Analysis Of Risk Factors Of Postpartum Pelvic Organ Prolapse

Pelvic Organ Prolapse(POP)is a result of pelvic floor muscle and fascia weakness leading to pelvic organ displacement leading to changes in organ location and function.Clinically,mainly divided into vaginal anterior(posterior)wall prolapse and uterine prolapse.ObjectiveThrough 6~8 weeks postpartum pelvic floor prolapse detection and Pelvic Organ Prolapse Quantitation(POP-Q)evaluation,combined with relevant information about patients with postpartum pelvic floor function self recovery,analysis of early postpartum POP and the related risk factors,and provide standard for pregnant women's perioperative confining care,clinical the basis for the early treatment of postpartum POP.Materials and methodsDuring the period of January 2015 to December 2016,6000 parturients were delivered at the Third Affiliated Hospital of Zhengzhou University and in our hospital after postpartum review.The muscle strength,fatigue and pelvic floor dynamic pressure of pelvic floor deep and shallow muscle(including class I muscle fiber and type II muscle fiber)were measured by PHENIXU8 low frequency neuromuscular stimulation instrument.The prolapse and classification were evaluated by Pelvic Organ Prolapse Quantitation(POP-Q)score by professional gynecologists and obstetricians.Check and record the maternal hospitalization information,including mode of delivery,age,prepregnancy BMI(Body Mass Index),gestational age,parity,neonatal weight,pregnancy complications(diabetes,hypertension,hypothyroidism),Streptococcus B(Group B Streptococcus,GBS)infection and weight gain during pregnancy,get effective data of 4045 cases.SPSS 21 statistical software package was used to analyze the data.The counting data are checked by chi square test with the rate or percentage.The measurement data using t test,it is represented by x±S.Multivariate analysis included binary variable logistic regression in variables with univariate analysis.Then calculate relative risk(OR)and 95% confidence interval(95% CI).The difference in P < 0.05 was statistically significant.Result1 A total of 4045 cases were studied.The prevalence of anterior vaginal wall was 83.2%(3368/4045).The posterior vaginal wall bulge rate was 54.5%(2205/4045).Uterine prolapse rate was 37.1%(1501/4045).2 Single factor analysis shows2.1 Age,weight of the newborn,mode of delivery,pregnancy weeks,hypertension,type I muscle fiber fatigue,type I muscle fibers and muscle fibers of class II were related to the early vaginal prolapse of the vagina after the postpartum period.2.2 Age,times of birth,birth weight,mode of delivery,gestational weeks,hypertension,type I muscle fiber and class II muscle fiber fatigue,type I muscle fiber and muscle fiber strength of class II muscle,dynamic pressure of pelvic floor,and postpartum vaginal posterior wall swelling related to postpartum.2.3 BMI before pregnancy,mode of delivery,diabetes,type I muscle fiber and class II muscle fiber fatigue,type I muscle fibers and muscle fibers of class II muscle,dynamic pressure of pelvic floor were related to early postpartum prolapse of uterus.3 Multiple factor analysis show3.1 Compared with women aged less than 30 years old,the risk of postpartum vaginal prolapse at 30~40 and 40 years old was significantly increased,and OR was 1.346(95%CI 1.110 ~ 1.631)and 13.930(95%CI 3.244 ~ 59.809).Compared with those of newborns whose weight was less than 2500 g,the rate of bulging of the anterior wall of the vagina was increased from 2500 to 4000 g and over 4000 g,and the OR values were 2.003(95%CI 1.482 ~ 2.707)and 2.363(95%CI 1.467 to 3.807)respectively.The risk of vaginal anterior wall prolapse is 6.333 times that of cesarean section(95%CI 5.214 to 7.693).Type I muscle fiber fatigue and Type II muscle fiber muscle strength increased the risk of bulging of the anterior vaginal wall.The OR values were 2.396(95% CI 1.997-2.876)and 3.991(95% CI 2.640-6.036).3.2 When the posterior vaginal wall prolapse as the dependent variable,Compared with women aged less than 30 years old,the risk of postpartum vaginal wall swelling at 30~40 and 40 years old was increased,and the OR values were 1.382(95%CI 1.167 ~ 1.635)and 4.365(95%CI 2.283 ~ 8.344).Compared with the number of births of 1,the bulge rate of the posterior wall of the vagina was significantly increased when the number of births was 2 and the number of births was 3 or more,the OR values were OR 1.926(95%CI 1.608-2.307)and OR 4.895(95%CI 3.090-7.754).Compared with maternal weight less than 2500 g,neonatal weight 2500 g ~ 4000 g,more than 4000 g of anterior vaginal wall prolapse rate were increased,the OR values were 1.636(95% CI 1.236 ~ 2.165)and 1.770(95% CI 1.168 ~ 2.684).The postpartum vaginal delivery risk of postpartum vaginal delivery is 6.504 times that of cesarean section(95%CI 5.523 ~ 7.658).Type I muscle fiber fatigue and type II muscle fiber muscle strength increased the prolapse rate of the posterior vaginal wall,and the OR values were 2.316(95%CI 1.994 to 2.688)and 1.916(95%CI 1.250 to 2.938).3.3 When the prolapse of the uterus prolapsed as a dependent variable,the risk of uterine prolapse after maternal vaginal delivery is 1.858 times higher than that of cesarean section(95% CI 1.615-2.138).Type I muscle fiber fatigue,type II muscle fiber strength and abnormal pelvic dynamic pressure increase uterine prolapse,and the OR values were 1.275(95% CI 1.106 to 1.470),2.439(95% CI 1.487 to 4.001)and 1.694(95% CI 1.351 to 2.124).4.There was no significant difference in maternal B group streptococcal infection and postpartum vaginal anterior wall bulging,posterior vaginal bulging,and uterine prolapse(P>0.05).Conclusion1.The incidence of POP was high in the early postpartum period,and the prolapse of the anterior vaginal wall is more common.2.The independent risk factors for POP in postpartum women were age,mode of delivery,parity,neonatal weight,type I muscle fiber fatigue,type II muscle fiber strength,and pelvic dynamic pressure value.Among them,spontaneous labor,age over 40 years,childbirth more than 3 times,type II muscle fiber muscle strength abnormalities significantly increased the risk of POP.