| Objective: To investigate the influence factors of pelvic organ prolapse after delivery and the expression level of molecular markers in serum including elastin,type I collagen,miRNA-30 d and miRNA-181 a,and to analyze their correlation with pelvic organ prolapse after delivery.Method: A total of 1013 cases of puerperae who came to Quanzhou Women's and Children's Hospital for postpartum examination from October,2016 to October,2017,42-60 days after delivery,were selected.The basic information and maternal information of the subjects was collected.Chi-square test,t-test,rank sum test,dichotomous Logistic regression analysis were used to analyze the influence factors of pelvic organ prolapse after delivery,including age,number of pregnancy,number of delivery,mode of delivery,neonatal body weight,postpartum BMI,pelvic floor muscle strength and urinary incontinence.The research method of case control was adopted,among the above mentioned subjects,40 cases of puerperae whose POP-Q grade of pelvic organ prolapse ?3 level were selected as research group and 40 cases with no pelvic organ prolapse,urinary incontinence and whose grades of pelvic floor muscle strength ? 3 level were selected as control group according to the matched age,number of delivery,mode of delivery,postpartum BMI,neonatal body weight.The concentration of elastin and type I collagen in serum of patients in research group and control group were measured quantitatively by enzyme-linked immunosorbent assay.Additionally,the expression level of miRNA-30 d and miRNA-181 a in serum of patients in research group and control group was measured through real-time fluorescence quantitative RT-PCR.Results:1.A total of 1040 cases of puerperae were investigated,among which 1013 cases were effectively selected subjects.641(63.3%)cases with anterior vaginal wall prolapse,270(26.7%)cases with posterior vaginal wall prolapse,245(24.2%)cases with pelvic organ prolapse,any of the aforementioned cases was deemed as pelvic organ prolapse,thus its occurrence rate was 68.7%(696/1013).2.Analysis of single factor of postpartum pelvic organ prolapse: age ? 35 years old,number of pregnancy,number of delivery,vaginal delivery,second stage of labor of primipara,postpartum BMI ? 24,newborn body weight ? 4.0kg,pelvic floor muscle strength <3 level and combined urinary incontinence were all factors that affected the postpartum pelvic organ prolapse(P<0.05).Further multiple-factor analysis: age?35(OR=2.0,95%CI 1.139-3.513),vaginal delivery(OR=2.74,95%CI 1.847-4.064),second stage of labor of primipara(OR=1.723,95%CI 1.201-2.472),postpartum BMI ? 24(OR=4.026,95%CI 2.646-6.124),newborn body weight?4kg(OR=5.407,95%CI 1.418-20.617),pelvic floor strength <3 level(19.657,95%CI 13.071-29.562)and combined urinary incontinence(1.917,95%CI 1.247-2.948)were the risk factors of postpartum pelvic organ prolapse.3.There was no significant difference in the concentration of type I collagen in the serum between research group and control group(Z =-0.65,P=0.516).There was no significant difference in the concentration of elastin(t=1.143,P=0.257).4.miRNA-30 d in the serum of research group was highly expressed compared to that of the control group,and the difference was of statistical significance(Z=-2.883,P<0.05).And miRNA-181 a in the serum of research group was highly expressed compared to that of the control group,and the difference was of statistical significance(Z=-2.966,P<0.05).Conclusion:1.Old age,vaginal delivery,prolonged second stage of labor of primipara,delivering fetal macrosomia,postpartum overweight or obesity are the risk factors that may cause postpartum pelvic organ prolapse.All the factors mentioned should be taken into account during the maternal health care as the key monitoring index to prevent the occurrence of pelvic organ prolapse.2.There is no difference in the concentration of type I collagen and elastin in the serum between the research group and the control group.Type I collagen and elastin in the serum might be of insignificance to the prediction of postpartum pelvic organ prolapse.3.miRNA-30 d and miRNA-181 a in the serum of patients with postpartum pelvic organ prolapse are highly expressed compared with those of puerpera with normal postpartum pelvic floor function,and both indexes are conducive to judging postpartum pelvic organ prolapse,which possibly can be used as hematological predictive indexes.Postpartum POP prediction model could be built by combining high risk factors and the detection of serum molecular marker miRNA. |
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