不同分娩方式对产后盆底超声指标及盆底肌力的影响

Effects of different delivery modes on indexes of postpartum pelvic floor ultrasonography and pelvic floor muscle strength

目的探讨不同分娩方式对产后盆底超声指标及盆底肌力的影响,为临床选择分娩方式预防盆底功能障碍性疾病(PFD)提供参考依据。方法选择2015年5月-2017年8月在成都市第五人民医院分娩的初产妇88例,根据分娩方式不同分为两组。选择性剖宫产组44例,经阴道分娩组44例,均于产后6～10周接受盆底超声检查和盆底肌电生物反馈仪检查。比较两组最大Valsalva动作状态和静息状态下膀胱尿道后角(PUA)、尿道倾斜角(UTA)、宫颈外口的位置(CMP)、膀胱颈的位置(BNP)、膀胱颈移动度(BND)、尿道旋转角(URA)、宫颈外口移动度(CDD)以及盆底不同肌纤维的肌力。结果静息状态下选择性剖宫产组UTA、BNP高于经阴道分娩组,CMP低于经阴道分娩组,差异有统计学意义(均P<0. 05);最大Valsalva状态下选择性剖宫产组UTA、BNP低于经阴道分娩组,CMP高于经阴道分娩组,差异有统计学意义(均P<0. 05);不同状态下两组PUA值比较,差异无统计学意义(P>0. 05);经阴道分娩组BND、URA、CDD值分别为(16. 35±8. 22) mm、(42. 78±32. 48) mm、(13. 94±9. 68) mm,选择性剖宫产组BND、URA、CDD值分别为(15. 01±9. 00) mm、(32. 10±28. 34) mm、(12. 14±10. 21) mm,差异有统计学意义(均P<0. 05);选择性剖宫产组前静息平均肌电值、快肌最大肌电值、混合肌平均肌电值、慢肌平均肌电值、后静息平均肌电值高于经阴道分娩组,差异有统计学意义(均P<0. 05)。结论与选择性剖宫产相比,经阴道分娩对产后早期盆底肌力的损伤以及对盆底结构与功能的影响较大,临床应根据孕产妇实际情况,恰当选择分娩方式,预防PFD发生。

Objective To explore the effects of different delivery modes on indexes of postpartum pelvic floor ultrasonography and pelvic floor muscle strength,provide a reference basis for selection of delivery modes and prevention of pelvic floor dysfunction(PFD).Methods Eighty-eight primiparous women giving birth to their babies in the Fifth People's Hospital of Chengdu from May 2015 to August 2017 were selected and divided into selective cesarean section group(44 women) and vaginal delivery group(44 women) according to delivery mode.All the women underwent pelvic floor ultrasonography and pelvic floor muscle electrical biofeedback instrument during 6-10 weeks after delivery.The posterior ureterovesical angel(PUA),urethral tilt angel(UTA),cervical mouth position(CMP),bladder neck position(BNP),bladder neck descent(BND),urethral rotation angel(URA),cervix down distance(CDD),and pelvic floor muscle strengths of different muscle fibers at maximum Valsalva action state and rest state were compared between the two groups.Results UTA and BNP at rest state in selective cesarean section group were statistically significantly higher than those in vaginal delivery group,while CMP was statistically significantly lower than that in vaginal delivery group(P<0.05).UTA and BNP at maximum Valsalva action state in selective cesarean section group were statistically significantly lower than those in vaginal delivery group,while CMP was statistically significantly higher than that in vaginal delivery group(P<0.05).There was no statistically significant difference in PUA at maximum Valsalva action state and rest state between the two groups(P > 0.05).BND,URA,and CDD in vaginal delivery group were(16.35 ± 8.22) mm,(42.78 ±32.48) mm,and(13.94±9.68) mm,respectively;BND,URA,and CDD in selective cesarean section group were(15.01±9.00) mm,(32.10±28.34) mm,and(12.14±10.21) mm,respectively,there were statistically significant differences between the two groups(P<0.05).The anterior resting averaged electromyogram,maximum fast muscle electromyogram,mixed muscle averaged electromyogram,slow muscle averaged electromyogram,and posterior resting averaged electromyogram in selective cesarean section group were statistically significantly higher than those in vaginal delivery group(P<0.05).Conclusion Compared with selective cesarean section,vaginal delivery has great effect on postpartum injury of pelvic floor muscle strength and pelvic structure and function,delivery modes should be selected according to the actual situation of pregnant women to prevent PFD.