摘要
目的探讨产程中不同时间行剖宫产术分娩妇女在产后发生盆腔器官脱垂(POP)的情况。方法横断面选取2019年1月至2019年6月于北京大学人民医院规律产前检查并行剖宫产术分娩,且于产后6~8周来院检查的345例产妇的临床资料,其中包括行剖宫产术时宫口开大情况,根据是否存在脱垂分为POP组和无POP组,统计分析产后POPⅠ度的发生率及其相关影响因素。结果(1)符合标准的产妇共345例,其中,POP组109例,无POP组236例;选择性剖宫产者占75.4%(260/345),临产后剖宫产者占24.6%(85/345)。行剖宫产术时宫口开大情况为0~10 cm,其中,宫口未开者占58.6%(202/345),宫口开全者占2.9%(10/345)。POP的发生率为31.6%(109/345),其中POPⅠ度者96例(27.8%,96/345),Ⅱ度13例(3.8%,13/345),无Ⅲ度或Ⅳ度者。(2)统计分析表明,POP组产妇行剖宫产术时的宫口(中位数为1.0 cm)明显大于无POP组(中位数为0 cm),两组比较,差异有统计学意义(Z=-2.227,P=0.026)。选择性剖宫产者的POP发生率为28.1%(73/260),低于临产后剖宫产者42.4%(36/85),两者比较,差异有统计学意义(P=0.014),临产后剖宫产者发生POP的风险大于选择性剖宫产者。但进一步行宫口开大情况、是否为选择性剖宫产与发生POP的Spearman相关分析及受试者工作特征曲线显示,两者的相关性及预测程度均较差。结论选择性剖宫产对产后POP的发生具有一定的保护作用,但临产后再行剖宫产对盆底的保护作用减弱。
Objective To study and analyze the incidence of pelvic organ prolapse(POP)in women who underwent cesarean section.Methods A cross-sectional study was conducted.The clinical data of the women who underwent regular antepartum examination and cesarean delivery in Peking University People′s Hospital from January 2019 to June 2019 were collected,including the cervical dilatation.The incidence of POP was analyzed.Results(1)A total of 345 women met the inclusion criteria,with cervical dilatation of 0-10 cm before cesarean section,the cervix was not dilatated in 58.6%(202/345)of the women,and the cervix was fully dilatated in 2.9%(10/345)of the women.There were 109 cases of POP stageⅠor above,13 cases of POP stageⅡ,and no stageⅢorⅣ.The incidence of POP was 31.6%(109/345).(2)Statistical analysis showed that the cervical dilatation of the POP group was significantly larger than that of the non-prolapse group(median:1.0 vs 0 cm;Z=-2.227,P=0.026).The risk of POP of vaginal trial-birth transfer to cesarean section was higher than that of elective cesarean section[42.4%(36/85)vs 28.1%(73/260),P=0.014].However,the further analysis of Spearman correlation between cervical dilatation,elective cesarean section and POP,as well as the receiver operating characteristic curve showed that the correlation and prediction value were poor.Conclusion Elective cesarean section has a certain protective effect on postpartum prolapse,but the protective effect of vaginal trial-birth transfer to cesarean section on pelvic floor is weakened.
作者
王青
于晓杰
杨欣
孙秀丽
王建六
Wang Qing;Yu Xiaojie;Yang Xin;Sun Xiuli;Wang Jianliu(Department of Obstetrics and Gynecology,the Key Laboratory of Female Pelvic Floor Disorders of Beijing,Peking University People's Hospital,Beijing 100044,China)
出处
《中华妇产科杂志》
CAS
CSCD
北大核心
2019年第11期751-755,共5页
Chinese Journal of Obstetrics and Gynecology
基金
国家重点研发计划(2018YFC2002204)
北京市科学技术委员会重大课题(D151100001915003)。
关键词
盆腔器官脱垂
剖宫产术
分娩
时间
Pelvic organ prolapse
Cesarean section
Parturition
Time
作者简介
通信作者:孙秀丽,Email:sunxiuli03351@126.com。
