产后盆腔器官脱垂危险因素的Meta分析

Risk factors of postpartum pelvic organ prolapse: a Meta-analysis

目的:通过Meta分析探索产后盆腔器官脱垂(POP)的相关危险因素。方法:计算机检索PubMed、the Cochrane Library、Web of Science、EMbase、中国知网(CNKI)、中国生物医学文献数据库(CBM)、维普数据库(VIP)、万方数据库,检索时限为各数据库建库至2022年2月28日,应用Stata MP 16.0软件进行Meta分析。结果:共纳入24篇文献,涉及31个危险因素。Meta分析结果显示,年龄≥35岁[OR=2.58,95%CI(1.53,4.33),P<0.001]、产前体质指数(BMI)[OR=1.23,95%CI(1.17,1.29),P<0.001]、妊娠期增加BMI[OR=1.85,95%CI(1.21,2.85),P=0.005]、产后BMI≥24 kg/m^(2)[OR=1.87,95%CI(1.64,2.14),P<0.001]、中重度体力劳动[OR=1.78,95%CI(1.05,3.00),P=0.031]、产次≥2次[OR=1.99,95%CI(1.80,2.20),P<0.001]、阴道分娩[OR=3.65,95%CI(3.15,4.22),P<0.001]、剖宫产[OR=0.21,95%CI(0.16,0.30),P<0.001]、新生儿出生体重≥4 000 g[OR=2.76,95%CI(2.15,3.55),P<0.001]、会阴侧切或撕裂[OR=2.48,95%CI(1.91,3.21),P<0.001]、第二产程时间延长[OR=1.97,95%CI(1.46,2.65),P<0.001]、肛提肌撕裂[OR=2.43,95%CI(1.71,3.46),P<0.001]、盆底肌力<3级[OR=3.69,95%CI(3.06,4.45),P<0.001]、产后压力性尿失禁[OR=1.54,95%CI(1.25,1.90),P<0.001]与产后盆腔器官脱垂发生有关,差异均有统计学意义。结论:现有证据表明,年龄≥35岁、产前BMI大、妊娠期增加BMI大、产后BMI≥24 kg/m^(2)、中重度体力劳动、产次≥2次、阴道分娩、新生儿出生体重≥4 000 g、会阴侧切或撕裂、第二产程时间延长、肛提肌撕裂、盆底肌力<3级、产后压力性尿失禁是产后盆腔器官脱垂发生的危险因素,剖宫产是产后盆腔器官脱垂的保护因素。对具有上述危险因素的女性应加强防护,采取针对性措施降低产后盆腔器官脱垂发生风险。

Objective:To explore the relevant risk factors for postpartum pelvic organ prolapse(POP)through Meta-analysis.Methods:The databases of PubMed,the Cochrane Library,Web of Science,EMbase,CNKI,CBM,VIP,WanFang Database were searched.The retrieval time was from inception to February 28,2022.Meta-analysis was performed by using Stata MP 16.0 software.Results:A total of 24 literatures were included,involving 31 risk factors.Meta-analysis results showed that,age≥35 years[OR=2.58,95%CI(1.53,4.33),P<0.001],prenatal body mass index(BMI)[OR=1.23,95%CI(1.17,1.29),P<0.001],increased BMI during pregnancy[OR=1.85,95%CI(1.21,2.85),P=0.005],postpartum BMI≥24 kg/m 2[OR=1.87,95%CI(1.64,2.14),P<0.001],moderate to severe physical labor[OR=1.78,95%CI(1.05,3.00),P=0.031],number of deliveries≥2 times[OR=1.99,95%CI(1.80,2.20),P<0.001],vaginal delivery[OR=3.65,95%CI(3.15,4.22),P<0.001],cesarean delivery[OR=0.21,95%CI(0.16,0.30),P<0.001],newborn birth weight≥4000 g[OR=2.76,95%CI(2.15,3.55),P<0.001],lateral episiotomy or tear[OR=2.48,95%CI(1.91,3.21),P<0.001],extended second stage of labor[OR=1.97,95%CI(1.46,2.65),P<0.001],levator ani muscle avulsion[OR=2.43,95%CI(1.71,3.46),P<0.001],pelvic floor muscle strength<grade 3[OR=3.69,95%CI(3.06,4.45),P<0.001],postpartum stress urinary incontinence[OR=1.54,95%CI(1.25,1.90),P<0.001]were associated with the occurrence of postpartum POP,and the difference was statistically significant.Conclusion:Current evidence shows that age≥35 years,prenatal BMI,increased BMI during pregnancy,postpartum BMI≥24 kg/m^(2),moderate to severe physical labor,number of deliveries≥2 times,vaginal delivery,newborn birth weight≥4000 g,lateral episiotomy or tear,extended second stage of labor,levator ani muscle avulsion,pelvic floor muscle strength<grade 3,postpartum SUI are risk factors for postpartum POP.Cesarean delivery is a protective factor for postpartum POP.Women with the above risk factors should strengthen protection and take targeted measures to reduce the risk of postpartum POP.