妊娠期女性盆底肌自主收缩的力量差异及对分娩、产后压力性尿失禁的影响

Difference in pelvic floor muscle strength among pregnant women and its effect on labour and postpartum stress urinary incontinence

目的探讨妊娠期女性盆底肌自主收缩的力量情况,对盆底肌锻炼(pelvic floor muscle training,FMT)的掌握程度及对分娩、产后压力性尿失禁(stress urinary incontinence,SUI)的影响。方法选取2018年9月~2021年3月于北京大学首钢医院规范孕检并分娩的单胎初产妇220例,于妊娠28周行阴道指诊评估盆底肌力情况,接受PFMT指导,并分为肌力强组(A,a)、中等组(B,b)组及弱组(C,c),分析3组产妇中与盆底肌力相关的参数,以及不同盆底肌力与产程、产后SUI的相关性。结果51.1%(A组113例)能够正确掌握PFMT,18.2%(C组40例)无法配合行PFMT,其余30.7%(B组67例)盆底肌力弱或伴持续时间不足。其中,135例足月经阴道分娩(a组75例、b组42例、c组18例),10例早产经阴道分娩,75例剖宫产分娩。A、B、C 3组的一般资料比较,A组的身高显著高于B、C组,差异有统计学意义(P<0.05);a、b、c 3组一般资料比较,a组孕前体重、孕前体质指数(body mass index,BMI)显著高于c组,差异有统计学意义(P<0.05);a组第一产程时长短于c组,差异具有统计学意义(P<0.05);产后随访,比较经阴道分娩及剖宫产分娩的盆底肌力强、中、弱3组SUI发生率,前者差异无统计学意义(P>0.05),后者盆底肌力强组SUI发生率显著低于盆底肌力弱组,差异有统计学意义(P<0.05)。结论妊娠期女性盆底肌力存在个体差异,与身高、孕前体重、BMI相关,盆底肌力强有助于缩短第一产程,并显著降低剖宫产后SUI的发生率,对于正确掌握PFMT有重要的临床意义。

Objective To investigate the difference in pelvic floor muscle strength among pregnant women and their mastery level of pelvic floor muscle training(PFMT)and explore the effect of pelvic floor muscle strength on labour and postpartum stress urinary incontinence(SUI).Methods A total of 220 singleton primiparae who received routine antenatal assessment and delivered in Peking University Shougang Hospital from September 2018 to March 2021 were selected.All participants underwent pelvic floor muscle strength assessment by vaginal palpation and PFMT instruction at the 28th week of gestation and were divided into a strong strength group(group A),a moderate strength group(group B),and a weak strength group(group C).Parameters related to muscle strength as well as correlation of muscle strength with delivery and SUI were analyzed in the three groups.Results Approximately 51.1%(113)of cases could perform PFMT correctly,while 18.2%(40 cases)could not,and the remaining 30.7%(67 cases)had weak muscle strength or insufficient endurance.Of the 220 women included,135 had full-term vaginal delivery(group A,75 cases;group B,42 cases;group C,18 cases),while 10 had premature vaginal delivery,and 75 had caesarean delivery.Body height was significantly higher in group A than in groups B and C(P<0.05),while there were significant differences in pre-pregnancy body weight and body mass index(BMI)between groups A and C(P<0.05).Pelvic floor muscle strength was positively correlated with body height,pre-pregnancy body weight,and BMI.Length of the first stage of labour in group A was shorter significantly than that in group C(P<0.05).The incidence of SUI in women who underwent vaginal delivery did not differ significantly among the three groups(P>0.05),but the incidence of SUI in women who underwent caesarean delivery in strong group was significantly lower in group A than in group B(P<0.05).Conclusion There are individual differences in pelvic floor muscle strength among pregnant women,which may be related to body height,pre-pregnancy body weight,and BMI.Strong pelvic floor muscle strength could help shorten the first stage of labour and reduce the incidence of SUI after caesarean delivery.Accurate PFMT is of great clinical importance in these women.