مقایسه بی‌اختیاری استرسی ادرار چهار ماه پس از زایمان طبیعی و سزارین انتخابی

نوع مقاله: اصیل پژوهشی

نویسندگان

1 دانشیار گروه زنان و مامایی، مرکز تحقیقات زایمان، دانشکده پزشکی، دانشگاه علوم پزشکی کرمانشاه، کرمانشاه، ایران.

2 دانشیار گروه آمار زیستی و اپیدمیولوژی، دانشکده پزشکی، دانشگاه علوم پزشکی کرمانشاه، کرمانشاه، ایران.

3 استادیار گروه زنان و مامایی، دانشکده پزشکی، دانشگاه علوم پزشکی کرمانشاه، کرمانشاه، ایران.

4 متخصص اورولوژی، بیمارستان امام رضا (ع)، دانشگاه علوم پزشکی کرمانشاه، کرمانشاه، ایران.

5 دستیار قلب و عروق، بیمارستان امام علی (ع)، دانشگاه علوم پزشکی کرمانشاه، کرمانشاه، ایران.

6 پزشک عمومی، دانشگاه علوم پزشکی کرمانشاه، کرمانشاه، ایران.

7 کارشناس ارشد پرستاری، دانشکده پرستاری، دانشگاه علوم پزشکی کرمانشاه، کرمانشاه، ایران.

چکیده

مقدمه: بی‌اختیاری استرسی ادرار (SUI) یک مشکل بسیار شایع در زنان بالغ است و اتیولوژی آن چند فاکتوری است. با توجه به اختلاف نظر در مورد شیوع و علل SUI در مطالعات گذشته، مطالعه حاضر با هدف مقایسه شیوع SUI چهار ماه بعد از زایمان واژینال و سزارین انتخابی و عوامل مؤثر بر آن انجام شد.
روشکار: این مطالعه تحلیلی در سال 1389 بر روی 1520 زن نخست زا در مراکز بهداشتی درمانی شهر کرمانشاه انجام شد. افراد در دو گروه مورد بررسی قرار گرفتند. گروه اول 4 ماه قبل زایمان واژینال طبیعی داشته و گروه دوم تحت عمل سزارین انتخابی قرار گرفته بودند. برای بررسی شدت و عوامل مؤثر بر SUI از پرسشنامه سندویک و پرونده بهداشتی استفاده شد. تجزیه و تحلیل داده ها با استفاده از نرم‌ افزار آماری SPSS (نسخه 16) و آزمون کولموگروف اسمیرنوف، آزمون لون، تی مستقل، من ویتنی و کای دو انجام شد. میزان p کمتر از 05/0 معنادار در نظر گرفته شود.
یافته‌ها: شیوع بی‌اختیاری استرسی ادرار، 4 ماه بعد از زایمان در دو گروه 3% بود. شیوع آن بعد از زایمان واژینال و سزارین انتخابی به ترتیب 3/4% و 87/1% بود، که بین دو گروه تفاوت آماری معنی‌داری وجود داشت (006/0=p). SUI با سن مادر (001/0=p)، شاخص توده بدنی مادر (043/0=p)، وزن نوزاد (042/0=p) ارتباط معنی‌داری داشت، اما با دور سر نوزاد (943/0=p) و انجام اپیزیوتومی (0/1=p) ارتباط معنی‌داری نداشت. دو گروه زایمان واژینال و سزارین انتخابی از نظر بی‌اختیاری استرسی ادرار شدید اختلاف آماری معنی‌داری نداشتند (0/1=p).
نتیجه گیری: نوع زایمان، وزن نوزاد، سن و شاخص توده بدنی مادر با بی‌اختیاری استرسی ادرار در ماه چهارم بعد از زایمان ارتباط دارد، اما زایمان واژینال باعث افزایش بی‌اختیاری استرسی ادرار شدید نمی شود.

کلیدواژه‌ها


عنوان مقاله [English]

Comparison of Stress urinary incontinence four months after normal vaginal delivery and elective cesarean section

نویسندگان [English]

  • Farahnaz Keshavarzi 1
  • Anisodoleh Nankali 1
  • Taravat Fakheri 1
  • Nasrin Jalilian 1
  • Mansour Rezaie 2
  • Noushin Mohammadi 3
  • Mohammad hasan Omidvar Borna 4
  • Zeinab Souhani 5
  • Hanieh Rezaie 6
  • Ahmad Khoshay 7
1 Associate Professor, Department of Obstetrics & Gynecology, Maternity Research Center, School of Medicine, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran.
2 Associate Professor, Department of Biostatistics and Epidemiology, School of Medicine, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran.
3 Assistant Professor, Department of Obstetrics & Gynecology, Imam Reza Hospital, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran
4 Specialist of Urology, Imam Reza Hospital, Department of Biostatistics and Epidemiology, School of Medicine, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran.
5 Resident of Cardiology, Imam Ali Hospital, Kermanshah University of Medical Sciences (KUMS), Iran.
6 General Practitioner, Kermanshah University of Medical Sciences, Kermanshah, Iran
7 M.Sc. of Nursing, School of Nursing, Kermanshah University of Medical Sciences, Kermanshah, Iran.
چکیده [English]

Introduction: Stress Urinary Incontinence (SUI) is a very common problem in adult women and its etiology is multifactorial. Due to different viewpoints in the prevalence and causes of SUI in previous studies, this study was performed with aim to compare the prevalence of SUI four months after vaginal delivery and elective cesarean section and the effective factors.
Methods: This analytical study was conducted on 1520 primiparous women in Kermanshah medical-health centers in 2010. The first group had normal vaginal delivery four months ago and the second group underwent elective cesarean section. Sandvik questionnaire and medical records were used to evaluate the severity and factors effective on SUI. Data analysis was performed using SPSS statistical software (version 16) and Kolmogorov-Smirnov test, Levene test, independent t-test, Mann-Whitney and chi square-test. PResults: The prevalence of stress urinary incontinence four months after vaginal delivery was 3%. After vaginal delivery and elective cesarean section, the prevalence was 4.3%, and 1.87%, respectively, significant difference was observed between the two groups (P = 0.006). There was a significant relationship between SUI with maternal age (P=0.001), maternal BMI (P=0.043) and neonatal weight (P=0.042), but there was no significant relationship with head circumference (P=0.943) and episiotomy (P=1.0). The two groups of vaginal delivery and elective cesarean section were not significantly different in terms of severe SUI (P=1.0).
Conclusions: Mode of delivery, neonate's weight, maternal age and BMI increase the prevalence of stress urinary incontinence four months after delivery, but normal vaginal delivery does not cause severe SUI.

کلیدواژه‌ها [English]

  • Cesarean delivery
  • Normal vaginal delivery
  • Stress Urinary Incontinence
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