316例初产妇产后早期盆底功能评估分析

Analysis of 316 cases of early postpartum pelvic floor function assessment in primiparous women

目的了解阴道分娩和剖宫产分娩的初产妇产后早期盆底功能状态及差异。方法回顾性研究2018年1月至2020年5月产后6周于产后康复门诊复查的316例单胎、足月分娩初产妇的病例资料,按分娩方式分为阴道分娩组220例和剖宫产组96例,采用χ2检验比较两组产妇的盆底肌力、肌肉疲劳度和阴道动态压力,尿失禁以及盆腔器官脱垂情况。结果产后6周阴道分娩组和剖宫产组盆底肌Ⅰ类和Ⅱ类肌纤维的肌力、肌肉疲劳度和阴道动态压力异常的发生率比较,差异均无统计学意义(P值均> 0.05)。妊娠期两组间尿失禁发生率比较差异无统计学意义(P> 0.05),产后6周尿失禁的发生率比较差异有统计学意义(P <0.05),产后6周阴道分娩组的阴道前壁脱垂、后壁脱垂、子宫脱垂的发生率以及盆腔器官脱垂情况均显著高于剖宫产组,差异均有统计学意义(P值均<0.05)。结论经阴道分娩和剖宫产分娩均可对盆底功能造成损伤,经阴道分娩会增加盆腔脏器脱垂的危险性,提倡产后早期接受盆底功能评估和治疗。

Objective To understand the status and differences in early postpartum pelvic floor function between primiparous women who underwent a vaginal delivery and those who underwent cesarean section. Methods A retrospective review of the medical records of 316 singleton, term deliveries of primiparous women reviewed at the postpartum rehabilitation clinic at 6 weeks after delivery from January 2018 to May 2020 was conducted. These cases were divided into 220 cases in the vaginal delivery group and 96 cases in the cesarean section group according to the mode of delivery, the pelvic floor muscle strength,muscle fatigue and dynamic vaginal pressure, urinary incontinence, and pelvic organ prolapse in both groups were compared with χ2 test. Results There was no significant difference in the incidence of muscle strength, fatigue, and abnormal vaginal dynamic pressure in pelvic floor muscle class Ⅰ and class Ⅱ muscle fibers between the vaginal delivery group and the cesarean section group at 6 weeks postpartum(all P >0.05). There was no significant difference in the incidence of urinary incontinence between the two groups during pregnancy(P > 0.05), and there was a statistically significant difference in the incidence of urinary incontinence at 6 weeks postpartum(P < 0.05). The incidences of anterior vaginal wall prolapse, posterior wall prolapse, uterine prolapse and pelvic organ prolapse were significantly higher in the group delivered vaginally at 6 weeks postpartum than in the group delivered by cesarean section, and the difference was statistically significant(P < 0.05). Conclusion Both vaginal and cesarean section can damage the pelvic floor function. Vaginal delivery increases the risk of pelvic organ prolapse. Early postpartum assessment and treatment of pelvic floor function is advocated.