不同分娩方式对产后早期盆底肌力的影响

The effect of different delivery modes on early postpartum pelvic floor muscles

目的观察不同分娩方式对产后早期盆底肌力的影响,分析盆底肌力异常与产科因素的相关性。方法通过问卷调查的方式获取从2017年6-10月就诊新疆医科大学第一附属医院的产后42d的妇女的产科相关信息,选取260例产后愿意行盆底肌检测的妇女(阴道分娩组130例,选择性剖宫产组130例),通过徒手和仪器检测盆底肌力,观察压力性尿失禁(SUI)和盆腔器官脱垂(POP)的发生情况,比较不同分娩方式对产后盆底肌损伤程度。结果选择性剖宫产组盆底肌前后静息状态均值、持续收缩力、耐力均值均高于阴道分娩组,差异有统计学意义(P<0.05);阴道分娩组盆底肌前后静息状态异常率低于选择性剖宫产组,差异有统计学意义(P<0.05);不同分娩方式产后早期发生SUI与产科因素没有统计学差异(P>0.05);产后早期发生POP与分娩方式、年龄、产次、孕期增加体质量均有显著相关性(P<0.05);产妇年龄>35岁、产次>1次、孕期体质量增加>15kg都会增加产后发生POP的风险。结论不同分娩方式的妇女产后早期盆底肌损伤的类型不同。产后早期发生SUI与分娩方式无关。分娩方式、高龄、多产、孕期增加体质量过高跟产后早期发生POP有关,和其他产科因素无关。盆底肌力检测可作为评估产后盆底肌力和盆底康复治疗疗效评价中客观、实用的参考指标。

Objective To observe the influence of different delivery methods on the pelvic floor muscle strength in the early postpartum period and analyze the correlation between pelvic floor muscle abnormalities and obstetric factors.Methods Questionnaire surveys were conducted to obtain obstetric-related information from women who were 42 days postpartum in the First Affiliated Hospital of Xinjiang Medical University from June to October 2017.260 women who were willing to undergo pelvic floor muscle test after delivery（130 cases of vagina childbirth group,130 cases of elective caesarean section）were selected.The pelvic floor muscle force was detected by hands and instruments.The occurrence of stress urinary incontinence（SUI）and pelvic organ prolapse（POP）was observed.The degree of muscle damage of different delivery methods for postpartum pelvic floor was compared.Results Mean resting state,sustained contraction force and endurance of the pelvic floor muscle in the elective cesarean section group were higher than that of the vaginal delivery group（P〈0.05）.Before and after resting state anomaly rate in the vaginal delivery group was lower than that of elective cesarean section group,and the difference was statistically significant（P〈0.05）.There was no significant difference in SUI and obstetric factors between the different postpartum methods（P〉0.05）.Early postpartum POP was significantly correlated with the delivery mode,age,number of births,and increased body mass during pregnancy（P〈0.05）.Maternal age〉35 years,parity 〉1 and weight gain during pregnancy〉 15 kg increased the risk of POP after childbirth.Conclusion The type of pelvic floor muscle injury in the early postpartum period varies among women with different delivery modes.The occurrence of SUI in the early postpartum was not related to the mode of delivery.The mode of delivery,advanced age,prolificacy,and increased body mass during pregnancy is associated with POP in the early postpartum period and is not related to other obstetrical factors.The pelvic floor muscle strength test can be used as an objective and practical reference indicator for assessing the efficacy of postpartum pelvic floor muscle strength and pelvic floor rehabilitation therapy.