经会阴实时四维超声评估不同分娩方式对产后女性盆膈裂孔的影响

Evaluation of the effect of different delivery modes on the pelvic diaphragm hiatus in postpartum women by transperineal real-time four-dimensional ultrasound

目的采用会阴四维超声评估不同分娩方式对产后女性盆膈裂孔的影响。方法选取2015年7月-2017年1月在湖南省妇幼保健院分娩的86例产妇,其中自然分娩46例、剖宫产40例;同时选取无生育流产史妇女45例作为对照,采用会阴四维超声评价女性盆膈裂孔形态。结果静息状态和Valsalva动作下,自然分娩组、剖宫产组和对照组盆膈裂孔左右径、前后径和面积比较,差异无统计学意义(P>0.05);缩肛动作下,自然分娩组盆膈裂孔左右径、前后径和面积分别为(3.81±0.48)cm、(4.27±0.53)cm和(12.08±2.06)cm^2,明显高于对照组和剖宫产组(P>0.05);缩肛动作下,剖宫产组和对照组盆膈裂孔左右径、前后径和面积比较差异无统计学意义(P>0.05)。结论经会阴四维超声可清晰观察盆底结构,在缩肛动作时阴道分娩产妇盆膈裂孔增加明显,静息及Valsalva动作下盆膈裂孔与分娩方式无明显关系。

Objective To evaluate the effect of different delivery modes on the pelvic diaphragm hiatus in postpartum women by transperineal real-time four-dimensional ultrasound. Methods From July 2015 to January 2017, 86 cases who gave birth in maternal and children＇ s health care hospital of Hunan province were selected. Among them, 46 cases were natural childbirth and 40 cases were cesarean section. At the same time, 45 women without birth and abortion history were selected as the control group. All of the cases were evaluated the morphology of female pelvic diaphragmatic hiatus by transperineal four-dimensional ultrasound. Results Under resting state and Valsalvaaction, there was no significant difference in the left and right diameter, the anteroposterior diameter and the area of pelvic diaphragm hiatus between the natural childbirth group, the cesarean section group and the control group （P 〉 0.05 ）. Under the action of anal contraction, the left and right diameters, the anteroposterior diameter and the area of pelvic diaphragm hiatus in the natural childbirth group were （3.81 ：tO. 48） cm, （4.27 ＋0.53） cm and （I2.08 ＋ 2.06） cm2, respectively. They were significandy higher than those in the control group and the cesarean section group （P 〉 0.05）. Under the action of anal contraction, there was no significant difference in the left and right diameters, the anteroposterior diameter and the area of the pelvic diaphragm hiatus in the cesarean section group and control group （P 〉 0.05）. Conclusion Transperineal four-dimensional ultrasound carl clearly observe the structure of the female pelvic floor. During the action of anal contraction, the pelvic diaphragm hiatus of vaginal delivery puerperais significantly increased. Under resting and Valsalva action, there was no significant relationship between the pelvicdiaphragm hiatus and the mode of delivery.