| Objectives(1)To find out the incidence of pelvic floor dysfunction during pregnancy women, including urinary distress symptoms, pelvic organ prolapse distress symptoms, and colorectal-anal distress symptoms, and explore the influencing factors.(2)To find out the knowledge, attitude and performance of pelvic floor muscle training(PFMT) during pregnancy, and analyze the influencing factors.(3)To evaluate the effect of nursing intervention of PFMT at enhance the compliance of home-based PFMT during pregnancy and postpartum, the influence of delivery mode, time of labor stage, the pelvic muscle myodynamia6weeks and3months after delivery, the morbidity of stress urinary incontinence(SUI)6weeks and3months after delivery.MethodsChapter2:1180pregnant women were investigated by a questionnaire. The questionnaire included basic document of the women and status of pelvic floor dysfunction, which referred from the pelvic floor distress inventory-short form 20(PFDI-20), International Consultation on Incontinence Questionnaire Female Lower Urinary Tract symptoms (ICIQ-FLUTs) and International urinary incontinence Questionnaire.Chapter3:A sample of618nullipara were interviewed by a self-designed questionnaire of knowledge and performance of pelvic floor muscle exercise.Chapter4:106nullipara were divided into two groups randomized as intervention group and control group. All the nullipara were attend the pelvic floor training program, teaches by a midwife. A pelvic floor physical therapist measured the women’s pelvic muscle myodynamia, and teaches them the right mode of pelvic muscle contraction before intervention. All the women should do the PFMT for at least6to8weeks. A registered nurse monitored the intervention group via telephone checkups twice a week. The control group didn’t receive the individual directions.ResultsChapter2:1095qualified questionnaires were got, the passing rate was92.8%.1.The most common pelvic floor distress status were urinary frequency (74.3%)and nocturia(61.6%),followed by constipation(41.4%), sense of pelvic falling (40.3%), and UI(49.14%), of which SUI was29.2%, UUI was3.7%, MUI was4.9%, Other UI was2.6%. The constituent ratio of SUI, UUI, MUI, and Other UI was72.6%,9.2%,12.1%,6.1%. The vaginal discomfort(30.0%), dysporia (29.5%), vesical tenesmus(28.5%), fecal incontinence(22.3%),defecation urgency(17.6%) was also common, Among the fecal incontinence, gas incontinence was14.9%, liquid dejection incontinence was5.6%, solid dejection incontinence was1.8%.Pain on defecation(9.9%),assisting defecation(7.1%), kysthoptosis(6.8%), anal canal prolapse(1.9%) and assisting urination was infrequently.2.The constituent ratio of UI was deferent from nullipara to multipara(χ2=20.442, P<0.001).SUI was the common type of UI to both the nullipara and multipara, and followed by MUI. The constituent ratio of UI was the same between the vaginal delivery ones and the cesarean section ones(x2=4.934, P=0.177). SUI was the common type of UI to the vaginal delivery ones, followed by MUI.SUI was also the common type of UI to the cesarean section ones, followed by Other UI.3.72%of the ones got up during night3times,86.3%of the ones got up during night4times,97.3%of the ones got up during night more than4times, complained of suffering from sleep disorders. The morbidity of nocturia of multipara were more severe than the nullipara (Z=2.368, P=0.018), the vaginal delivery ones were more severe than the cesarean section ones(Z=3.264, P=0.001).4.The morbidity of urinary frequency of the multipara were more severe than the nullipara (χ2=11.153, P=0.001). there were no difference of those symptoms between the vaginal delivery ones and the cesarean section ones(x2=3.761, P=0.052). also excited no difference among different gestational weeks(χ2=8.917, P=0.112).5.The morbidity of vesical tenesmus of the multipara were more severe than the nullipara (χ2=7.037, P=0.008). there were no difference of those symptoms between the vaginal delivery ones and the cesarean section ones(x2=2.339, P=0.126). also excited no difference among different gestational weeks(x2=2.660, P=0.752).6.The morbidity of sense of pelvic falling excited difference among different gestational weeks (χ2=108.354, P<0.001),but there han no differences between the nullipara and the multipara (χ2=0.004, P=0.949), also the the vaginal delivery ones and the cesarean section ones (χ2=0.510, P=0.475)7.The morbidity of vaginal discomfort excited difference among different gestational weeks (χ2=73.032, P<0.001), but had no differences between the nullipara and the multipara (χ2=0.319, P=0.572), also the the vaginal delivery ones and the cesarean section ones (χ2=2.965, P=0.085) 8.The morbidity of kysthoptosis of the multipara were higher than the nullipara(x2=8.237, P=0.004), the vaginal delivery ones were higher than the cesarean section ones(x2=7.789, P=0.005), the difference also exited among different gestational weeks(x2=36.444, P<0.001).9.The morbidity of anal canal prolapse of the multipara were higher than the nullipara (χ2=4.624, P=0.032), the difference exited among different gestational weeks(x2=31.410, P<0.001), but no difference between the vaginal delivery ones and the cesarean section ones(χ2=3.291, P=0.070).10.The morbidity of assisting defecation, defecation urgency excited difference among different gestational weeks(χ2=36.431,<0.001), but had no differences between the nullipara and the multipara (χ2=1.920, P=0.166), also the the vaginal delivery ones and the cesarean section ones(χ2=1.940, P=0.164).11.The morbidity of constipation of the vaginal delivery ones were higher than the cesarean section ones(χ2=19.489, P<0.001), the difference also exited among different gestational weeks(x2=308.069, P<0.001).There were no difference between the nullipara and the multipara of the morbidity of constipation(χ2=1.548, P=0.213).12.The morbidity of dysporia of the nullipara were higher than the multipara (χ2=5.012,P=0.025),the difference also exited among different gestational weeks(χ2=263.926, P<0.001),but there had no difference between the vaginal delivery ones and the cesarean section ones(χ2=0.180, P=0.671).13.The morbidity of pain on defecation of the multipara were higher than the nullipara (χ2=14.249, P<0.001), the difference also exited among different gestational weeks(χ2=159.548, P<0.001), but there had no difference between the vaginal delivery ones and the cesarean section ones(x2=0.242, P=0.623).14.The morbidity of fecal incontinence exited no difference between the nullipara and the multipara (χ2=0.146, P=0.702), the differenct types of fecal incontinence also had no differences (χ2=1.642, P=0.200;χ2=0.105, P=0.746; χ2=2.765; P=0.096).The gas incontinence was the most common type of them, followed by the liquid dejection incontinence.There also exited no difference between the vaginal delivery ones and the cesarean section ones(χ2=0.085, P=0.771), the differenct types of fecal incontinence also had no differences (χ2=0.774, P=0.379; χ2=0-592, P=0.442;χ2=0.398; P=0.528).The gas incontinence was the most common type of the fecal incontinence of them, followed by the liquid dejection incontinence. The difference exited among different gestational weeks(χ2=414.405, P<0.001).15.The morbidity of cavity of defecation urgency excited difference among different gestational weeks(χ2=310.946, P<0.001), but had no differences between the nullipara and the multipara (χ2=0.384, P=0.535), also the vaginal delivery ones and the cesarean section ones(χ2=1.028, P=0.311).16.The pregnant women were divided into4groups per5-year-old stage, the pelvic floor dysfunction scores were increasing with age (χ2=29.729, P<0.001). The pregnant women were divided into6groups per4-gestational-week stage, the pelvic floor dysfunction scores were increasing with gestational weeks (χ2=391.950, P<0.001). The pelvic floor dysfunction score of the multipara were higher than the nullipara (Z=3.955, P<0.001). The pelvic floor dysfunction scores of the vaginal delivery ones were higher than the cesarean section ones(Z=5.383, P<0.001). The pregnant women were divided into3groups by the frequency of abortion, there had no difference among the pelvic floor dysfunction score of the groups (χ2=3.081, P=0.149). The pregnant women were divided into3groups by the BMI, there extied difference among the pelvic floor dysfunction score of the groups (χ2=90.496, P<0.001).Through linear regression analysis, we found the status of PFD were associated with age (t=6.132, P<0.001), mode of delivery(t=6.817, P<0.001), times of delivery (t=5.833, P<0.001), BMI(t=3.430, P=0.001), and the gestational weeks (t=19.401, P<0.001) of the pregnant women.Chapter3:30.7%of the nullipara knew pelvic floor muscle exercise while only11.3%knew the specific techniques of pelvic floor muscle exercise and2.1%exercised daily. There was a positive relationship between the knowledge level and educational background of the nullipara (Wald=10.550, P=0.001), the higher of the educational background, the higher of the knowledge level(OR=1.340).There was a significantly positive relationship between knowledge and frequency of exercise (Wald=145.481, P<0.001), the higher of the knowledge level, the better exercise doing(OR=57.628).Chapter4:The frequency of PFMT of the intervention group was better than the control group (Z=7.554, P<0.001; Z=8.090, P<0.001). The rate of cesarean section and elective cesarean section had no difference between the two groups (χ2=3.446, P=0.076;χ2=2.343, P=0.185). There was difference in the second stage of labor between the two groups (t=2.101, P=0.040), the other two labor stages had no difference (t=1.771, P=0.081; t=1.142, P=0.263). The gestational weight gain (t=0.196, P=0.845), the neonatal weight(t=0.113, P=0.911), the rate of episiotomy (χ2=0.932, P=0.351) and laceration of perineum (χ2=0.022, P=0.982) also had no differences.The pelvic muscle myodynamia of the intervention group were better than the control group6weeks and3months after delivery (Z=2.855, P=0.004; Z=3.899, P<0.001; Z=2.106, P=0.035; Z=2.293, P=0.022; Z=5.165, P<0.001; Z=6.106, P<0.001; Z=4.047, P<0.001; Z=4.256, P<0.001). the pelvic muscle myodynamia of the intervention group6weeks after delivery were worse than pregnancy (P=0.007; P=0.001),except the deep Ⅱ class fiber (P=0.062) and the superficial Ⅱ class fiber (P=0.072), The pelvic muscle myodynamia of all types3months after delivery were better than6weeks after delivery (P<0.001; P=0.001; P=0.007; P=0.001). There was no difference between3months after delivery and during pregnancy (P=0.908; P=0.553; P=0.358; P=0.298).The pelvic muscle myodynamia of the control group6weeks (P<0.001; P<0.001; P<0.001; P<0.001) and3months (P<0.001; P<0.001; P<0.001; P<0.001) after delivery were worse than pregnancy,6weeks and3months after delivery exited no difference (P=0.180; P=0.059; P=0.083; P=0.180)The morbidity of SUI6weeks and3months after delivery of the intervention group were lower than the control group (P<0.05). The morbidity of SUI of elective cesarean section ones (10.7%、7.1%) were lower both than the unslective cesarean section ones (40.0%、26.7%) and the vaginal delivery ones (31.7%、27.0%)6weeks and3months after delivery, the morbidity of SUI of unslective cesarean section ones (40.0%) was higher than the vaginal delivery ones (31.7%)6weeks after delivery, and almost the same (26.7%) with the vaginal delivery ones (27.0%)3months after delivery. There had no significant differences among the three groups(P>0.05).The influencing factors of the morbidity of SUI6weeks after vaginal delivery were prolonged second stage, BMI before delivery and frequency of PFMT after delivery. Among which, prolonged second stage (OR=15.121), BMI before delivery (OR=1.319), were dangerous factors, and frequency of PFMT after delivery (OR=0.503), was protective factor. The influencing factors of the morbidity of SUI6weeks after cesarean section were elective gestational weight gain, both of them were protective factors(OR=0.067, OR=0.745). The influencing factors of the morbidity of SUI3months after vaginal delivery were gestational weight gain, neonatal weight, and frequency of PFMT after delivery. Among which gestational weight gain (OR=1.372), neonatal weight (OR=48.767), were dangerous factors, and frequency of PFMT after delivery (OR=0.279), was protective factor. The influencing factors of the morbidity of SUI3months after cesarean section, was neonatal weight (OR=18.650), was dangerous factor.Conclusion1. The status of lower urinary tract symptoms and pelvic floor dysfunction was very common among pregnant women. These symptoms were severely impact the quality of life of the women during pregnancy. The medical staff should pay attention to the situation of the pregnant women with those symptoms.2. This study got the same prevalence of UI of pregnant women as foreign reports, SUI was the most common type of UI, followed by MUI, UUI.3. The symptom of nocturia of the multipara were more severer than the nullipara. The vaginal delivery ones were more severe than the cesarean section. It prompted that the nocturia may be related to women’s pelvic floor function, the poor the pelvic floor function, the more severely of the symptom of nocturia.4. The morbidity of cavity of pelvis bearing down, assisting defecation of the nullipara and the multipara, exited no differences, also had no differences between the vaginal delivery ones and the cesarean section. Further study was needed to assess the incidence of POP from symptoms survey of the pregnant women.5. The prevalence of constipation was high of the pregnancy women; it rose with the increase of gestational week. The medical staff should conducted health education include the knowledge of prevent constipation to the pregnant women to prevent or relieve the occurrence of it.6. In this study, the relationship between the fecal incontinence and the mode of delivery, and the parity, were difference from aboard. So further study need to be done.7. The status of PFD were associated with age, mode of delivery, times of delivery, BMI, and the gestational weeks of the pregnant women. The medical staff should intervention the high-risk groups at right time, and improves the quality of life of the pregnant women.8. The knowledge of pelvic floor muscle training remains poor in nullipara, consequently, they lack related exercise. The performance was related to knowledge level. Corresponding measures should be taken to improve the knowledge and eventually to improve the performance of pelvic floor muscle exercise.9. The pelvic muscle myodynamia of the pregnant women declined with the increase of the gestational weeks, the most significant period was the third trimester of pregnancy. It indicated that take the measures to prevent pelvic floor muscle myodynamia decline in the second trimester a more appropriate time.10. The twice a week telephone follow-up of PFMT of the pregnant (postpartum) women had play a good supervisory role, which not only improve the women and their families’satisfaction for the hospital services, but also promote the compliance of their exercises.11. The persistent nursing intervention to the pregnant (postpartum) women made them to have a good pelvic floor muscle exercise behavior, helped to shorten the second stage of labor, contribute to the recovery of postpartum pelvic floor muscle myodynamia, and reduce the mobility of the SUI postpartum. The influence of nursing intervention of this study to the delivery mode, rate of episiotomy and laceration of perineum was undiscovered.12. Postpartum pelvic floor muscle exercises behavior was a protective factor for postpartum SUI, and elective cesarean section may be the temporary pretective factor.Gestational overweight gain, newborn overweight, higher BMI of the mother before the delivery were the risk factors of postpartum SUI. The medical staff should strengthen the health education during pregnancy and the prenatal examination, give a reasonable guidance about the nutrition and exercises, and conduct the necessary intervention of weight, to prevent the excessive growth of weight gain during pregnancy, and strive to get good pregnancy outcomes, and to take precaution against postpartum SUI. |
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