| Objective Pelvic floor ultrasound can show the imaging condition of pelvic floor dynamically in real time without changing the normal anatomical morphology and function of female pelvic floor,be capable of understanding the influence factors of female pelvic floor changes comprehensively and deeply.In this study,transperineal pelvic floor ultrasound technology was used to study the pelvic floor structure and analyze the effect of different delivery modes on the pelvic floor structure and function of primiparas in the early postpartum period,which can provide reference for the early detection and prediction of female pelvic floor disorders.The increase of the levator hiatus area is associated with avulsion of levator ani muscle and pelvic organ prolapse,ultrasonic measurement of the levator hiatus area can be used as a reliable parameter for ultrasonic evaluation of pelvic floor anatomy and morphology.To explore the extent of levator hiatus dilated and the related obstetric factors in the early stage after delivery,it is helpful to further understand the pathogenesis of pelvic floor dysfunction,and can bring guiding significance for early clinical intervention and prevention,and preventing the further occurrence of the forward pelvic floor diseases through early rehabilitation treatment.Methods In the first part of this retrospective study,175 primiparas who were admitted to the obstetrics and gynecology clinic of the First Affiliated Hospital of Anhui University of Science and Technology from April 2020 to December 2020 at 6～8weeks postpartum.According to different delivery modes,102 cases were vaginal delivery group and 73 cases were cesarean section group.All subjects underwent pelvic floor ultrasound examination to measure the detrusor of the bladder,the distance between the bladder neck and the pubic symphysis,the posterior angle of the bladder,the movement of the bladder neck,the rotation angle of the urinary tract,the anal right angle,the average thickness of the levator ani muscle and the form of levator ani muscle at rest and Valsalva states.The downward movement distance of the external cervix and rectal ampulla,the activity of bladder neck and the levator hiatus area were calculated.Meanwhile,the opening of the internal urethra and funnel-like changes were observed.Statistical analysis was conducted to compare the following:(1)age、weight gain during pregnancy、gestational age and fetal weight between the two groups;(2)different types of pelvic floor damage at the early postpartum period between the two groups;(3)ultrasonic measurement indexes at the rest and Valsalva states between the two groups;(4)the ultrasonic measurement indexes of different pelvic floor dysfunction diseases at Valsalva state in the vaginal delivery group.The second part of the study,250 women who were admitted to the obstetrics and gynecology clinic of the First Affiliated Hospital of Anhui University of Science and Technology from April2020 to December 2020 at 6～8 weeks postpartum.The study group was 105 patients with dilated levator hiatus,as the control group was 145 patients with normal levator hiatus.Three-dimensional ultrasound volume imaging showed the morphology and size of levator hiatus,stored data and images,measured the size of levator hiatal area at rest and Valsalva state.Analysis of the extent of levator hiatus dilation and the related factors was conducted on Logistic regression analysis.Results In the first study,no significant differences in age、weight gain during pregnancy、gestational age and fetal weight were found between the two groups(all P values>0.05);In the comparison of pelvic floor damage,34 cases(33.3%)of postpartum uterine prolapse were found in the vaginal delivery group,and 9 cases(12.3%)were found in the cesarean section group,the difference was statistically significant(X~2=10.129,P<0.05).No statistically significant differences were found in stress urinary incontinence、urethral funnelation、cystocele and rectocele(all P values were>0.05);At rest state,the posterior angle of bladder,the anal right angle and the levator hiatus area in the vaginal delivery group were all larger than those in the cesarean section group,the difference was statistically significant(X~2=3.211,2.658,-0.191,2.835,all P values<0.05);In Valsalva state,the distance between the bladder neck and the pubic symphysis in the vaginal delivery group was smaller significantly than that in the cesarean section group,which were(-8.2±7.9)㎜and(6.3±7.0)㎜respectively,while the mobility of the bladder neck、the rotation angle of the urethra and the levator hiatus area were all larger than that in the cesarean section group,and the difference was statistically significant(all P values<0.05);In patients with uterine prolapse、the levator hiatus area、the mobility of the bladder neck and the rotation angle of the urethra were greater than those with typeⅡcystocele and urethral funnelation,whereas the posterior angle of the bladder was the largest in patients with urethral funnel formation,the difference was statistically significant(all P values<0.05).In the second study,90 cases(85.7%)had mild dilation,12 cases(11.4%)had moderate dilation,and 3 cases(2.9%)had severe dilation,and the incidence of cystocele、uterine prolapse and rectocele in the study group was higher than that in the control group,the difference was statistically significant(X~2=9.768、49.413、10.576,all P values<0.05),no significant differences in stress urinary incontinence and urethral funnelation(all P values<0.05).Logistic regression analysis of the study group showed that fetal body mass and pelvic organ prolapse were the risk factors of levator hiatus dilation;the duration of the second stage of labor and the use of oxytocin during vaginal delivery were also significant correlation with the levator hiatus dilation(all P values<0.05),but lateral episiotomy、laceration and analgesia labor had no significant effect on the levator hiatus dilation(all P values>0.05).Conclusions1.Pelvic floor ultrasound clearly shows the structure and biomechanical changes of the pelvic floor in women in the early postpartum period,which can quantitatively analyze the changes in pelvic floor function under different functions(at rest,Valsalva and pelvic floor muscle contraction).2.Patients who have vaginal delivery have more serious pelvic floor injuries through ultrasound measured,selective cesarean section may have a potential protective effect on recent pelvic floor muscle and peripheral support system injury after delivery.To analysis the effect of delivery modes on the complex anatomical structure and biomechanical function of female pelvic floor is helpful to understand deeply the etiology and prevention of pelvic floor injury.3.Female pelvic organ prolapse is an influential factor of levator hiatus dilation.Prolonged second stage of labor in vaginal delivery、increased use of oxytocin and body weight of newborn could dilated levator hiatus,reduced the contraction of levator ani muscle,which caused pelvic floor disease further.4.Pelvic floor ultrasound can not only make qualitative analysis of pelvic floor injury in postpartum women,but also positively distinguish the damaged pelvic floor structure,three-dimensional imaging technology can better evaluate the morphology of the levator hiatus and whether there is avulsion of levator ani muscle on the axial plane,pelvic floor diseases are diagnosed timely and accurately,it make up for the deficiency of clinical examination to a large extent.Figure[4]table[8]reference[109]... |
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