经阴道分娩对不同年龄初产妇盆底结构和功能的影响

Effects of Transvaginal Delivery on Pelvic Floor Structure and Function in Primiparas of Different Ages

目的:探讨经阴道分娩对不同年龄初产妇盆底结构和功能的影响。方法:选取2021年1月—2023年12月在宜春市人民医院经阴道分娩的产妇84例,年龄<23岁的28例初产妇作为低龄组,年龄23~30岁的28例初产妇作为适龄组,年龄>30岁的28例初产妇作为高龄组。产后6周用盆底三维超声对产妇静息时、最大Valsalva动作时的肛提肌裂孔面积、膀胱尿道后角(PUA)、子宫颈外口位置(CMP)、膀胱颈位置(BNP)进行测量,并计算尿道旋转角(URA)、膀胱颈移动度(BND)、子宫颈外口移动度(CDD)。记录三组盆底功能障碍发生情况。结果:高龄组静息时肛提肌裂孔面积大于适龄组和低龄组,差异均有统计学意义(P<0.05)。高龄组最大Valsalva动作时肛提肌裂孔面积、CMP、BNP均大于适龄组和低龄组,差异均有统计学意义(P<0.05)。高龄组URA、BND、CDD均大于适龄组和低龄组,差异均有统计学意义(P<0.05)。高龄组尿道内口漏斗形成、子宫脱垂发生率均高于适龄组和低龄组,膀胱膨出发生率高于低龄组,差异均有统计学意义(P<0.05)。Spearman相关性分析显示,年龄与尿道内口漏斗形成、膀胱膨出、子宫脱垂发生均呈正相关(r_(s)=0.425、0.361、0.374,P<0.05)。结论:初产妇年龄越大,在分娩过程中盆底结构和功能受损的程度可能越严重。

Objective:To explore the effects of transvaginal delivery on pelvic floor structure and function in primiparas of different ages.Method:A total of 84 primiparas who delivered vaginal in Yichun People's Hospital from January 2021 to December 2023 were selected.28 primiparas<23 years old were selected as the young age group,28 primiparas aged 23-30 years old were selected as the appropriate age group,and 28 primiparas aged>30 years old were selected as the elderly group.The levator hiatus area,posterior urethrovesical angle(PUA),cervical mouth position(CMP)and bladder neck position(BNP)at rest and maximum Valsalva action were measured by pelvic floor three-dimensional ultrasound at 6 weeks postpartum,and urethral rotation angle(URA),bladder neck descent(BND)and external cervix down distance(CDD)were calculated.The occurrence of pelvic floor dysfunction in three groups were recorded.Result:At rest,the levator hiatus area in the elderly group was larger than that in the appropriate age group and the young age group,the differences were statistically significant(P<0.05).The levator hiatus area,CMP and BNP at maximum Valsalva action in the elderly group were larger than those in the appropriate age group and the young age group,the differences were statistically significant(P<0.05).The URA,BND and CDD of the elderly group were higher than those of the appropriate age group and the young age group,the differences were statistically significant(P<0.05).The incidence of infundibulum formation of internal urethral orifice and uterine prolapse in the elderly group were higher than those in the appropriate age group and the young age group,and the incidence of cystocele was higher than that in the young age group,the differences were statistically significant(P<0.05).Spearman correlation analysis showed that age was positively correlated with infundibulum formation of internal urethral orifice,cystocele and uterine prolapse(r_(s)=0.425,0.361,0.374,P<0.05).Conclusion:The older the primipara,the more severe the damage to pelvic floor structure and function during delivery may be.