【摘要】 目的探讨不同分娩方式与脱垂发病相关性,寻找脱垂的发病因素。方法选择本院2015年5月～2019年6月间105例健康产妇,根据产后发生脱垂的结局,分为脱垂组16例和非脱垂组89例,两组的分娩方式包括水中分娩、自然分娩。两组产妇在分娩年龄、新生儿体重、BMI、产次、母体孕期增重差异无统计学意义。在产后7周,分析脱垂发病率与两种分娩方式、分娩年龄、新生儿体重、BMI、产次、母体孕期增重、Ⅰ类肌肌力、Ⅱ类肌肌力、阴道最大压力差值、膀胱颈移动度、尿道膀胱后角、肛提肌裂孔、尿失禁发病率之间的相关性。结果单因素统计学方法分析后显示,膀胱颈移动度、肛提肌裂孔大小及分娩方式是脱垂发病的危险因素(P<0.05)。Ⅰ类肌肌力、Ⅱ类肌肌力、阴道最大压力差值、尿道膀胱后角、尿失禁发病率则无明显相关性。进一步行多因素统计学分析后,水中分娩组发生产后脱垂是自然分娩组的0.088倍(95%CI:0.014～0.535,P=0.008<0.05);膀胱颈移动度异常患者发生脱垂是正常组的30.804倍(95%CI:5.515～172.040,P<0.001),肛提肌裂孔增大发生产后脱垂是正常组的9.806倍(95%CI:1.255～76.628,P=0.030<0.05)。结论分娩方式、分娩年龄、产前BMI、新生儿出生体重、膀胱颈移动度和肛提肌裂孔大小是产后脱垂发病的独立危险因素。分娩年龄大、产前BMI高、新生儿出生体重增加、膀胱颈移动度过大和肛提肌裂孔增大会增加脱垂发病概率。水中分娩相较自然分娩可降低产后脱垂的发生率。更多还原

【Abstract】 Objective To explore the correlation between various delivery modes and the prolapse onset and to identify the pathogenic factors of prolapse. Methods A total of 105 healthy parturients in our hospital from May 2015 to June2019 were selected. According to the outcome of postpartum prolapse,they were divided into the prolapse group(n=16)and the non-prolapse group(n=89). The delivery modes of the two groups included water birth and natural delivery. There were no significant differences between the included parturients of the two groups in delivery age, newborn weight,BMI, parity and maternal weight gain during pregnancy. 7 weeks after delivery, the correlations between the incidence rate of prolapse and the two delivery modes, delivery age, newborn weight, BMI, parity, maternal weight gain during pregnancy, muscle strength of class Ⅰ and Ⅱ muscle, the maxim difference value of vaginal pressure, bladder neck movement degree, urethrovesical rear angle, levator ani hiatus and incidence rate of urinary incontinence were analyzed.Results Univariate statistical analysis showed that bladder neck movement degree, levator ani hiatus size and delivery mode were the risk factors of the prolapse onset(P<0.05). There was no significant correlations between the incidence rate of prolapse with the muscle strength of class Ⅰ and Ⅱ muscle, the maxim difference value of vaginal pressure,urethrovesical rear angle and incidence rate of urinary incontinence. According to further multivariate statistical analysis,the incidence rate of postpartum prolapse in the water birth group was 0.088 times higher than that in the natural delivery group(95%CI:0.014-0.535, P=0.008<0.05), the incidence rate of postpartum prolapse in the patients with abnormal bladder neck movement degree was 30.804 times higher than that in the normal group(95% CI: 5.515-172.040,P<0.001), and the incidence rate of postpartum prolapse in patients with enlarged levator ani hiatus was 9.806 times higher than that in the normal group(95% CI:1.255-76.628, P=0.030<0.05). Conclusion Delivery mode, delivery age,prenatal BMI, newborn weight, bladder neck movement degree and the levator ani hiatus size are independent risk factors for the onset of postpartum prolapse. Older delivery age, higher prenatal BMI, increased newborn weight,excessive bladder neck movement degree and enlarged levator ani hiatus will increase the incidence rate of prolapse.Water birth, compared with natural delivery, can reduce the incidence rate of postpartum prolapse.更多还原