The Impact On Anatomy And Function In Continent Of Female Lower Urinary Tract After Pregnancy And Delivery In Primigravidae

Objective We aim to investigate the anatomic and functional changes of female lower urinary tract in continent after pregnancy and delivery in primigravidae undergoing perineal sonographic urodynamics measurement. We also want to explore whether postpartum caused by pregnancy itself, whether the selected caesarean section could protect female lower urinary tract. Method From January to December in 2003, 31 primigravidae at 38～40 gestational weeks and 20 nulliparous childbearing women in controlled group have been recruited for perineal sonographic urodynamics measurement. We divided 24 primigravida whose VLPP≥90cmH2O into spontaneous vaginal delivery and selected caesarean section. The following parameters have been determined through perineal sonographic urodynamics including postvoid residual bladder volume(PVRBV) ,mobility of urethrovesical junction (UVJ-M),maximal urethral closure pressure (MUCP),functional urethral length (FUL) and Valsalva leak point pressure The impact on anatomy and function in continent of female lower urinary tract after pregnancy and delivery in primigravidae Abstract (VLPP). We analysed the difference between primigravidae in third trimester and postpartum with nulliparous women on all parameters. Results The average gestational weeks of thirty one primigravidae are 273.06±5.57 days. The results of VLPP is less than 90 cmH2O in five cases(16%) and more than 90 cmH2O in twenty six cases. Comparing with them, UVJ-M increased to 20.70±1.99mm in the cases of five and 13.04±4.91mm in the other twenty six cases, the difference was great significant(P<0.01). We also found that the hypermobility of urethrovesical junction was significantly in the third trimester compared with non-pregnant women(P<0.01),but did not reduce in postpartum period of 6～8 weeks after delivery . MUCP increased after delivery in two types, but the difference was nonsignificant(P>0.05), while FUL decreased with very significant differnence(P<0.01). The parameters of UVJ-M ,MUCP and FUL showed nonsignificantly different between two types of delivery(P>0.05).There is no urinary retention before and after delivery(PVRBV<10ml). Conclusion Female lower urinary tract function in continence was not descended transitorily by spontaneous vaginal delivery or selected caesarean section, nevertheless the datum has suggested that there is hypermobility of bladder neck in the thirdThe impact on anatomy and function in continent of female lower urinary tract after pregnancy and delivery in primigravidae Abstract trimester, which is regarded as a key risk anatomical factor to develop stress urinary incontinence after childbirth. It's necessary to perform pelvic floor exercises or other treatment to strengthen the supporting of female lower urinary tract in the second and third trimester to reduce the rate of postpartum urinary incontinence.