The Ultrasonic Observation Of Female Pelvic Floor Changes During The Different Stage Of Pregnancy And Delivery

ObjectiveNowadays, with the improvement of people’s life quality, Pelvic Floor Functional Disorder(PFD) has been Known by more and more people. This topic is based on the Pelvic Perineum Ultrasound to observe the differences of the ultrasonic image about the pelvic floor structure which is from the pregnant women of different gestation period, the maternal of different modes of delivery and the healthy volunteers. And then to discuss the influence of female pelvic floor structure during the different stage of pregnancy and delivery. Last, it is to provide the objective and accurate imaging data for clinical diagnosis of pelvic floor functional disorder.MethodColor Doppler ultrasound perineum is applied to conduct a ultrasonic dynamic observation about 68 non-pregnant cases (control group),60 early-pregnant cases (be pregnant for 2-3 months),130 late-pregnant cases (be pregnant for 7-9 months),40 cases of vaginal delivery group,45 cases of vaginal delivery artificial midwifery group (including the left lateral vaginal, the right lateral vaginal and forceps delivery), 32 cases of cesarean women with the changes of bilateral pubic rectum muscle echo and puborectalis front portion thickness, the pubic symphysis separation disease incidence (pubic symphysis gap width and pubic symphysis about interleaving degree), the anterior pelvic organ prolapse incidence (the bladder neck or bladder distention the leading edge of the commonly is used to quantitatively determine the front pelvic organs to be down). The research aims at analyzing the differences between the observed indicators of those groups by statistical analysis and investigating the effects of different mode of delivery for women during pregnancy and pelvic floor structure.Result一. Puborectalis Sonography1. Echo1.1 The pregnant group and non-pregnant control groupThe women puborectalis muscle which is from non-pregnant group, early-pregnant group and late-pregnant group appears the uniform consistency of the echo are 68 cases (100%),59 cases (98.3%) and 30 cases (23.1%) in the ultrasonic imaging, and appears uneven echo manifestations are 0 case (0%),1 case (2%) and 100 cases (77%). Statistics show that the puborectalis echo pattern of the non-pregnant group and early-pregnant group has no significant difference, P>0.05; the puborectalis echo pattern incidence which is from the later-pregnant group is significantly higher than that of non-pregnant group and early pregnancy group, P<0.05.1.2 Cesarean section group, Vaginal delivery group, Artificial assisted vaginal delivery group:before the delivery and after the deliveryCesarean section group, vaginal delivery group, vaginal delivery artificial midwifery group which is before the delivery of the puborectal muscle appears homogeneous echo image are 7 cases(21.8%),8 cases (20%),8 cases (17.7%), appears uneven echo have 25 cases (78.1%),32 cases (80%),37 cases (82.2%), after the delivery, the puborectalis muscle appears homogeneous echo image are 6 cases (18.7%),7 cases (17.5%),4 cases (8.8%), appears uneven echo are 26 cases(81.2%),33 cases (82.5%),41 cases (91.1%). Each group between the before and after delivery, the occurrence rate of puborectal muscle which appears uneven echo is not statistically significant, P>0.05.2. Thickness2.1 The pregnant group and non-pregnant control groupThe thickness of the resting right anterior about the puborectalis on the non-pregnant group, the early-pregnant group, the late-pregnant group of women are 8.29+0.86mm,8.11+0.79mm,6.19+0.51mm, the left front thickness are 8.32+ 0.92mm,8.21+0.82mm,6.13+0.47mm. Non-pregnant group and early-pregnant group have no significant difference, P>0.05. Late-pregnant group is significantly lower than that of the non-pregnant group and early-pregnant group, P<0.05. The thickness comparison of puborectalis muscle.which is from the woman’s both side on non-pregnant group, early-pregnant group, late-pregnant group has no statistically significant, P>0.05.2.2 Cesarean section group, Vaginal delivery group, Artificial assisted vaginal delivery group:before the delivery and after the delivery2.2.1 Cesarean section groupBefore the delivery, the thickness of puborectalis anterior:the right side is 8.25+ 0.86 mm, the left side is 8.27+0.93mm.After the delivery, the thickness of puborectalis anterior:the right side is 5.58+ 0.36mm, the left side is 5.56+0.35mm on the left.Before and after delivery, the front thickness of the puborectalis muscle has significant difference, P<0.05. Before the delivery:the thickness of the puborectalis muscle has no difference between the left and right sides, P>0.05. After the delivery: the thickness of the puborectalis muscle has no difference between the left and right sides, P>0.05.2.2.2 Artificial assisted vaginal delivery groupBefore the delivery, the thickness of puborectalis anterior:the right side is 8.77+ 1.16mm, the left side is 8.25+1.03mm.After the delivery, the thickness of puborectalis anterior:the right side is 4.55+ 0.69mm, the left side is 4.72+0.66mm.Before and after delivery, the front thickness of the puborectalis muscle has significant difference, P<0.05. Before the delivery:the thickness of the puborectalis muscle has no difference between the left and right sides, P>0.05. After the delivery: the thickness of the puborectalis muscle has no difference between the left and right sides,P>0.05.2.3 Vaginal delivery groupBefore the delivery, the thickness of puborectalis anterior:the right side is 9.64+ 0.80mm, the left side is 9.26+0.56mm.After the delivery, the thickness of puborectalis anterior:the right side is 5.96+ 0.25mm, the left side is 6.13+0.46mm.Before and after delivery, the front thickness of the puborectalis muscle has significant difference, P<0.05. Before the delivery:the thickness of the puborectalis muscle has no difference between the left and right sides, P>0.05. After the delivery: the thickness of the puborectalis muscle has no difference between the left and right sides, P>0.05.2.4 Cesarean section group, Vaginal delivery group, Artificial assisted vaginal delivery groupThe degree of injury on the thickness of right puborectal anterior muscle is 2.67+0.89mm; 3.68+0.79mm; 4.22+1.50mm; the difference of thickness has statistically significance, P<0.05.The degree of injury on the thickness of left puborectal anterior muscle is 2.70+ 0.95mm; 3.14+0.59mm; 3.53+1.28mm; the difference of thickness has statistically significance, P<0.05.二. The disease incidence of the pubic symphysis (detection index:pubic symphysis gap width and pubic symphysis about interleaving degree).1. The disease incidence of pubic symphysis separation is 0%.2. Non-pregnant, early-pregnant group and late-pregnant group:pubic symphysis gap width, and pubic symphysis about interleaving degree doesn’t have statistically significance(P>0.05); cesarean section, vaginal delivery, vaginal delivery group artificial midwifery group:before the delivery and after the delivery:pubic symphysis gap width, and pubic symphysis about interleaving degree doesn’t have statistically significance (P>0.05).三. The Comparison of Anterior Pelvic Organ Prolapse (with the incidence of bladder neck to the distance of pubic symphysis on BSD)1. The resting period:each group doesn’t have prolapses (the prolapse occurs in 0%).2. The tension period:2.1 The non-pregnant group compared with early-pregnant group and late-pregnant group:the incidence rate of the 1-3 months pregnant group and the non-pregnant are 0%, the incidence rate of 7-9 months pregnant group has mild prolapse is 37.69%, and moderate prolapse is 7.69%.2.2 Cesarean section group, Vaginal delivery group, Artificial assisted vaginal delivery groupThe probability of cesarean section group has mild prolapse is 34.38%, and moderate prolapse is 6.24%, the probability of vaginal delivery group has mild prolapse is 35%, and moderate prolapse is 7.5%, the probability of artificial assisted vaginal delivery group has mild prolapse is 35.56%, and moderate prolapse is 6.66%. There is no significant difference in prolapse (P=1.000).2.3 Cesarean section group, Vaginal delivery group, Artificial assisted vaginal delivery groupThe probability of cesarean section group has mild prolapse is 37.5%, and moderate prolapse is 9.38%, the probability of vaginal delivery group has mild prolapse is 40%, and moderate prolapse is 30%, but severe prolapse is 2.5%, the probability of Artificial assisted vaginal delivery group has mild prolapse is 48.89%, and moderate prolapse is 28.89%, but severe prolapse is 22.22%. There is significant difference in prolapse (P=0.001).Conclusion1.The comparison between the early-pregnant group and non-pregnant group:the puborectalis echo, the thickness on both sides of the puborectalis and anterior pelvic organ prolapse doesn’t have significantly changes.2. The comparison between the late-pregnant group and non-pregnant group:(1)the puborectalis echo is abnormal, and the front thickness has become thin;(2)Some pregnant women have mild and moderate prolapse on the anterior pelvic organ.3. Cesarean section group, Vaginal delivery group, Artificial assisted vaginal delivery group before the delivery(1) Most of the puborectalis muscle appears uneven echo;(2) The thickness difference of the front puborectalis muscle in each group doesn’t have statistical significance;(3) The difference of anterior pelvic organ prolapse doesn’t have statistical significance4.Cesarean section group, Vaginal delivery group, Artificial assisted vaginal delivery group after the delivery(1) Most of the puborectalis muscle appears uneven echo;(2) The thickness of the front puborectalis muscle has become thin (injury), the degree of damage:Artificial assisted vaginal delivery group>vaginal delivery group> cesarean section group;(3) The proportion and degree of anterior pelvic organ prolapse:Artificial assisted vaginal delivery group>vaginal delivery group>cesarean section group.5. The incidence rate of pubic symphysis separation is 0% in this topic.