盆底超声参数与经阴道分娩初产妇产后盆底功能的关系及对早期发生盆腔脏器脱垂的预测研究

Relationship between Pelvic Floor Ultrasound Parameters and Puerperal Pelvic Floor Function in Parturient Parturients with Vaginal Delivery and Prediction of Early Pelvic Organ Prolapse

目的:探讨盆底超声参数与经阴道分娩初产妇产后盆底功能的关系及对早期发生盆腔脏器脱垂的预测价值。方法:选择2021年9月至2022年9月来我院行规律产检的阴道分娩产妇80例作为研究对象。本研究对80例产妇在产后6~8周进行盆底超声检查,记录检查时的Valsalva、缩肛动作下的肛提肌裂孔面积、前后径、膀胱尿道后角信息。对比两组静息、缩肛状态下及Valsalva动作的肛提肌裂孔面积、前后径、膀胱尿道后角水平,分析两组盆底肌功能指标,分析病例组盆底肌功能指标与静息、缩肛、Valsalva动作时盆底超声参数指标的相关性,盆底超声参数预测早期发生盆腔脏器脱垂的ROC曲线分析。结果:病例组的静息、缩肛状态下及Valsalva动作的肛提肌裂孔面积、前后径、膀胱尿道后角水平较对照组高(P<0.05)。病例组的盆底Ⅰ类肌肌力、盆底Ⅱ类肌肌力、阴道指诊盆底肌力明显较对照组低(P<0.05)。盆底Ⅰ类肌肌力、盆底Ⅱ类肌肌力、阴道指诊盆底肌力与静息、缩肛、Valsalva动作时的肛提肌裂孔面积、前后径、膀胱尿道后角水平均呈负相关(P均<0.05)。静息、缩肛、Valsalva动作时的盆底超声参数指标对盆腔脏器脱垂的AUC均超过0.5,P均<0.05。结论:盆底超声参数与经阴道分娩初产妇产后盆底功能呈负相关,可用于早期发生盆腔脏器脱垂的预测,值得临床上推广应用。

Objective:To investigate the pelvic ultrasound parameters and the vaginal delivery mothers postpartum pelvic floor functional relations and value for early prediction of pelvic organ prolapse.Methods:80 vaginal parturients who came to our hospital from September 2021 to September 2022 for regular birth examination were selected as subjects.In this study,80 parturient women underwent pelvic floor ultrasound examination at 6-8 weeks postpartum,and recorded the information of Valsalva,hiatus area of levator ANI muscle under anal contraction,anteroposterior diameter and posterior Angle of bladder and urethra during the examination.The hiatus area of levator anal muscle,anterior-posterior diameter and posterior Angle of bladder and urethra of the two groups were compared under resting and anal contraction and Valsalva movements,and the pelvic floor muscle function indexes of the two groups were analyzed,and the correlation between the pelvic floor muscle function indexes and ultrasonic parameters of the pelvic floor under resting,anal contraction and Valsalva movements in the case group was analyzed.ROC curve analysis of pelvic floor ultrasonic parameters predicting early pelvic organ prolapse.Results:The levels of hiatus area,anterior-posterior diameter and posterior Angle of vesicurethra of levator anal muscle at rest,anal retraction and Valsalva movement in case group were higher than those in control group(P<0.05).The classⅠmuscle strength,classⅡmuscle strength and vaginal finger diagnosis pelvic floor strength of case group were lower than those of control group(P<0.05).Pelvic floor class I muscle strength,pelvic floor class II muscle strength,and vaginal finger pelvic floor muscle strength were negatively correlated with the area of anal fissure,anterior-posterior diameter,and level of posterior vesicourethral angle during resting,retraction,and Valsalva maneuvers(all P<0.05).The AUC of pelvic floor ultrasound parameters indexed during resting,retraction,and Valsalva maneuvers for pelvic organ prolapse exceeded 0.5(all P<0.05).Conclusion:Pelvic floor ultrasound parameters are negatively correlated with the puerperal pelvic floor function of primipara during vaginal delivery,which can be used to predict the early occurrence of pelvic organ prolapse and is worthy of clinical application.