The Effect of Pregnancy Interval on Pelvic Floor Dysfunction and the Establishment of Risk Prediction Model

doi:10.12280/gjszjk.20230104

Abstract

Abstract:

Objective: To explore the effect of gestational interval time on postpartum pelvic floor dysfunction (PFD) of multiparas, and to establish a prediction model for PFD of multiparas to guide the clinical screening. Methods: A total of 636 cases of multiparas from October 2021 to October 2022 were retrospectively analyzed. These cases were divided into the PFD group (n=244) and the non-PFD group (n=392) according to whether PFD occurred after delivery. A total of 471 multiparas from January 2021 to September 2021 were selected as the validation set. The predictive power of postpartum PFD was analyzed by receiver operator characteristic (ROC) curve. Univariate and Logistic multivariate analysis were used to analyze the influencing factors of PFD. The PFD risk prediction model was established and the effectiveness of centralized analysis was tested. Results: The incidence of PFD was 38.36% (244/636). The optimal cut-off was 23.5 months. The independent influencing factors of PFD in multiparas were the age ≥35 years (OR=9.262, 95%CI: 2.103-40.749), family history of PFD (OR=6.297, 95%CI: 1.538-25.789), gestational interval ≤23.5 months (OR=78.971, 95%CI: 19.283-323.414), vaginal delivery of the current pregnancy (OR=5.483, 95%CI: 1.420-21.170), and neonatal weight ≥4 kg (OR=4.357, 95%CI: 1.243-15.277). Risk prediction model was F=-18.718+9.262×age (≥35 years=1, <35 years=0)+6.297×family history of PFD (yes=1, no=0)+gestational interval (≤23.5 months=1, >23.5 months=0)+5.483×vaginal delivery of this pregnancy (yes=1, no=0)+4.357×newborn weight (≥4 kg=1, <4 kg=0). The area under the curve (AUC) of ROC of risk model was 0.878 (95%CI: 0.852-0.966), the sensitivity was 0.892, and the specificity was 0.820. Conclusions: Multiparas with gestational interval ≤23.5 months should be alert to the postpartum PFD, and the risk prediction model of PFD is helpful for the PFD screening in multiparas.

Key words: Parturition, Pelvic floor disorders, Urinary incontinence, stress, Pelvic organ prolapse, Regression analysis, Forecasting, Menstruation

CHEN Jing, LI Jia-yi, ZHANG Lan. The Effect of Pregnancy Interval on Pelvic Floor Dysfunction and the Establishment of Risk Prediction Model[J]. Journal of International Reproductive Health/Family Planning, 2023, 42(4): 282-286.

Figures/Tables 4

References 24

[1]	Schütze S, Heinloth M, Uhde M, et al. The effect of pelvic floor muscle training on pelvic floor function and sexuality postpartum. A randomized study including 300 primiparous[J]. Arch Gynecol Obstet, 2022, 306(3):785-793. doi: 10.1007/s00404-022-06542-z. doi: 10.1007/s00404-022-06542-z pmid: 35377043
[2]	裘轶超. 产妇盆底功能障碍列线图预测模型的构建[J]. 中国妇幼健康研究, 2021, 32(5):724-729. doi: 10.3969/j.issn.1673-5293.2021.05.022. doi: 10.3969/j.issn.1673-5293.2021.05.022
[3]	林忠, 朱雪红. 妊娠和分娩对盆底功能的影响及治疗的研究进展[J]. 中国计划生育和妇产科, 2023, 15(1):15-18. doi: 10.3969/j.issn.1674-4020.2023.01.05. doi: 10.3969/j.issn.1674-4020.2023.01.05
[4]	朱丽娟, 江华, 朱开欣. 南京市产妇盆底功能障碍性疾病的流行病学研究[J]. 中国妇幼保健, 2020, 35(19):3544-3546. doi: 10.19829/j.zgfybj.issn.1001-4411.2020.19.007. doi: 10.19829/j.zgfybj.issn.1001-4411.2020.19.007
[5]	Shen L, Yang J, Bai X, et al. Analysis of the current status of pelvic floor dysfunction in urban women in Xi′an City[J]. Ann Palliat Med, 2020, 9(3):979-984. doi: 10.21037/apm-20-784. doi: 10.21037/apm-20-784 URL
[6]	Egorov V, Lucente V, VAN Raalte H, et al. Biomechanical mapping of the female pelvic floor: changes with age, parity and weight[J]. Pelviperineology, 2019, 38(1):3-11. pmid: 31341548
[7]	中华医学会妇产科学分会妇科盆底学组. 女性压力性尿失禁诊断和治疗指南(2017)[J]. 中华妇产科杂志, 2017, 52(5):289-293. doi: 10.3760/cma.j.issn.0529-567x.2017.05.001. doi: 10.3760/cma.j.issn.0529-567x.2017.05.001
[8]	周惠玲, 汤佩玲, 杨存珍, 等. 轻、中度盆腔器官脱垂的超声诊断与临床定量分期相关性研究[J]. 中国实用妇科与产科杂志, 2017, 33(10):1062-1065. doi: 10.19538/j.fk2017100118. doi: 10.19538/j.fk2017100118
[9]	Rieger M, Duran P, Cook M, et al. Quantifying the Effects of Aging on Morphological and Cellular Properties of Human Female Pelvic Floor Muscles[J]. Ann Biomed Eng, 2021, 49(8):1836-1847. doi: 10.1007/s10439-021-02748-5. doi: 10.1007/s10439-021-02748-5 pmid: 33683527
[10]	Urbankova I, Callewaert G, Blacher S, et al. First delivery and ovariectomy affect biomechanical and structural properties of the vagina in the ovine model[J]. Int Urogynecol J, 2019, 30(3):455-464. doi: 10.1007/s00192-017-3535-9. doi: 10.1007/s00192-017-3535-9 pmid: 29313089
[11]	Marschalek ML, Bodner K, Kimberger O, et al. Sexual Function in Postmenopausal Women with Symptomatic Pelvic Organ Prolapse Treated Either with Locally Applied Estrogen or Placebo: Results of a Double-Masked, Placebo-Controlled, Multicenter Trial[J]. J Sex Med, 2022, 19(7):1124-1130. doi: 10.1016/j.jsxm.2022.04.007. doi: 10.1016/j.jsxm.2022.04.007 URL
[12]	Kasyan G, Vishnevskiy D, Akulenko L, et al. Collagen type 3A1 and 1A1 polymorphisms in women with pelvic organ prolapse and urinary incontinence assessed with Sanger sequencing method[J]. Cent European J Urol, 2021, 74(4):566-570. doi: 10.5173/ceju.2021.0200. doi: 10.5173/ceju.2021.0200 pmid: 35083078
[13]	Hage-Fransen M, Wiezer M, Otto A, et al. Pregnancy- and obstetric-related risk factors for urinary incontinence, fecal incontinence, or pelvic organ prolapse later in life: A systematic review and meta-analysis[J]. Acta Obstet Gynecol Scand, 2021, 100(3):373-382. doi: 10.1111/aogs.14027. doi: 10.1111/aogs.14027 URL
[14]	程贤鹦, 孙志强. 多次生育产妇产后盆底功能研究现状及三孩政策下防治管理策略探讨[J]. 中国优生与遗传杂志, 2022, 30(11):2082-2084.
[15]	陈敏枝, 刘丹, 许正先, 等. 经产妇和初产妇盆底功能比较及盆底功能障碍发生的危险因素分析[J]. 中国医刊, 2020, 55(11):1254-1257. doi: 10.3969/j.issn.1008-1070.2020.11.028. doi: 10.3969/j.issn.1008-1070.2020.11.028
[16]	王晓晔, 钟若忻, 王妍, 等. 经产妇产后早期压力性尿失禁的临床危险因素分析[J]. 中国妇产科临床杂志, 2019, 20(1):25-27. doi: 10.13390/j.issn.1672-1861.2019.01.009. doi: 10.13390/j.issn.1672-1861.2019.01.009
[17]	李旻, 石婧, 吕秋波, 等. 再生产妇产后早期盆底肌力受损的多因素分析[J]. 中华医学杂志, 2018, 98(11):818-822. doi: 10.3760/cma.j.issn.0376-2491.2018.11.005. doi: 10.3760/cma.j.issn.0376-2491.2018.11.005
[18]	Reimers C, Siafarikas F, Stær-Jensen J, et al. Risk factors for anatomic pelvic organ prolapse at 6 weeks postpartum: a prospective observational study[J]. Int Urogynecol J, 2019, 30(3):477-482. doi: 10.1007/s00192-018-3650-2. doi: 10.1007/s00192-018-3650-2
[19]	李晓慧, 喻琴艳, 韩建梅. 二次妊娠产妇盆底肌再次损伤的高危因素分析[J]. 中国妇幼保健, 2019, 34(22):5163-5166. doi: 10.7620/zgfybj.j.issn.1001-4411.2019.22.28. doi: 10.7620/zgfybj.j.issn.1001-4411.2019.22.28
[20]	Hwang JY, Kim BI, Song SH. Parity: a risk factor for decreased pelvic floor muscle strength and endurance in middle-aged women[J]. Int Urogynecol J, 2019, 30(6):933-938. doi: 10.1007/s00192-019-03913-0. doi: 10.1007/s00192-019-03913-0 pmid: 30868194
[21]	Halle TK, Staer-Jensen J, Hilde G, et al. Change in prevalence of major levator ani muscle defects from 6 weeks to 1 year postpartum, and maternal and obstetric risk factors: A longitudinal ultrasound study[J]. Acta Obstet Gynecol Scand, 2020, 99(10):1403-1410. doi: 10.1111/aogs.13878. doi: 10.1111/aogs.13878 URL
[22]	Xuan R, Yang M, Gao Y, et al. A Simulation Analysis of Maternal Pelvic Floor Muscle[J]. Int J Environ Res Public Health, 2021, 18(20):10821. doi: 10.3390/ijerph182010821. doi: 10.3390/ijerph182010821 URL
[23]	Chen Y, Geng X, Zhou H, et al. Systematic review and meta-analysis of evaluation of selective cesarean section in postpartum pelvic floor function recovery under perineal ultrasound[J]. Ann Palliat Med, 2022, 11(2):730-742. doi: 10.21037/apm-22-46. doi: 10.21037/apm-22-46 pmid: 35249350
[24]	杨明丽, 王青, 于晓杰, 等. 5143例产后早期妇女的盆底功能状况及其影响因素分析[J]. 中华妇产科杂志, 2019, 54(8):522-526. doi: 10.3760/cma.j.issn.0529-567x.2019.08.004. doi: 10.3760/cma.j.issn.0529-567x.2019.08.004

变量	PFD组（n=244）	非PFD组（n=392）	χ²	P	变量	PFD组（n=244）	非PFD组（n=392）	χ²	P
年龄			17.892	<0.001	妊娠间隔时间			95.896	<0.001
≥35岁	132	84			≤23.5个月	216	40
<35岁	112	308			>23.5个月	28	352
BMI			0.712	0.396	孕周			0.317	0.573
≥24 kg/m²	88	168			≤37周	32	40
<24 kg/m²	156	224			>37周	212	352
吸烟			0.006	0.940	本次分娩方式			14.332	<0.001
是	24	40			阴道分娩	132	96
否	220	352			剖宫产	112	296
饮酒			0.398	0.528	分娩镇痛			1.472	0.225
是	44	56			是	184	260
否	200	336			否	60	132
流产史			0.556	0.456	胎膜早破			1.473	0.225
是	36	76			是	56	60
否	208	316			否	188	332
PFD家族史			28.621	<0.001	胎位			0.139	0.709
是	132	56			LOA	228	360
否	112	336			非LOA	16	32
高血压			0.078	0.781	新生儿体质量			12.069	0.001
是	44	64			≥4 kg	140	116
否	200	328			<4 kg	104	276
糖尿病			4.312	0.038	哺乳			0.470	0.493
是	92	88			是	184	276
否	152	304			否	60	116
既往分娩方式			8.630	0.003
阴道分娩	140	132
剖宫产	104	260

变量	PFD组（n=244）	非PFD组（n=392）	χ²	P	变量	PFD组（n=244）	非PFD组（n=392）	χ²	P
年龄			17.892	<0.001	妊娠间隔时间			95.896	<0.001
≥35岁	132	84			≤23.5个月	216	40
<35岁	112	308			>23.5个月	28	352
BMI			0.712	0.396	孕周			0.317	0.573
≥24 kg/m²	88	168			≤37周	32	40
<24 kg/m²	156	224			>37周	212	352
吸烟			0.006	0.940	本次分娩方式			14.332	<0.001
是	24	40			阴道分娩	132	96
否	220	352			剖宫产	112	296
饮酒			0.398	0.528	分娩镇痛			1.472	0.225
是	44	56			是	184	260
否	200	336			否	60	132
流产史			0.556	0.456	胎膜早破			1.473	0.225
是	36	76			是	56	60
否	208	316			否	188	332
PFD家族史			28.621	<0.001	胎位			0.139	0.709
是	132	56			LOA	228	360
否	112	336			非LOA	16	32
高血压			0.078	0.781	新生儿体质量			12.069	0.001
是	44	64			≥4 kg	140	116
否	200	328			<4 kg	104	276
糖尿病			4.312	0.038	哺乳			0.470	0.493
是	92	88			是	184	276
否	152	304			否	60	116
既往分娩方式			8.630	0.003
阴道分娩	140	132
剖宫产	104	260

变量	赋值	β	SE	Wald χ²	OR	95%CI	P
年龄	≥35岁=1、<35岁=0	2.226	0.756	8.659	9.262	2.103~40.749	0.003
PFD家族史	是=1、否=0	1.840	0.719	6.543	6.297	1.538~25.789	0.011
糖尿病	是=1、否=0	0.064	0.710	0.008	1.066	0.265~4.284	0.928
既往阴道分娩	是=1、否=0	0.498	0.636	0.614	1.646	0.473~5.726	0.433
妊娠间隔时间	≤23.5个月=1、>23.5个月=0	4.369	0.719	36.892	78.971	19.283~323.414	<0.001
本次妊娠阴道分娩	是=1、否=0	1.702	0.689	6.094	5.483	1.420~21.170	0.014
新生儿体质量	≥4 kg=1、<4 kg=0	1.472	0.640	5.286	4.357	1.243~15.277	0.021

变量	赋值	β	SE	Wald χ²	OR	95%CI	P
年龄	≥35岁=1、<35岁=0	2.226	0.756	8.659	9.262	2.103~40.749	0.003
PFD家族史	是=1、否=0	1.840	0.719	6.543	6.297	1.538~25.789	0.011
糖尿病	是=1、否=0	0.064	0.710	0.008	1.066	0.265~4.284	0.928
既往阴道分娩	是=1、否=0	0.498	0.636	0.614	1.646	0.473~5.726	0.433
妊娠间隔时间	≤23.5个月=1、>23.5个月=0	4.369	0.719	36.892	78.971	19.283~323.414	<0.001
本次妊娠阴道分娩	是=1、否=0	1.702	0.689	6.094	5.483	1.420~21.170	0.014
新生儿体质量	≥4 kg=1、<4 kg=0	1.472	0.640	5.286	4.357	1.243~15.277	0.021