The Study Of Recovery Situation And The Influence Factor Of Pelvic Floor Function In Post-partum Women

BackgroundThe pelvic floor muscle mainly contains two types fibers: type Ⅰ muscle fiber, type Ⅱ muscle fiber. Type Ⅰ muscle fiber is slow, and related with support functions under resting conditions. It occurs allelic contraction, maintains a long and continuous time, with no fatigue. Type Ⅱ muscle fiber is fast, and related with the strong contraction functions. It occurs isotonic contraction, fast and agile, but easy to fatigue.Female pelvic floor dysfunctional diseases (PFDS), was a condition characterized by the weak Pelvic support organization, and then the pelvic organs shift, leading to the other pelvic organs’location and function abnormal. The common clinical manifestations or symptoms of female pelvic floor dysfunctional diseases were pelvic organ prolapsed (POP) and urinary incontinence(UI), fecal incontinence (FI), sexual dysfunction (SD), chronic pelvic pain (CPP) and so on.No matter in developed countries or developing countries, pelvic organ prolapsed is a serious health problems. A study about Women’s Health Initiative, among women of 50-79 years old,41% are sustaining different degree of pelvic organ prolapsed. In economy developed country, urinary incontinence is more common than hypertension, depression and diabetes, the hospitalization costs have far exceeded the cost of Coronary heart disease, osteoporosis and breast cancer. Fecal incontinence usually refers to a liquid or solid waste dischargein controllably. Fecal incontinence would severely affects patients’social, economic, and psychology, severely reduce the patient’s quality of life. The prevalence rates of fecal incontinence in women in Beijing urban and ruralarea is 1.28%, and along with the age increasing, the prevalence rate of urinary incontinence is increasing. Chronic pelvic pain is the aperiodic pain of pelvic cavity, before the abdominal wall (umbilical week or below), lumbosacral portion or haunch, which continue six months or more, often cause Dysfunction or require medication or surgery.Pregnancy and childbirth make the maternal vaginal wall relax, the elasticity of pelvic floor muscle and fascia weaken because of the excessive labor, and accompany part of muscle fiber fracture, so that the before and after vaginal wall prolapsed, urinary incontinence, haemorrhoids, not satisfied with sexual life, even more somebody appear Uterine prolapsed, severe urinary incontinence when they Enter the menopausal transition. Nowadays, the known main reasons of pelvic floor dysfunctional diseases were pregnancy and childbirth. The timely recovery of pelvic floor function has positive effect on the prevention of female pelvic floor dysfunctional diseases.ObjectiveBy the detection of comprehensive strength, fatigue and vaginal resting pressure of pelvic floor muscles in women postpartum 42 days (Pelvic floor basically completed repair themselves), to find the recovery conditions of women pelvic floor function in Postpartum women, analysis the effects of different ways of delivery on injury of pelvic floor issues, and to provide theoretical basis for pregnant woman to help choose delivery mode and the way of pelvic floor functional rehabilitation training.Objects and methodsThis study combined the baseline survey and opportunistic screening, to analysis the epidemiological survey data. Research objects were from voluntary women who came to Jinan maternal and child care service centre to participate in pelvic floor functional screening. Inclusion criteria: Postpartum 6-8 weeks, single birth, no bleeding in vagina, no history of pregnancy urogenital fistula, uropoiesis and reproduction surgery, neuromuscularlesion and so on.Collect general information: the age of pregnant women, education, the age and education of husband, pre-pregnancy height, weight, pregnancy height, gravidity, parity, delivery mode, the number of days of pregnancy, the gender, weight and body length of newborn. Data of pelvic floor function:strength grade of type Ⅰ muscle fiber, type Ⅱ muscle fiber, fatigue grade of type Ⅰ muscle fiber, type Ⅱ muscle fiber, vaginal resting pressure.Use SPSS 19.0 statistical software to enter and analysis, use t test and chi-square test to compare the differences of demographic data and reproductive related information in groups of vaginal delivery and cesarean delivery, and to compare the pelvic floor functional damage in two groups. Use single factor and multi-factor Logistic regression model to explore the effect of various factors on injury of pelvic floor issues. P values< 0.05wereconsideredsignificant.In the Collinearity Diagnosticsa of Logistic regression model, if the Variance inflation factor> 5, or Eigenvalue Close to zero, or Close to zero> 30, then we can consider There are colinearity in model. We should exclude some influence factor to ensure the stability of model.Results1. There were 2355 women in our study,1342 chose vaginal delivery and 1013 chose cesarean delivery. The women’s age ranged from 19 to 44 years old, with mean age 28.10 ± 3.56. The mean BMI was 22.70 ± 3.38 kg/m2. Mean frequency of gravidity and abortion was 1.66 ± 0.93,0.51 ±0.81. The mean frequency of production was 0.15 ± 0.36. The neonatal birth weight ranged from 800 to 5250 g, the mean weight was 3369.77 ± 454.60g.2. The abnormal rate of muscle strength of type Ⅰ and Ⅱ muscle fiber of pelvic floor were 51.6% and 30.9%, The abnormal rates of muscle fatigue grade of type Ⅰ and Ⅱ muscle fiber of pelvic floor were 17.7% and 3.7%. The mean vaginal resting pressure was 75.22±18.64 mmHg, the abnormal rate was 65.4%. In vaginal delivery group, the abnormal rates of muscle strength of type Ⅰ and Ⅱ muscle fiber were 54.0% and 32.9% (P<0.01). In cesarean delivery, the abnormal rates were 48.5% and 28.2%(P<0.01).3. The results of Logistic regression model3.1 The possibility of muscle strength abnormal of type Ⅰ muscle fiber in women who chose vaginal delivery is 1.520 (95% CI,1.194-1.935) times compared to that in women who chose cesarean delivery. When women are not first pregnancy, the OR was 5.431 (95% CI,4.133-7.135) for muscle strength abnormal of type Ⅰ muscle fiber. While women give birth to fetal macrosomia, they had 1.719 (95% CI, 1.060-2.788) times risk for muscle strength abnormal of type Ⅰ muscle fiber. Compared to women< 25 years old,25～44 years old women had reduced risk for muscle strength abnormal of type I muscle fiber, (the OR,0.516 (95% CI,0.359-0.740),0.623 (95% CI,0.395-0.981) respectively). When compared to women whose BMI were normal, the ORs were 0.662 (95% CI,0.483-0.908),1.130 (95% CI,1.029-1.241),1.273 (95% CI,1.058-1.530) for women whose BMI were<18.5 kg/m2, overweight, or obesity.3.2 The possibility of muscle strength abnormal of type Ⅱ muscle fiber in women who chose vaginal delivery is 1.227 (95% CI,1.020-1.475) times compared to that in women who chose cesarean delivery. When compared to women whose BMI were normal, the ORs were 0.533 (95% CI,0.330-0.863),2.024 (95% CI,1.429-2.874), 2.088 (95% CI,1.314-3.311) for women whose BMI were<18.5 kg/m2, overweight, or obesity.3.3 Compared to women< 25 years old,30-44 years old women had reduced risk for muscle fatigue grade abnormal of type Ⅰ muscle fiber, the OR was 0.642 (95% CI, 0.419-0.984). Other factor, such as delivery mode, first pregnancy or not, first parity or not, neonatal birth weight, menstrual cycle had nothing to do with muscle fatigue grade of type Ⅰ muscle fiber.3.4 When women gave birth to girl, macrosomia, or they were multipara, the risks for muscle fatigue grade abnormal of type Ⅱ muscle fiber were 1.661 (95% CI,1.066-2.588),2.977 (95% CI,1.496-5.926) and 2.310 (95% CI,1.178-4.532) respectively.3.5 When women were multipara or chose vaginal delivery, the risks for vaginal resting pressure abnormal were 1.396 (95% CI,1.158-1.684) and 1.524 (95% CI, 1.117-2.081) respectively. When women’s BMI were<18.5 kg/m2, overweight, or obesity, the risks for vaginal resting pressure abnormal were 0.640 (95% CI,0.442-0.925),1.742 (95% CI,1.172-2.591) and 1.715 (95% CI,1.042-2.825) respectively.Conclusion1. The abnormal rate of muscle strength of type Ⅰ muscle fiber of pelvic floor was 51.6%, the rate of muscle strength of type Ⅱ muscle fiber was 30.9%, the abnormal rates of muscle fatigue grade of type Ⅰ and Ⅱ muscle fiber of pelvic floor were 17.7% and 3.7%, the abnormal rate of vaginal resting pressure was 65.4%. The abnormal rate of muscle strength and vaginal resting pressure were higher than others.2. The independent factors of pelvic floor dysfunctional were mode of delivery, BMI, age, neonatal weight, and multipara or not. Vaginal delivery, obesity, neonatal weight>4kg, would damage pelvic floor function obviously.