孕中期盆底肌肉锻炼计划对围生期结局及产后尿失禁的影响

Effect of maternal pelvic floor muscle training plan on perinatal outcomes and postpartum urinary incontinence

目的探讨孕中期盆底肌肉锻炼计划对围生期结局及产后尿失禁的影响。方法回顾性分析2017年1月~2018年1月于海口市妇幼保健院分娩的98例产妇的临床资料,根据其开始盆底肌肉锻炼的时间分为对照组(49例)和观察组(49例),分别于产后7 d与孕20周开始行盆底肌肉锻炼。比较两组产妇产程时间、分娩结局、产后子宫脱垂、压力性尿失禁情况及盆底肌力、阴道肌力[阴道静息压(VRP)、阴道收缩压(VSP)]、盆底功能障碍调查表(PFDI-20)和盆底障碍影响问卷(PFIQ-7)评分。结果观察组第一、二、三产程均短于对照组,剖宫产率低于对照组(P <0.05);产后42 d,观察组子宫脱垂、压力性尿失禁发生率,PFDI-20和PFIO-7评分均显著低于对照组(P <0.05),盆底肌力≥Ⅲ级人数、VRP和VSP均显著高于对照组(P <0.05)。结论孕中期行盆底肌肉锻炼可以有效缩短产程时间,提高顺产率,有助于恢复盆底和阴道肌力,减少子宫脱垂和压力性尿失禁的发生。

Objective To explore the effect of pelvic floor muscle exercise program on perinatal outcomes and postpartum urinary incontinence during the second trimester of pregnancy. Methods Clinical data of 98 parturients delivered in Haikou Maternal and Child Health Hospital from January 2017 to January 2018 was retrospectively analyzed. According to the time of pelvic floor muscle exercises, they were divided into control group(49 cases) and observation group(49 cases), pelvic floor muscle exercises were performed at 7 days postpartum and 20 weeks postpartum respectively. The duration of labor, delivery outcome, postpartum uterine prolapse, stress urinary incontinence, vagina muscle strength [vaginal resting pressure(VRP) and vaginal systolic pressure(VSP)] and pelvic floor, PFDI-20 and PFIO-7 scores of the two groups were compared. Results The first, second and third stages of labor were shorter than those of the control group, and the number cesarean section rate in the observation group was lower than that in the control group(P < 0.05). At 42 d postpartum, the incidence of uterine prolapse and stress urinary incontinence, scores of PFDI-20 and PFIO-7 in the observation group were significantly lower than those in the control group(P < 0.05), and the number of pelvic floor muscle strength(greater than or equal to Ⅲ grade), VRP and VSP were significantly higher than those in the control group(P < 0.05). Conclusion Pelvic floor muscle exercise during the second trimester of pregnancy can effectively shorten the duration of labor, improve the birth rate, help to restore pelvic floor, vaginal muscle strength,and reduce the occurrence of uterine prolapse and stress urinary incontinence.