自然分娩产妇盆底功能障碍的风险因素分析

Risk factors of pelvic floor dysfunction in women with natural childbirth

目的探讨自然分娩产妇盆底功能障碍发生情况及其相关因素,为减少产后盆底功能障碍的发生提供科学依据。方法以2021年6月至2023年6月淮南市妇幼保健院、安徽理工大学第一附属医院及淮南东方医院集团总医院产科自然分娩且于产后42 d接受医院产后随访、回访的产妇为研究对象,对其进行分娩相关资料收集并进行盆底肌力检测,采用描述性分析方法对自然分娩产妇盆底功能障碍发生情况进行分析,并采用单、多因素分析方法对盆底功能障碍的影响因素进行分析。结果1823名自然分娩产妇中有782例检出盆底功能障碍,发生率为42.90%。多因素logistic回归模型结果显示年龄≥35岁(OR=2.869)、有盆腔手术史(OR=1.579)、无孕期缩肛训练(OR=2.482)、有孕期合并症(OR=3.043)、孕期增重高于推荐标准(OR=2.776)、有孕期尿失禁情况(OR=2.298)、未遵医进行盆底功能康复锻炼(OR=2.474)、第二产程时间长(OR=2.907)、新生儿体质量高(OR=2.575)、产褥期泌尿系统感染(OR=1.929)的自然分娩产妇盆底功能障碍发生风险更高。结论自然分娩产妇盆底功能障碍检出率较高,检出风险较高的产妇主要包括年龄≥35岁、有盆腔手术史、无孕期缩肛训练、有孕期合并症、孕期增重高于推荐标准、有孕期尿失禁情况、未遵医进行盆底功能康复锻炼、第二产程时间长、新生儿体质量高、产褥期泌尿系统感染者,为降低盆底功能障碍的发生风险,可据此给予风险孕妇针对性的干预或预防措施。

Objective To explore the occurrence and related factors of pelvic floor dysfunction in women with natural childbirth and provide the scientific basis for reducing the occurrence of postpartum pelvic floor dysfunction.Methods From June 2021 to June 2023,pregnant women who delivered spontaneously and received postpartum follow-up and return visit 42 days after delivery in the Obstetrics Department of Huainan Maternal and Child Health Hospital,the First Affiliated Hospital of Anhui University of Science and Technology,and General Hospital of Huainan Oriental Hospital Group were selected for the study.Birth-related data were collected and pelvic floor muscle strength was detected.Descriptive analysis method was used to analyze the occurrence of pelvic floor dysfunction,and univariate and multivariate analysis methods were used to analyze the influencing factors of pelvic floor dysfunction.Results Out of 1823 women with natural childbirth,782 cases were found to have pelvic floor dysfunction,with an incidence rate of 42.90%.The results of multivariate logistic regression showed that the risk of pelvic floor dysfunction was higher in women with natural childbirth who aged≥35(OR=2.869),with history of pelvic surgery(OR=1.579),absence of anal contraction training during pregnancy(OR=2.482),presence of pregnancy complications(OR=3.043),weight gain during pregnancy higher than recommended standards(OR=2.776),presence of urinary incontinence during pregnancy(OR=2.298),failure to follow medical advice for pelvic floor rehabilitation exercise(OR=2.474),long duration of second stage of labor(OR=2.907),high newborn body weight(OR=2.575),and postpartum urinary tract infection(OR=1.929).Conclusions The detection rate of pelvic floor dysfunction in women with natural childbirth is relatively high,and the high-risk women mainly include those aged≥35,with history of pelvic surgery,absence of anal contraction training during pregnancy,presence of pregnancy complications,weight gain during pregnancy higher than recommended standards,presence of urinary incontinence during pregnancy,failure to follow medical advice for pelvic floor rehabilitation exercise,long duration of second stage of labor,high newborn body weight,and postpartum urinary tract infection.To reduce the risk of pelvic floor dysfunction,accordingly,targeted interventions or preventive measures can be given to at-risk pregnant women.