Study On The Rehabilitation Of Multiparous Pelvic Floor Function In Postpartum

Objective:To study the multiparity effects on the pelvic floor function,observing the natural rehabilitation of the pelvic floor function in postpartum.Methods:It’s a bidirectional observation study.The research objects are women for routine health checking in 42 days postpartum.Made questionnaire byself,partially retrospective investigated puerpera’s relevant basic information and the UI incidence during pregnancy.Given the routine checking on pelvic floor function in 42 days postpartum,including the pelvic floor muscles force test、UI screen、POP-Q,then prospectively observed the pelvic floor function in postpartum 3 months,6 months and 1 year.Using SPSS22.0 statistical software,choosing the crowd with two delivery modes(vaginal delivery and elective caesarean section),analyzed the difference of the pelvic floor muscles damage proportion(≤level 2)、UI incidence、POP-Q between two birth multiparity and primiparity,then discussed multiparous effect on pelvic floor function,and by comparison between the next recovery time in same group,observed the natural rehabilitation of the pelvic floor function。Results:The situation of pelvic floor muscle damage:Type I muscle damage ratio is lower in second vaginal delivery women in 42 days postpartum,there exists significant difference between the two groups(P<0.01),the muscle fiber damage ratio between the two groups does not exist significant difference in postpartum 3 months,6 months and 1 year(P>0.05).Type Ⅱ muscle damage ratio after vaginal delivery does not exist significant difference between the two groups in postpartum 42 days,3 months,6 months,1 year(P>0.05).The muscle(type Ⅰ and Ⅱ)damage ratio after elective caesarean section does not exist statistical difference between the two group(P>0.05).The multiparous pelvic floor muscle recover more slowly than primiparous group,pelvic floor muscle damage will reduce significantly in postpartum 6 months in vaginal delivery women,that will not significantly decrease in postpartum 1 year in elective caesarean section women.The situation of UI incidence:Second vaginal delivery women’s UI incidence is higher than first vaginal delivery women in pregnancy and postpartum 1 year,there exists statistical difference between the two group(P<0.05),there is no statistical difference between the two group in postpartum 42 days,3 months and 6 months(P>0.05).There is no difference between the two groups after elective caesarean section in pregnancy and postpartum 42 days、3 months、6 months、lyears(P>0.05).Multiparous UI recovery is similar to primiparity,UI ratio will reduce significantly in postpartum 3 months after vaginal delivery,then become more slowly later,but there is few reduction of the UI incidence after elective caesarean section。The situation of POP-Q:The prolapse quantization of vaginal anterior、uterus、vaginal posterior after second vaginal delivery are all more serious than those after first vaginal delivery in postpartum short-term(42 days)and postpartum long-term(1 year),there exists difference between the two groups(P<0.05).The recovery of vaginal anterior prolapse after second vaginal delivery is similar to that after first vaginal delivery,the vaginal anterior recover rapidly and obviously within postpartum 6 months,the uterus and vaginal posterior prolapse after second vaginal delivery recover more slowly than those after first vaginal delivery.The vaginal anterior prolapse after two ECS is more serious than that after first ECS in postpartum 42 days,there exists statistical difference between the two groups(P<0.05),and recover significantly from postpartum 3 months to 6 months,then exist no difference between the two groups in postpartum 3 months.6months and 1 year(P>0.05);there exist no difference of the uterus and vaginal posterior prolapse between the two groups in every postpartum(P>0.05).The recovery of vaginal posterior and uterus prolapse after twice ECS are both inapparent,are similar to those after first ECS.Conclusion:1.The second vaginal delivery do not have more effect on the pelvic floor muscle,maybe the first vaginal delivery is the biggest harm for the pelvic floor muscle,the second pregnancy have few effect on the pelvic floor.Multiparous pelvic floor muscles’recover more slowly and less obviously than primiparity.2.The symptom of UI in postpartum short-term may not appear after second vaginal delivery,but will arise in long-time(postpartum 1 year)and be more obviously than the first vaginal delivery.ECS maybe protect the postpartum pelvic floor function,The UI incidence after second ECS is similar to that after the first ECS.The UI recovery after second vaginal delivery is similar to that after the first vaginal delivery,obviously within postpartum 3 months,then recover more slowly later,The UI recovery is few after second ECS.3.The effect caused by second vaginal delivery on pelvic organ prolapse in postpartum short-term and long-term is bigger than that caused by first vaginal delivery.The extent of pelvic organ prolapse after second and first ECS are similar.ECS maybe protect the postpartum pelvic organ prolapse.The second pregnancy maybe increase the primary pelvic organ anterior prolapse transiently,it can self-repair;then become less distinctive with the first pregnancy.The recovery speed of vaginal anterior prolapse after second vaginal delivery is similar to that after first delivery,the recovery of uterus and vaginal posterior prolapse are poorer than those after the first vaginal delivery.