产后6~8周盆腔器官脱垂患病率的Meta分析

Meta-analysis of the Prevalence of Pelvic Organ Prolapse at 6-8 Weeks Postpartum

目的系统评价产后6~8周盆腔器官脱垂的发病情况,以期为产妇盆腔器官脱垂的预防及管理提供依据。方法计算机检索CNKI、WanFang Data、VIP、CBM、PubMed、Web of Science、The Cochrane Library和EMbase数据库,搜集有关产后6~8周盆腔器官脱垂患病率的横断面研究和队列研究,检索时限均从建库至2021年4月。由2名研究者独立筛选文献、提取数据,并对纳入研究质量进行偏倚风险评估,研究结果使用Stata 15.0进行Meta分析。结果共纳入13篇原始研究,涵盖25307名产妇。Meta分析结果显示:产后6~8周盆腔器官脱垂的患病率为35.2%[95%CI(16.6%~53.9%)]。亚组分析结果显示:阴道前壁膨出的患病率为34.6%[95%CI(5.7%~82.4%)],高于阴道后壁膨出的16.2%[95CI(5.3%~40.1%)]和子宫脱垂的15.7%[95%CI(1.9%~64.2%)];POP-Q分期的Ⅰ度脱垂患病率为16.2%[95%CI(3.3%~52.3%)],高于Ⅱ度脱垂的2.7%[95%CI(1.3%~4.2%)]和Ⅲ度脱垂的1.0%[95%CI(0.5%~1.5%)];经阴道分娩产妇的患病率为54.5%[95%CI(12.6%~96.4%)],高于剖宫产产妇的31.8%[95%CI(13.3%~50.4%)];以脱离正常解剖位置为诊断标准的患病率为61.3%[95%CI(58.3%~64.3%)],高于以POP-Q分期为诊断标准的36.6%[95%CI(8.0%~65.2%)]和以POP-Q≥Ⅱ度为诊断标准的14.1%[95%CI(7.3%~20.9%)];华东地区的患病率为46.3%[95%CI(40.3%~52.2%)],高于华南地区的44.2%[95%CI(21.3.0%~67.1%)]和华北地区的17.5%[95%CI(4.0%~41.9%)];2010~2015年的患病率为53.2%[95%CI(41.8%~64.7%)],高于2016~2020年的29.8%[95%CI(7.4%~52.3%)]。结论2016年以后较2016年以前产后6~8周盆腔器官脱垂的患病率虽明显下降,但仍高达29.8%,应引起产妇、医院及社会的高度关注。为关爱产后女性,助力产后科学康复,应采取适当防治措施。

Objective To systematically evaluate the incidence of pelvic organ prolapse at 6-8 weeks postpartum,in order to provide a basis for the prevention and management of pelvic organ prolapse.Methods CNKI,WanFang Data,VIP,CBM,PubMed,Web of Science,The Cochrane Library and EMbase databases were searched by computer to collect cross-sectional studies and cohort studies on the prevalence of pelvic organ prolapse at 6-8 weeks postpartum.The search time was from the establishment of the database to April 2021.Two reviewers independently screened literature,extracted data,and assessed the risk of bias of included studies.Meta-analysis was performed using Stata 15.0.Results A total of 13 original studies were included,with 25307 women.The results of Meta-analysis showed that the prevalence of pelvic organ prolapse at 6-8 weeks postpartum was 35.2%[95%CI(16.6%-53.9%)].The results of subgroup analysis showed that the prevalence of anterior vaginal wall prolapse was 34.6%[95%CI(5.7%-82.4%)],which was higher than 16.2%[95%CI(5.3%-40.1%)]of posterior vaginal wall prolapse and 15.7%[95%CI(1.9%-64.2%)]of uterine prolapse.The prevalence of grade Ⅰ prolapse in POP-Q stage was 16.2%[95%CI(3.3%-52.3%)],which was higher than 2.7%[95%CI(1.3%-4.2%)]of grade Ⅱ prolapse and 1.0%[95%CI(0.5%-1.5%)]of grade Ⅲ prola pse.The prevalence of vaginal delivery was 54.5%[95%CI(12.6%-96.4%)],which was higher than 31.8%[95%CI(13.3%-50.4%)]of cesarean section.The prevalence was 61.3%[95%CI(58.3%-64.3%)]with the diagnostic criteria of detachment from normal anatomical position,which was higher than 36.6%[95%CI(8.0%-65.2%)]with the diagnostic criteria of POP-Q stage and 14.1%[95%CI(7.3%-20.9%)]with the diagnostic criteria of POP-Q≥Ⅱ degree.The prevalence in East China was 46.3%[95%CI(40.3%-52.2%)],which was higher than 44.2%[95%CI(21.3.0%-67.1%)]in South China and 17.5%[95%CI(4.0%-41.9%)]in North China.The prevalence in 2010-2015 was 53.2%[95%CI(41.8%-64.7%)],which was higher than 29.8%[95%CI(7.4%-52.3%)]in 2016-2020.Conclusion The prevalence of pelvic organ prolapse at 6-8 weeks postpartum after 2016 is significantly lower than that before 2016,but it is still as high as 29.8%,which should be highly concerned by parturients,hospitals and society.In order to care for postpartum women and help postpartum scientific rehabilitation,appropriate preventive measures should be taken.