Analysis of Pelvic Organ Prolapse and Related Factors in Primipara in Early Postpartum Period
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摘要:
目的 探讨初产妇分娩各项因素与产后早期盆腔脏器脱垂（POP）的相关性。 方法 回顾性收集2021年1月至2022年6月于云南大学附属医院分娩后42～50 d进行常规超声检查的初产妇，病例组为超声诊断为POP的产妇141例，对照组为随机选取同时期未发生POP的产妇119例，结合产妇分娩方式、胎儿体重、顺产时产程及会阴侧切等指标分析初产妇分娩各项因素与产后POP的相关性。 结果 分娩各项因素中年龄、胎儿出生体重、顺产、顺产第2产程及会阴侧切与初产妇产后早期发生POP相关（P < 0.05）。 结论 年龄、胎儿出生体重、第2产程、顺产、会阴侧切是产后早期发生POP的危险因素，为临床预测产后发生POP提供参考，在妊娠及分娩过程中进行临床干预来降低产后POP的发生率。 Abstract:Objective To investigate the correlation between delivery factors and early postpartum pelvic organ prolapse （POP） in primipara. Methods From January 2021 to June 2022, primiparas who underwent routine ultrasound examination at the Affiliated Hospital of Yunnan University were retrospectively analysed. The case group included 141 primiparas diagnosed as POP by ultrasound, and the control group included 119 primiparas without POP randomly selected during the same period. The correlation between primiparas’ delivery factors and postpartum POP was analyzed by combining the indexes of fetal weight, labor process and lateral episiotomy. Results Age, birth weight, second stage of labor, vaginal delivery and episiotomy were significantly correlated with the occurrence of POP in primiparas （P < 0.05） . Conclusion Age, birth weight, second stage of labor, vaginal delivery, episiotomy are significantly correlated with early postpartum POP. These findings provide reference significance for clinical prediction of postpartum POP, and crucial for appropriate interventions during pregnancy and delivery, so as to reduce the incidence of postpartum POP. -
Key words:
- Pelvic organ prolapse /
- Factors of childbirth /
- Correlation
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图 1 不同状态下盆腔脏器位置变化
A：静息状态；B：最大Valsalva状态；（P：耻骨，BL：膀胱，UR：尿道，UT：子宫体，CX：宫颈，R：直肠）。
Figure 1. Position changes of pelvic organs in different states
图 2 分娩各项因素t检验，绘制小提琴图
A：年龄；B：胎儿出生体重；C：顺产第2产程；D：BMI；E：BPD；F：顺产第1产程；G：顺产第3产程；H：顺产总产程；I：分娩孕周。**P ≤ 0.01，****P ≤ 0.0001。
Figure 2. T-test of various factors in labor and violin diagram
表 1 2组初产妇产后膀胱颈、宫颈外口、直肠壶腹移动度比较（
$\bar x \pm s $ ）Table 1. Comparison of postpartum movement of bladder neck，outer cervix and rectal ampulla between the two groups of primipara （
$\bar x \pm s $ ）组别 n 膀胱颈
（mm）宫颈外口
（mm）直肠壶腹
（mm）病例组 141 22.96 ± 8.86 20.72 ± 7.43 16.27 ± 9.27 对照组 119 11.41 ± 2.22 10.30 ± 2.43 5.94 ± 1.34 t 11.832 9.851 13.219 P < 0.001* < 0.001* < 0.001* *P < 0.05。 
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表 2 分娩各项因素比较[（
$\bar x \pm s $ ）/n（%）]Table 2. Comparison of various factors in childbirth [（
$\bar x \pm s $ ）/n（%）]项目 病例组 对照组 t/χ2 P 年龄（岁） 29.81 ± 3.92 28.20 ± 4.06 3.239 < 0.001* 身高（cm） 159.20 ± 4.83 159.48 ± 5.12 -0.454 0.650 体重（Kg） 69.23 ± 9.19 67.55 ± 8.62 1.518 0.130 BMI（kg/m2） 27.31 ± 3.33 26.56 ± 3.12 1.869 0.063 分娩孕周（周） 39.12 ± 1.33 38.81 ± 1.67 1.682 0.094 胎儿出生体重（g） 3184 ± 427 3038 ± 441 2.697 0.007* BPD（cm） 9.18 ± 0.41 9.14 ± 0.47 0.735 0.463 生产方式 7.189 0.007* 顺产 119（84.4） 84（70.6） 剖宫产 22（15.6） 35（29.4） 顺产会阴裂伤（有/无） 70/49（58.8/41.2） 43/41（51.2/48.8） 1.502 0.220 顺产会阴侧切（是/否） 23/96（19.3/80.7） 31/53（36.9/63.1） 7.145 0.008* 顺产总产程（min） 332 ± 133.63 362 ± 158.26 1.454 0.148 顺产第1产程（min） 286 ± 121.69 318 ± 148.54 1.675 0.096 顺产第2产程（min） 39.6 ± 38.99 28.08 ± 17.88 2.527 0.012* 顺产第3产程（min） 6.43 ± 3.57 6.87 ± 3.81 0.842 0.401 *P < 0.05。
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表 3 初产妇分娩各项因素与产后发生POP的二元Logistic回归分析
Table 3. Binary Logistic regression analysis of the factors of primiparous childbirth and the occurrence of postpartum POP
因素 β S.E. Wald P OR 95%CI 年龄 0.103 0.033 9.728 0.002* 1.109 1.039~1.183 胎儿出生体重 0.001 0.000 6.853 0.009* 1.001 1.000~1.001 会阴侧切 −0.860 0.326 6.967 0.008* 0.423 0.224~0.801 第2产程 0.013 0.005 5.757 0.016* 1.013 1.002~1.024 分娩方式 −0.813 0.307 7.0 0.008* 0.444 0.243~0.810 *P < 0.05。
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