初产妇的不同分娩方式对产后早期盆底功能的影响

Impacts of different delivery methods on early postpartum pelvic floor function in primipara

目的:探讨初产妇分娩时择期剖宫产、产钳助产和会阴侧切对盆底功能的影响。方法:将2016年1月至2017年5月在本院住院分娩的初产妇,分成择期剖宫产、产钳助产和会阴侧切三组,于产后42 d检查时无子宫出血的产妇返院进行盆底功能评估,对比三者对盆底功能的影响。结果:选择性剖宫产组阴道前壁脱垂、后壁脱垂、子宫脱垂以及盆底肌力损伤与阴道分娩组的会阴侧切、产钳助产比较,差异有统计学意义(P<0.05)。在压力性尿失禁、排尿困难方面,选择性剖宫产和会阴侧切两组比较差异无统计学意义(P>0.05);但与产钳助产相比差异有统计学意义(P<0.05)。伤口疼痛情况剖宫产与会阴侧切和产钳助产相比差异有统计学意义(P<0.05)。性生活障碍方面三者比较差异有统计学意义(P<0.05)。且产钳助产组发生率最高。结论:与阴道分娩无论是否助产比较,剖宫产可以降低子宫、阴道脱垂、盆底肌力损伤的发生,增加了伤口疼痛的发生。产钳助产组增加了压力性尿失禁、排尿困难、性生活障碍的发生。

Objective: To investigate the impact of elective caesarean section, forceps delivery and episiotomy on postpartum pelvic floor function in primipara. Methods: The primipara who stayed in our hospital for delivery between January 2016 and May 2017 were enrolled and divided into three groups: the elective caesarean section group,forceps delivery group,and episiotomy group. At 42 days postpartum,those without uterine bleeding were invited to our hospital for evaluation of pelvic floor function. The impacts of the three delivery methods on the pelvic floor function were compared. Results: There were significant differences in the incidence of vaginal anterior wall prolapse,posterior wall prolapse,uterine prolapse and pelvic floor muscle tone impairment when comparing the elective cesarean section group with women who underwent vaginal delivery with episiotomy or forceps( P < 0. 05). For the incidence of stress urinary incontinence and dysuria,the elective cesarean section group was comparable with the episiotomy group( P> 0.05) but differ from the forceps delivery group( P<0.05). The difference in wound pain was statistically significant when comparing the cesarean section group with the episiotomy group and forceps delivery group( P < 0. 05). There was a statistically significant difference in sexual disturbance among the three groups( P < 0. 05),and the highest incidence was found with forceps delivery. Conclusion: Compared with vaginal delivery with or without forceps,cesarean section may reduce the incidence of uterine prolapse,vaginal prolapse,and pelvic floor muscle tone impairment,but meanwhile increase the wound pain. Forceps delivery may lead to more likelihood of stress urinary incontinence,dysuria,and sexual disturbance.