■肛门失禁(AI)是一种普遍的产后疾病。这项研究旨在调查和量化中国人群在阴道分娩后第一年发生AI的危险因素。
■病例对照研究在北京大学第三医院进行,包括2014年1月1日至2018年6月30日期间阴道分娩的所有女性。参与者在分娩后1年进行电话采访。使用Jorge和Wexner的回顾性评分高于0,AI被定义为肛门或粪便的无意识损失。从病历系统检索临床数据。应用单变量和多变量分析来识别导致AI的潜在风险因素。基于Logistic回归模型,构建列线图以预测产后AI的概率.限制性三次样条用于探索出生体重与产后AI之间的潜在非线性关系。
■在140个AI和421个无AI病例中,我们观察到产前因素,如每100克出生体重增加(OR1.39,95%CI1.30-1.49),而产钳辅助阴道分娩等产时因素(OR7.11,95%CI2.60-19.45),会阴中线切开术(OR13.11,95%CI1.71-100.89),会阴二度撕裂(OR6.51,95%CI1.16-36.68),三度至四度会阴撕裂是产后AI的独立危险因素。重要的是,出生时体重超过3,400g的婴儿增加了产后AI的风险.基于Logistic回归模型,我们构建了一个列线图来估计阴道分娩后1年AI的风险.
■我们的研究结果表明,在阴道分娩后的第一年,出生体重在3400克或以上的婴儿,产钳辅助阴道分娩,会阴中线切开术,会阴二度至四度撕裂会增加患人工智能的风险。因此,必须限制产钳和会阴中线切开术的常规使用,并在产前护理期间监测胎儿体重。
UNASSIGNED: Anal incontinence (AI) is a prevalent postpartum disorder. This study aims to investigate and quantify the risk factors for AI in the Chinese population during the first year following vaginal delivery.
UNASSIGNED: The
case control study was conducted at Peking University Third Hospital, including all women who delivered vaginally between January 1, 2014, and June 30, 2018. Participants were followed up by telephone interviews 1 year after delivery. AI was defined as the involuntary loss of flatus or feces using a retrospective Jorge and Wexner score above 0. Clinical data were retrieved from the medical record system. Univariate and multivariate analyses were applied to identify potential risk factors accounting for AI. Based on the logistic regression model, a nomogram was constructed to predict the probability of AI postpartum. Restricted cubic spline was utilized to explore potential non-linear relationships between birth weight and AI postpartum.
UNASSIGNED: Among the 140 AI and 421 none AI cases, we observed antepartum factors like every 100 g of birth weight gain (OR 1.39, 95% CI 1.30-1.49), while intrapartum factors like forceps-assisted vaginal delivery (OR 7.11, 95% CI 2.60-19.45), midline episiotomy (OR 13.11, 95% CI 1.71-100.89), second-degree perineal tear (OR 6.51, 95% CI 1.16-36.68), and third to fourth-degree perineal tear were independent risk factors for postpartum AI. Significantly, infant weighing over 3,400 g at birth increased the risk of AI postpartum. Based on logistic regression model, we constructed a nomogram to estimate the risk of AI 1 year after vaginal delivery.
UNASSIGNED: Our findings indicated that during the first year following vaginal delivery, infant with birth weight of 3,400 g or more, forceps-assisted vaginal delivery, midline episiotomy, and second to fourth-degree perineal tear increased the risk of AI. As a result, it is essential to limit the routine use of forceps and midline episiotomy and to monitor fetal weight during prenatal care.