| Objective1.To understand the relationship between pregnancy and childbirth and some postpartum pelvic floor dysfunctions including postpartum pelvic floor muscle injury,stress urinary incontinence and pelvic organ prolapse.2.To evaluate the effect of the combination therapy of pelvic floor muscle training and electrical stimulation for postpartum pelvic floor dysfunction so as to provide theoretical basis for prevention and treatment of postpartum pelvic floor dysfunction.MethodsBy convenient sampling,2173 single birth postpartum women with a mean age of 29.49±3.93 years were selected while having their routine follow-up 6-8 weeks after delivery at the outpatient department of maternal and child health hospital of Gansu province from November 2015 and April 2016 to carry out the following studies:(1)Some information including the basic situation of postpartum women,childbirth and pregnancy complications were collected through a questionnaire survey and reviewing their electronic medical records;(2)The pelvic floor muscle strength was detected by the digital palpation method and vaginal dynamometer so as to analyze the incidence of pelvic muscle damage;(3)The clinic diagnosis and pelvic organ prolapse quantitation(POP-Q)system were respectively used to detect stress urinary incontinence(SUI)and pelvic organ prolapse(POP),so as to obtain the incidence of SUI and POP;(4)Combined with the questionnaire survey and reviewing medical records information,single factor analysis and multi-factor Logistic regression were used to analyze the influencing factors of postpartum pelvic floor muscle damage,SUI and POP;(5)315 cases postpartum women were chosen from women who accepted postpartum examination at our outpatient department according to the identified inclusion and exclusion criteria.On the basis of the pelvic floor function evaluation by pelvic floor electromyography biofeedback instrument,the pelvic floor rehabilitation therapeutic apparatus USB4 was used to conduct a combined treatment of electrical stimulation and biofeedback.And then,some indicators such as the pelvic floor surface electromyography(sEMG)indexs,pelvic floor muscle strength,the scores of pelvic floor distress inventory-short form 20(PFDI-20),the scores of incontinence quality of life questionnaire(I-QOL)and the changes in SUI symptoms were investigated and compared between before and after treatment so as to evaluate the effect of the rehabilitation therapy.Results1.The influencing factors analysis on postpartum PFD(1)The detection rates of type ? and type ? pelvic floor muscle fiber damage were 94.29% and 83.53% respectively.The single factor analysis showed that delivery mode and fetal weight were associated with postpartum pelvic floor muscle damage.Multi-factor analysis showed vaginal delivery(OR=1.890,95%CI: 1.298-2.753)was a risk factor for postpartum pelvic floor muscle damage.(2)The detection rates of SUI in pregnancy and after delivery were 23.19% and 8.47% respectively.The symptoms of SUI in pregnancy lasted up to the postpartum period and accounted for 56.90% of the postpartum SUI.The single factor analysis showed that maternal age,pre-pregnant BMI,laceration of perineum,delivery mode,parity and fetal head circumference were associated with postpartum SUI.Multi-factor analysis showed that maternal age?35 years increased the risk for the postpartum SUI(OR=2.102,95%CI: 1.222-3.615);women with overweight and prepregnancy BMI were more likely to elevate the risk for postpartum SUI(OR=1.895,95%CI: 1.105-3.251);vaginal delivery(OR=8.869,95%CI: 4.231-18.59)and parity(OR=1.510,95%CI: 1.011-2.256)were also risk factors for postpartum SUI.(3)The detection rates of the vaginal anterior and posterior prolapse were 19.05% and 4.23%,respectively,the total amount of the two conditions accounted for 17.4% of the number of patients with vaginal anterior and posterior prolepses.The detection rates of POP-Q including 0,? and ? degree were 80.17%,15.97%,3.87%,respectively.The single factor analysis showed that maternal age,pregnant times,laceration of perineum,delivery mode,parity,and fetal head circumference were associated with the postpartum vaginal anterior and posterior prolapse.Multi-factor analysis showed that maternal age ?30 years increased the risk for postpartum vaginal anterior and posterior prolapse(30~35 years OR=1.375,95%CI: 1.072-1.765;maternal age ?35 years OR=1.726,95%CI: 1.151-2.589);vaginal delivery(OR=5.139,95%CI: 3.396-7.779)and parity(OR=1.514,95%CI: 1.077-1.129)were also risk factors for postpartum vaginal anterior and posterior prolapse.2.Evaluation of therapeutic effects of postpartum pelvic floor rehabilitation(1)Compared with before treatment,the average sEMG of Glazer was significantly lower after postpartum pelvic floor rehabilitation treatment.The maximum sEMG of rapid contraction,the average sEMG of sustained contraction and endurance contraction elevated significantly than before treatment(t=-24.969~2.014,P<0.05).(2)After postpartum pelvic floor rehabilitation,the average of type ? and type ? muscle fiber strength was 2.66±1.29 and 3.61±1.23,respectively.Compared with before treatment,the average of pelvic floor muscle fiber strength was obviously improved(P<0.05).The detection rates of type ? muscle fiber damage before and after treatment were 96.19% and 48.25%,respectively.In addition,the detection rates of type ? muscle fiber damage before and after treatment were 90.16% and 25.71%,respectively.The detection rates of pelvic floor muscle fiber damage significantly decreased after treatment(P<0.05).(3)After postpartum pelvic floor rehabilitation,the scores of I-QOL obviously increased and PFDI-20 obviously decreased(P<0.05).(4)After postpartum pelvic floor rehabilitation,the symptoms of SUI improved greatly(P<0.05).Conclusions1.The detection rates of pelvic floor muscle damage are at a high level in women of receiving the early postpartum reexamination.In addition,the detection rates of postpartum SUI and postpartum vaginal anterior and posterior prolapse were still at a high level.2.The vaginal delivery is a risk factor for postpartum pelvic floor muscle damage;maternal age ?35 years,overweight and obesity,vaginal delivery and parity were risk factors for postpartum SUI;maternal age ?30 years,vaginal delivery and parity are risk factors for postpartum vaginal anterior and posterior prolepses.3.The combination treatment of the postpartum pelvic floor dysfunction with the pelvic floor muscle training and electrical stimulation with biofeedback shows an obvious clinical therapeutic effect in improving the function of postpartum pelvic floor and the quality of life,and deserved to promote widely. |
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