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Abstract:
BACKGROUND:Pelvic floor disorders (including urinary and anal incontinence and pelvic organ prolapse) are associated with childbirth. Injury to the pelvic floor muscles during vaginal childbirth, such as avulsion of the levator ani muscle, is associated with weaker pelvic floor muscle strength. As weak pelvic floor muscle strength may be a modifiable risk factor for the later development of pelvic floor disorders, it is important to understand how pelvic floor muscle strength affects the course of pelvic floor disorders over time. OBJECTIVE:To investigate the association between pelvic floor muscle strength and the incidence of pelvic floor disorders, and to identify maternal and obstetrical characteristics that modify the association. MATERIALS AND METHODS:This is a longitudinal study investigating pelvic floor disorders after childbirth. Participants were recruited 5-10 years after their first delivery and were assessed for pelvic floor disorders annually for up to 9 years. Stress incontinence, overactive bladder, and anal incontinence were assessed at each annual visit using the Epidemiology of Prolapse and Incontinence Questionnaire. Pelvic organ prolapse was assessed on physical examination, and was defined as descent of the vaginal walls or cervix beyond the hymen during forceful Valsalva. The primary exposure of interest was pelvic floor muscle strength, defined as the peak pressure during a voluntary pelvic muscle contraction (measured with a perineometer). The relationship between pelvic floor muscle strength and the cumulative incidence (time to event) of each pelvic floor disorder was evaluated using lognormal models, stratified by vaginal vs cesarean delivery. The relative hazard for each pelvic floor disorder (among those women free of the disorder at enrollment and thus more than 5-10 years from first delivery), was estimated using semiparametric proportional hazard models as a function of delivery mode, pelvic floor muscle strength, and other covariates. RESULTS:Of 1143 participants, the median age was 40 (interquartile range, 36.6-43.7) years, and 73% were multiparous. On perineometry, women with at least 1 vaginal delivery were more likely to have a low peak pressure, defined as <20 cm H2O (243 of 588 women with at least 1 vaginal delivery vs 107 of 555 women who delivered all of their children by cesarean delivery, P < .001). Among women who had at least 1 vaginal delivery, a pelvic floor muscle strength of <20 cm H2O was associated with a shorter time to event for stress incontinence (time ratio, 0.67; 95% confidence interval, 0.50e0.90), overactive bladder (time ratio, 0.67; 95% confidence interval, 0.51e0.86), and pelvic organ prolapse (time ratio, 0.76; 95% confidence interval, 0.65e0.88). No such association was found among women who delivered all of their children by cesarean delivery. Among women with at least 1 vaginal delivery and considering only pelvic floor disorders that developed during study observation (5e10 years after the first delivery), and controlling for maternal characteristics (body mass index and genital hiatus), women who had a peak pressure of <20 cm H2O had hazard ratios (relative to 20 cm H2O) of 1.16 (95% confidence interval, 0.74e1.81) for stress incontinence, 1.27 (95% confidence interval, 0.78e2.05) for overactive bladder, and 1.43 (95% confidence interval, 0.99e2.07) for pelvic organ prolapse. Among women who delivered all of their children by cesarean delivery, there was no association between muscle strength and relative hazard of pelvic floor disorders when controlling for maternal characteristics. CONCLUSION: After vaginal delivery, but not cesarean delivery, the cumulative incidence of pelvic organ prolapse, stress incontinence, and overactive bladder is associated with pelvic muscle strength, but the associations attenuate when adjusting for genital hiatus and body mass index.
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最新影响因子:10.693 | 期刊ISSN:0002-9378 | CiteScore:3.5 |
出版周期:Monthly | 是否OA:YES | 出版年份:1920 |
期刊官方网址:http://www.ajog.org/
自引率:11.90% | 研究方向:医学-妇产科学 |
出版地区:UNITED STATES |
SCI期刊coverage:Science Citation Index Expanded(科学引文索引扩展)
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The American Journal of Obstetrics and Gynecology, “The Gray Journal”, covers the full spectrum of Obstetrics and Gynecology. The aim of the Journal is to publish original research (clinical and translational), reviews, opinions, video clips, podcasts and interviews that will have an impact on the understanding of health and disease and that has the potential to change the practice of women's health care. An important focus is the diagnosis, treatment, prediction and prevention of obstetrical and gynecological disorders. The Journal also publishes work on the biology of reproduction, and content which provides insight into the physiology and mechanisms of obstetrical and gynecological diseases.
美国妇产科杂志,“灰色杂志”,涵盖了妇产科的所有领域。该杂志的目的是发表原创研究(临床和翻译)、评论、意见、视频剪辑、播客和访谈,这些将对健康和疾病的理解产生影响,并有可能改变妇女保健的做法。妇产科疾病的诊断、治疗、预测和预防是一个重要的研究重点。该杂志还出版了生殖生物学方面的著作,内容涉及妇产科疾病的生理学和机制。 好处的作者
大类(学科) | 小类(学科) | 学科排名 |
医学 |
OBSTETRICS & GYNECOLOGY (妇产科学) 1区 |
2/82 |
年度总发文量 | 年度论文发表量 | 年度综述发表量 |
343 | 310 | 33 |
引文计数(2018)
文献(2015-2017)
6254次引用
1788篇文献
序号 | 类别 | 排名 | 百分位 |
1 |
大类(学科):Medicine
小类(学科):Obstetrics and Gynecology
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研究方向:妇产科
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研究方向:妇产科
审稿时间: 2个月内
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研究方向:妇科肿瘤
审稿时间: 2个月内 接受率: 比较困难(25%命中)
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研究方向:临床 流行病学 妇科学
审稿时间: 2个月内 接受率: 比较困难(25%命中)
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研究方向:妇产科
审稿时间: 2个月内 接受率: 比较困难(25%命中)
影响因子:2.473
ISSN:1362-4393
研究方向:医学-临床神经学
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研究方向:CLINICAL NEUROLOGY-PEDIATRICS
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研究方向:医学-康复医学
影响因子:4.895
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研究方向:医学-康复医学
影响因子:4.655
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研究方向:CLINICAL NEUROLOGY-REHABILITATION
影响因子:1.452
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研究方向:PEDIATRICS-REHABILITATION
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研究方向:PEDIATRICS-REHABILITATION
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