| Background and ObjectiveHuman pelvic floor tissues mainly comprise the pelvic outlet closure of the multi-layer muscle and fascia.The complex pelvic floor support system can support and maintain pelvic organs(such as: uterine and adjacent bladder and rectum)in the normal anatomical position,and maintain physiological functions of urination,defecation,sexual pleasure.The pathological changes of structure of pelvic tissue due to pregnancy,delivery,aging and other causes,eventually led to a series of diseases corresponding pelvic organ dysfunction.That is clinically termed pelvic floor dysfunction(PFD),which mainly referring to the stree urinary incontinence(SUI),and pelvic organ prolapse(POP).PFD is considered to be a globly public health problem that has a critical impact on physical and mental health and quality of life for women,as the development of society and requirement for high life quality.The mode of delivery is a independent risk factor of PFD,the damage of vaginal delivery on pelvic floor function is more obviously.Therefore,the problem that needs to solve for preventing the disease is how to reduce the injury of vaginal delivery on the pelvic floor function,and reduce the incidence of PFD.Clinically,water immersion and epidural anesthesia during labor were common in the first stage of labor.American congress of Obstetricians and Gynecologists pointed out that water immersion during the first stage of labor may be associated with decreased labor pain or use of anesthesia and decreased the duration of labor.Recent studies have shown that epidural analgesia can directly mitigating labor pain,and may be associated with a prolonged duration of second stage of labor.Whether different laboring modes during the first stage of labor can reduce the injury of vaginal delivery on the pelvic floor function was still a lack of clinical data.This study by comparing effects of water immersion during labor,epidural anesthesia labor and conventional labor on the pelvic floor function in primipara in in the early postpartum period,to explore which laboring mode contribute to reducing the injury of function pelvic floor function by vaginal delivery.Accordingly to provide theoretical basis for prevention and treatment of the disease.Materials and Methods1.Study objectThis study included 293 cases healthy primipara hospitalized in Obstetrical Department of Third Affiliated Hospital of Zhengzhou University for vaginal delivery during June 2015 and February 2016 featured by singleton pregnancies and cephalic presentation.According the choice of laboring mode to divided into water immersion labor group,epidural analgesia labor group and conventional labor group.group;According the mode of delivery to further excluded cesarean section,and 190 cases of vaginal delivery,water immersion labor group was 60 cases,epidural analgesia labor group was 63 cases and conventional labor group was 67 cases.2.Methods(1)The cesarean section rate of three groups were followed.(2)The maternal and neonatal outcomes of primipara by vaginal delivery of three groups were followed: the duration of labors,episiotomy and perineal laceration,intrapartum and postpartum bleeding,neonatal body weight and Apgar score.(3)Stress urinary incontinence symptoms at pregnancy and at 42 days after delivery of primipara by vaginal delivery of three groups were followed.(4)Using pelvic organ prolapse quantitation to evaluate pelvic organ prolapse at 42 days after delivery.(5)Using PHENIX U8 neuromuscular stimulator to test pelvic floor electrical physiological at 42 days after delivery: Pelvic floor muscle strength(type?and type?muscle fibers strength),the degree of pelvic floor muscle fatigue(the degree of type?and type?muscle fibers fatigue),and dynamic pressure of vaginal.3.Statistical methodsSPSS statistics(version 21.0)was used for this statistical analysis.The decriptive analysis was developed by calculating the means and standard deviations quantitative variables.One-way AVOVA was used to analysis three groups variables,and least significant difference test was used to analysis two groups date.For the analysis of categorical variables,we calculated the absolute frequencies and quartiles.?2 test was used to analysis categorical variables.Statistical signicance was considered when P < 0.05.Statistical significance of every two groups was considered when P < 0.017.Result1.The basic information of pregnant womenThe comparison of the age,the body mass index of prepregnancy and intrapartum and gestation age of pregnant women among three groups was no significant difference(P > 0.05).2.The rate of cesarean sectionThe rate of cesarean section of water immersion group was 14.3%(9/69),was significantly lower than conventional group 29.5%(28/95),the difference was statistically significant(P < 0.017).3.The maternal and neonatal outcomes of primipara(1)The indexes of the duration of third stage of labor and second stage of labor >2h,perineal laceration rate,intrapartum and postpartum bleeding,neonatal body weight,Apgar score at 1minute and 5minute had no statistically significant difference(P > 0.05).(2)The incidence of episiotomy of water immersion group was 41.7%(25/60),was significantly lower than conventional group 64.2%(43/67)and epidural anesthesia group 68.3%(43/63),separately compared,the differences were statistically significant(P < 0.017).(3)The duration of first stage of labor in water immersion group was(577.67 ± 230.96)min,was significantly shorter than epidural anesthesia group(709.73 ± 270.55)min,there was statistically significant(P < 0.017).(4)The duration of second stage of labor in epidural anesthesia group was(70.05 ± 42.20)min,was significantly longer than conventional group(51.49 ± 37.06)min,the difference was statistically significant(P < 0.017).4.The incidence of stress urinary incontinence symptoms(1)The incidence of stress urinary incontinence symptoms during pregnancy of three groups had no statistically significant difference(P > 0.05).(2)The incidence of stress urinary incontinence symptoms 42 days postpartum of water immersion group was 8.3%(5/60),was significantly lower than conventional group 25.8%(17/66),epidural anesthesia group 30.6%(19/62),separately compared,the differences were statistically significant(P < 0.017).5.Pelvic organ prolapse quantitation at 42 days after delivery(1)According to Points Aa,water immersion group was(-2.03 ± 0.75)cm,the downward movement of the point was significantly slighter than conventional group(-1.56 ± 0.69)cm and epidural anesthesia group(-1.62 ± 0.82)cm,separately compared,there were statistically significant(P < 0.017).(2)According to Points Ba,water immersion group was(-2.03 ± 0.70)cm,the downward movement of the point was significantly slighter than conventional group(-1.55 ± 0.76)cm and epidural anesthesia group(-1.61 ± 1.05)cm,separately compared,there were statistically significant(P < 0.017).6.Pelvic floor muscle strength at 42 days after delivery(1)The proportion above leve ? of type?muscle fibers strength inwater immersion group,conventional group and epidural anesthesia group were:63.3%(38/60),40.9%(27/66)and 29.0%(18/62);the proportion above leve ? of type?muscle fibers strength in water immersion group were higer than conventional group and epidural anesthesia group,the differences were statistically significant(P < 0.017).(2)The proportion above leve ? of type?muscle fibers strength inwater immersion group,conventional group and epidural anesthesia group were: 65.0%(39/60),42.4%(28/66)and 24.2%(15/62);the proportion above leve ? of type?muscle fibers strength in water immersion group was higer than conventional group and epidural anesthesia group,the differences were statistically significant(P < 0.017).ConclusionWater immersion during labor is associated with a lower rate of cesarean section and episiotomy and a shortened duration of second stage of labor.Water immersion during labor may be a protective factor of PFD,it is a fit laboring method for primipara. |
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