初产妇不同产程阶段行剖宫产对产后盆底肌功能的影响

Effects of cesarean section of primipara during different stages of labor on their postpartum pelvic floor muscle function

目的:分析初产妇临产后宫口扩张不同程度剖宫产对产后盆底肌功能的影响。方法:收集2018年10月-2020年6月本院分娩且产后68周行盆底肌功能功能检查的产妇临床资料,根据分娩方式分为阴道分娩组、未临产剖宫产组、临产后剖宫产组。将临产后剖宫产组根据剖宫产时宫口扩张程度进一步分为宫口<6cm组、宫口610cm组、第二产程组。比较各组产妇盆底肌功能差异,分析不同产程阶段剖宫产对产后盆底肌功能的影响。结果:盆底肌力异常总发生率阴道分娩组(76.1%)与临产后剖宫产组(77.9%)无差异但均高于未临产剖宫产组(60.7%)(P<0.001),各组盆底肌力异常类型构成比无差异(P>0.05);产妇肛提肌ΔA、ΔC、ΔL、ε阴道分娩组与临产后剖宫产组无差异但均大于未临产剖宫产组(P<0.001);临产后剖宫产组盆底肌力异常总发生率宫口610cm组(89.4%)与第二产程组(91.4%)无差异但均高于宫口<6cm组(69.2%)(P<0.001),盆底肌力异常类型构成比不同宫口组无差异(P>0.05);产妇肛提肌ΔA、ΔC、ΔL、ε宫口610cm组与第二产程组无差异但均大于宫口<6cm组(P<0.001);产妇年龄、体质指数、新生儿出生体重及宫口扩张610cm、第二产程剖宫产均是盆底肌力异常的影响因素(P<0.05)。结论:初产妇临产后剖宫产对盆底肌损伤程度与阴道分娩相似,宫口扩张≥6cm时行剖宫产会加重对产妇盆底肌功能的损伤。

Objective: To analyze the influence of cesarean section of primiparas when different dilation degrees of uterine mouth during labor on their postpartum pelvic floor muscle function. Methods: The clinical data of women who underwent pelvic floor muscle function examination during postpartum 6-8 weeks from October 2018 to June 2020 were collected. According to the delivery mode, these women were divided into group A(women with vaginal delivery), group B(women with cesarean section before labor), and group C(women with cesarean section after labor). Then according to the dilation degrees of uterine mouth when cesarean section, the women in group C were further divided into group C1(women with uterine mouth dilation <6 cm), group C2(women with uterine mouth dilation 6-10 cm), and group C3(women in the second labor process). The difference of pelvic floor muscle function of the women was compared among these groups. The influence of cesarean section at different stages of labor on postpartum pelvic floor muscle function was analyzed. Results: There was no significant difference in the incidence of abnormal pelvic floor muscle strength(76.1% vs.77.9%) of the women between group A and group C, but the incidence of abnormal pelvic floor muscle strength of the women in group A and group C was significant higher than that(60.7%) of the women in group B(P<0.001). There was no significant difference in the composition ratio of abnormal pelvic floor muscle strength type of the women among group A, B, and C(P>0.05). There were no significant difference in the rates of levator muscle ΔA, ΔC, ΔL, and ε of the women between group A and group C, but which were all significant higher than those of the women in group B(P<0.001). There was no significant difference in the total incidence of abnormal pelvic floor muscle strength(89.4% vs. 91.4%) between group C2 and group C3, but which of the women in group C2 and group C3 were significant higher than that(69.2%)of the women in group C1(P<0.001).There was no significant difference in the composition ratio of abnormal pelvic floor muscle strength type of the women among group C1,C2,and C3(P>0.05).There were no significant difference in the rates of levator muscleΔA,ΔC,ΔL,andεof the women between group C2 and group C3,but which were all significant higher than those of the women in group C1(P<0.001).Maternal age,body mass index,neonatal birth weight,uterine mouth dilation to 6-10 cm,cesarean section during the second stage of labor were all the influencing factors of abnormal pelvic floor muscle strength(P<0.05).Conclusion:The damage to pelvic floor muscle of the primiparas with cesarean section of after labor has the similar to that of the primiparas with vaginal delivery.Cesarean section after uterine mouth dilation over 6 cm will aggravate the damage to pelvic floor muscle function.