不同分娩方式及不同阶段剖宫产对盆底影响的超声研究

Research of the impact of different delivery modes and cesarean section in different stages of delivery on pelvic floor by ultrasound

目的探讨不同分娩方式及不同阶段剖宫产对产后早期盆底功能的影响。方法分别设置:择期剖宫产组、阴道分娩组、第二产程剖宫产组及对照组(未生育)四组分别通过尿垫试验和体格检查,了解有无SUI及POP情况,再进行经会阴超声检查,测量静息至valsalva状态下膀胱颈移动度(bladder neck down distance,BND)、子宫颈外口移动度(the cervix down distance,CD)、直肠壶腹移动度(the rectal ampulla down distance,RAD)、提肛肌裂孔直径差值(the differences of levator hiatal diameter,LHD-d)及横径差值(the differences of levator hiatal lateral diameter,LHLR-d),四组之间进行对比,探讨不同分娩方式及不同阶段剖宫产对产后早期盆底功能的影响。结果阴道分娩组和第二产程剖宫产组SUI发生率相近,而两组与择期剖宫产组比较,发生率均显著增大。阴道分娩组、第二产程剖宫产组与对照组比较,两组各指标除第二产程剖宫产组RAD以外均显著增大;阴道分娩组、第二产程剖宫产组与择期剖宫产组比较各指标差异均有统计学意义;阴道分娩组与第二产程剖宫产组比较,除RAD以外各数据差异均无统计学意义。结论第二产程剖宫产与阴道分娩SUI发病率相近,而择期剖宫产能降低产后SUI发生的风险。在临床工作中应尽量避免第二产程剖宫产。

Objective To investigate the impact of different delivery modes and cesarean section in different stages of de-livery on early postpartum pelvic floor function .Methods 20 nulliparous women ,21 women with elective cesarean sec-tion ,21 women with vaginal delivery and 10 women with cesarean section in second stage of delivery were enrolled in this study .Urine pud test and phgsical examination was done on every women to know whether they have SUI or POP symp-toms .Perineum ultrasound was examined at both resting position and valsalva position and the following data were meas-ured ：bladder neck down distance （BND） ,the cervix down distance （CD） ,the rectal ampulla down distance （RAD） ,the difference of levator hiatal diameter （LHD-d） and the difference of levator hiatal lateral diameter （LHLR-d） between rest-ing position and valsalva position .Then the data were compared between the four groups .Results The incidence of SUI was similar between the cesarean section in second stage of delivery group and the vaginal delivery group compared with the elective cesarean section group ,SUI incidence of the two groups were both increased ;Compared with the control group ,all the data of vaginal delivery group and almost all data except RAD of the group of cesarean section in the second stage of delivery increased differently .In vaginal delivery group and the cesarean sections in the second stage of delivery group compared with elective cesarean section group ,each index difference had statistical significance .Compared with the vaginal delivery group ,all the data except RAD of the group of cesarean sections in the second stage of delivery showed no statistical significance .Conclusion The incidence of SUI is similar between the cesarean section in second stage of delivery group and the vaginal delivery group ,and elective cesarean section reduces the risk of postpartum SUI .We should try to avoid the cesarean section in second stage of delivery in clinical work .