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Pregnancy- and obstetric-related risk factors for urinary incontinence, fecal incontinence, or pelvic organ prolapse later in life: A systematic review and meta-analysis.

妊娠和产科相关的尿失禁,大便失禁或盆腔器官脱垂的危险因素: 系统综述和荟萃分析。

  • 影响因子:2.21
  • DOI:10.1111/aogs.14027
  • 作者列表:"Hage-Fransen MAH","Wiezer M","Otto A","Wieffer-Platvoet MS","Slotman MH","Nijhuis-van der Sanden MWG","Pool-Goudzwaard AL
  • 发表时间:2021-03-01
Abstract

INTRODUCTION:Risk factors for pelvic floor disorders are often related to pregnancy and delivery. Consistent evidence is needed to develop prevention strategies targeting risk factors. The objective of this study is to identify which pregnancy- and/or obstetric-related risk factors can predict urinary incontinence, fecal incontinence, or pelvic organ prolapse later in life by means of a systematic review and meta-analysis. MATERIAL AND METHODS:Systematic review Prospero number: CRD42019131758. Literature searches of PubMed, EMBASE, CINAHL, and Cochrane Library were conducted according to PRISMA guidelines (April 2020). Prospective cohort studies describing more than two pregnancy- and/or obstetric-related risk factors on urinary incontinence, fecal incontinence (including flatal incontinence), or pelvic organ prolapse were eligible. Risk of bias was assessed (using Quality In Prognosis Studies [QUIPS]). Studies with high risk of bias were excluded. Data were extracted and checked for accuracy with the CHARMS checklist. Sub-groups were used to distinguish between a short- and long-term follow-up period: <18 months (shortterm) and >18 months (long-term) postpartum. Odds ratios were calculated from reported prevalence rates. Log odds ratios were calculated using SPSS v.24. Variables were pooled using RevMan5. RESULTS:Data were extracted from nineteen studies for urinary incontinence, nine for fecal incontinence, and two for pelvic organ prolapse. Multivariate analysis was not possible because of the heterogeneity of the population and outcome measures. Pooled univariate risk factors for urinary incontinence were: urinary incontinence during pregnancy, instrumental vaginal delivery, episiotomy, tears, and constipation. Pooled univariate risk factors for fecal incontinence were: fecal incontinence during pregnancy, maternal age over 35 years, prenatal body mass index over 30 kg/m2 , instrumental vaginal delivery, a spontaneous vaginal delivery, oxytocin augmentation, and when the weight of the newborn was more than 4000 g. Both studies for pelvic organ prolapse had a short-term follow-up period and cesarean section was the only risk factor that could be pooled. CONCLUSIONS:Pregnancy- and obstetric-related risk factors predicting pelvic floor disorders postpartum are multifactorial and differ between pelvic floor disorders. The strongest risk factor for incontinence later in life was incontinence during pregnancy. Better quality research with long-term follow up is needed on this topic.

摘要

引言: 盆底疾病的危险因素往往与妊娠和分娩有关。需要一致的证据来制定针对风险因素的预防策略。本研究的目的是通过系统回顾和荟萃分析,确定哪些妊娠和/或产科相关的风险因素可以预测尿失禁,大便失禁或盆腔器官脱垂。 材料和方法: 系统评价Prospero编号: crd42019131758。根据PRISMA指南 (2020年4月) 对PubMed、EMBASE、CINAHL和Cochrane Library进行文献检索。描述尿失禁、大便失禁 (包括食管裂孔性尿失禁) 或盆腔器官脱垂的两个以上妊娠和/或产科相关危险因素的前瞻性队列研究是合格的。评估偏倚风险 (使用预后研究中的质量 [QUIPS])。排除偏倚风险高的研究。提取数据并使用魅力清单检查准确性。亚组用于区分短期和长期随访期: <18个月 (短期) 和> 18个月 (长期) 产后。根据报告的患病率计算比值比。使用SPSS v.24计算对数比值比。使用revman5汇总变量。 结果: 从19项关于尿失禁的研究中提取数据,9项关于大便失禁,2项关于盆腔器官脱垂。由于人群和结果测量的异质性,多变量分析是不可能的。尿失禁的单变量危险因素汇总为: 妊娠期尿失禁,器械阴道分娩,会阴切开术,流泪和便秘。大便失禁的单变量危险因素汇总为: 妊娠期大便失禁,产妇年龄超过35岁,产前体重指数超过30千克kg/m2,器械阴道分娩,阴道自然分娩,催产素增加,当新生儿体重超过4000g时。两项关于盆腔器官脱垂的研究都有短期随访期,剖宫产是唯一可以汇总的危险因素。 结论: 妊娠和产科相关的危险因素预测产后盆底疾病是多因素的,并且盆底疾病之间存在差异。在以后的生活中尿失禁的最强风险因素是怀孕期间的尿失禁。需要对这一主题进行更高质量的长期随访研究。

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