion Pelvic floor muscle strength among postpartum women is weak, and the prevalence of anterior vaginal prolapse is relatively high;Diastasis recti abdominis, overweight, obesity, twice or more pregnancy and childbirth, history of macrosomia play significant roles in the occurrence of anterior vaginal prolapse.