不同分娩方式对孕前高BMI患者产后盆底功能的影响  

Effect of Different Delivery Modes on Postpartum Pelvic Floor Function in Patients with High BMI before Pregnancy

作　　者：谷茂红[1] 徐友娣[1] 严檬洁 GU Maohong;XU Youdi;YAN Mengjie(Department of Obstetrics,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,China)

机构地区：[1]南京医科大学附属南京医院南京市第一医院产科,南京210006

出　　处：《医学综述》2020年第14期2910-2912,F0003,共4页Medical Recapitulate

基　　金：江苏省妇幼健康科研项目(F-201661)。

摘　　要：目的探讨不同分娩方式对孕前高体质指数(BMI)患者产后盆底功能的影响。方法回顾性分析2015年6月至2017年3月在南京医科大学附属南京医院产科就诊的141例孕前高BMI产妇的临床资料,根据不同分娩方式分为阴道分娩组(72例)和剖宫产组(69例),比较两组妊娠期并发症(妊娠期糖尿病、妊娠期高血压)、分娩并发症发生率以及产后生活质量评分。结果两组妊娠期糖尿病和妊娠期高血压发生率比较差异无统计学意义(P>0.05)。阴道分娩组产后出血、压力性尿失禁、Ⅰ度以上子宫脱垂的发生率高于剖宫产组[6.94%(5/72)比0%(0/69)、26.39%(19/72)比2.89%(2/69)、22.22%(16/72)比1.45%(1/69)](P<0.05),而巨大儿和新生儿窒息的发生率低于剖宫产组[1.39%(1/72)比11.59%(8/69)、0%(0/72)比7.24%(5/69)](P<0.05);阴道分娩组盆底功能障碍量问卷简表-20评分显著高于剖宫产组[(13.7±2.4)分比(8.2±1.6)分],但性生活质量量表-12评分显著低于剖宫产组[(51.3±7.8)分比(81.1±9.4)分](P<0.05)。结论对于孕前高BMI患者,剖宫产较阴道分娩对盆底功能的保护作用更强,但阴道分娩有助于胎儿肺成熟,并可减少新生儿窒息的发生,故应根据产妇个体差异谨慎选择分娩方式。Objective To explore the effect of different delivery methods on postpartum pelvic floor function of patients with high body mass index(BMI)before pregnancy.Methods The clinical data of 141 pregnant women with high BMI before pregnancy in Department of Obstetrics,Nanjing Hospital Affiliated to Nanjing Medical University from Jun.2015 to Mar.2017 were retrospectively analyzed.According to the delivery method,they were divided into a vaginal delivery group(72 cases)and a cesarean section group(69 cases).The incidence of pregnancy complications(gestational diabetes mellitus,gestational hypertension),the incidence of delivery complications and the quality of life after delivery were compared between the two groups.Results There was no significant difference in the incidence of gestational diabetes mellitus,gestational hypertension between the two groups(P>0.05).The incidences of postpartum hemorrhage,stress urinary incontinence and uterine prolapse above degreeⅠin the vaginal delivery group were significantly higher than those in the cesarean section group[6.94%(5/72)vs 0%(0/69),26.39%(19/72)vs 2.89%(2/69),22.22%(16/72)vs 1.45%(1/69)](P<0.05),the incidences of macrosomia and neonatal asphyxia in the vaginal delivery group were significantly lower than those in the cesarean section group[1.39%(1/72)vs 11.59%(8/69),0%(0/72)vs 7.24%(5/69)](P<0.05).The Pelvic Floor Distress Inventory-20 score of the vaginal delivery group was significantly higher than that of the cesarean section group(13.7±2.4 vs 8.2±1.6),but the Sexual Life Quality Questionnaire-12 score was significantly lower than that of the Cesarean section group(51.3±7.8 vs 81.1±9.4)(P<0.05).Conclusion For the patients with high BMI before pregnancy,Cesarean section has a stronger protective effect on pelvic floor function than vaginal delivery,but vaginal delivery is helpful to the mature of the fetal lung and reduce the incidence of neonatal asphyxia.Therefore,the delivery mode should be carefully selected according to individual differences.

关 键 词：妊娠 孕前体质指数 分娩方式 盆底功能障碍 

分 类 号：R714[医药卫生—妇产科学]