Evaluation Of Rehabilitation Effect Of Postpartum Pelvicfloor Dysfunction By Ultrasound

Objective: To observe the pelvic floor structure in postpartum women by the perineumultrasound who choose postpartum pelvic floor rehabilitation treatment. To study theimaging parameters which can evaluate the effect of pelvic floor dysfunctionrehabilitation treatment and provide intuitive, reliable imaging evidence for clinical.Methods:(1)Collected data of67patients who were diagnosed female pelvic floor dysfunction inour postpartum care clinics from January of2013to december of2013.All patients wererandomly divided into2groups: rehabilitation group(35patients) and control group (32patients),two groups were both adopted self control analysis.(2)The patients of rehabilitation group began to accept pelvic floor rehabilitationtherapy in the pelvic floor rehabilitation center after postpartum8weeks，the time oftreatment were8weeks; The patients in control group were only taking general healtheducation and postpartum exercises after postpartum. The rehabilitation group were taketransperineal ultrasonography in postpartum6-8weeks and after postpartum pelvic floorrehabilitation treatment; The control group were take transperineal ultrasonography inpostpartum6-8weeks and postpartum20weeks.(3)Observed dynamicly the pelvic floor structure of FPFD patients after acceptingpostpartum rehabilitation under the conditions of resting, shrinking anus, valsalvamaneuver by perineum ultrasound. The datas of bladder neck descen（BND）， storagethree-dimensional volume were collected and conducted by4D view post-processingsoftware, then measured and analyzed pelvic diaphragm hiatal areas, perimeters,anteroposterior diameters, mediolateral dimension and the width of pubic rectummuscles. Results:(1)Rehabilitation group: Pelvic diaphragm hiatal areas, perimeters,anteroposteriordiameters after rehabilitation treatment were narrower than that before rehabilitationtreatment (postpartum6-8weeks) under the conditions of resting and valsalva maneuver, itwas statistically significant（p＜0.05）.There were no obvious change in mediolateraldimensions and the width of pubic rectum muscles（p＞0.05）,compared to beforerehabilitation treatment,BND decreased,it was statistically significant（p＜0.05）; Theareas, perimeters,anteroposterior diameter and transverse diameter of pelvic diaphragmhiatus after rehabilitation treatment were narrower than that before rehabilitation treatmentunder the conditions of shrinkage anal,（p＜0.05）,the width of pubic rectum muscles wasgreater than that of before rehabilitation treatmen（tp＜0.05）,it was statistically significant.(2)Control group: there were no obvious changes of the pelvic diaphragm hiatal areas,perimeters, anteroposterior diameters, the width of pubic rectum muscles and BND underthe conditions of resting and valsalva maneuver in postpartum20weeks compare topostpartum6-8weeks（p＞0.05）. It was no statistically significant in mediolateraldimensions of pelvic diaphragm hiatal under the conditions of resting（p＞0.05）,comparedto postpartum6-8weeks, mediolateral dimensions of pelvic diaphragm hiatal under theconditions of valsalva maneuver was enlarger（p＜0.05）; pelvic diaphragm hiatal areas,perimeters,anteroposterior diameters, mediolateral dimensions in postpartum20weeks atthe condition of shrinkage anal were less than that in postpartum6-8weeks（p＜0.05）;Itwas no obvious change in the width of pubic rectum muscles（p＞0.05）,compared topostpartum6-8weeks.(3)Compared parameters between rehabilitation group and control group: under theconditions of resting and valsalva maneuver, pelvic diaphragm hiatal areas, perimeters,anteroposterior diameters and BND in the rehabilitation group were smaller than that in thecontrol group, it was statistically significan（p＜0.05）; Under the conditions of resting,there was no change in pubic rectum muscles; under the conditions of valsalvamaneuver,the width of pubic rectum muscles was a little wider than control group(p＜0.05; There were no obvious changes in the pelvic diaphragm hiatal areas and pubicrectum muscles of two groups under the conditions of shrinkage anal. (4)Compared difference value of parameters between rehabilitation group and controlgroup: there were no obvious change of difference values of pelvic diaphragm hiatal areas,perimeters, anteroposterior diameters, mediolateral dimensions and pubic rectum musclesunder the conditions of resting（p＞0.05）;There were obvious change in the difference ofpelvic diaphragm hiatal areas, perimeters, anteroposterior diameters, mediolateraldimensions under the conditions of valsalva maneuvebetween two groups（p＜0.05）; therewas no obvious change in difference of pubic rectum muscles（p＞0.05）;there was changein difference of BND in the rehabilitation group and control group（p＜0.05）;there weredifference in difference values of pelvic diaphragm hiatal areas, anteroposterior diameters,mediolateral dimensions at the time of shrinkage anal（p＜0.05）, there were no obviouschange in difference of perimeters and pubic rectum muscles（p＞0.05）.Conclusion:(1) The research observed the abnormal imaging of postpartum pelvic floor structure,which confirmed that pregnancy and delivery caused different degrees of injury on pelvicfloor structure of women which is an important risk factor caused early postpartumFPFD.;the transperineal ultrasound can be applied widely in postpartum screening anddiagnosis, evaluation of therapeutic effect of FPFD widely.It is an irreplaceable andclinical value imaging techniques.(2) That observing the changes of pelvic floor dynamic parameters by perineal ultrasoundbefore and after the rehabilitation treatment can be used as an important imaging index inthe assessment of pelvic floor rehabilitation, because the statistical analysis results show-ed that pelvic diaphragm hiatus, rectal muscle and BND pubic can comprehensiv-elyand dynamically reflect the structure and function of pelvic floor. At the same time, itcan evaluate the pelvic morphology and function, provide true, reliable basis for clinicalimaging.