Study On The Effect Of Pelvic Floor Muscle Training To Prevent Pelvic Floor Dysfunction During Pregnancy And Postpartum

Objective:To investigate the effect of pelvic floor muscle training(PFMT)during gestation and postpartum on preventing pelvic floor dysfunction(PFD).Method:This is a case controlled study based on hospital.A total of 456 subjects with regular antenatal care and primiparity from obstetrics and gynecology department at Xiamen Chunggung Hospital from 2014.01.01 to 2014.12.31 were recruited in this study and divided randomly into PFMT group and control group.Physical therapists from pelvic floor rehabilitation center were responsible for the training in PFMT group,from 20 th gestational week to 12 months after delivery(at least 3 times a week).Control group was given health education and guidance for both pregnancy and postpartum,excluding PFMT.The VRP,VSP and SUI rate,POP rate were measured at the 36 th gestation week,six months and twelve months after the delivery;we use SUI occurrence rate,POP-Q scoring questionnaire to diagnosis SUI and POP,questionnaire via FSFI rating scalet to evulate satisfaction index of sexual life.We use the methods of t-test and chi-square test in STATA 16.0 system.Result:1.The VRP and VSP values of PFMT group in 36 th gestation week were 53.3±9.6cm H2 O and 86.8±13.4cmH2 O respectively,and the VRP and VSP values of PFMT were46.5±8.1cmH2 O,70.8±11.0cmH2 O,the former were significantly higher than the control group with significant differences(P<0.05);the incidence rates of SUI were8.3% and 11.2% respectively,and the urinary incontinence rate in PFMT group was remarkably lower than that of control group(P<0.05).2.The delivery states comparison : The first stage of labor of experimental group and control group were 11.2±1.03 h ? 11.8±1.08,the cesarean section rate of the two group were 16.7% and 14.9%,respectively,the second stage of labor of the two group were50.5±21.3mins and 68.3±27.2mins,and vaginal assisted delivery rates were 7.2%and9.8%,respectively.There was no statistical significance observed in the first stage of labor and cesarean section rate between two groups(P>0.05).But the second stage of labor and vaginal assisted delivery rate were obviously lower in PFMT group(P<0.05).3.The VRP and VSP of the experimental group were 49.7±8.5cmH2 O,80.3±12.8cm H2 O,while the value of control group were 42.6±7.0cm H2 O,69.8±10.2cmH2 O,the former value were remarkably higher than the control group(P<0.05).The proportions of O-grade by POP-Q scoring in experimental group and control group 6 weeks after labor were 62.6 % and 48.9%,the former was significantly higher than the controls(P<0.05).SUI incident rate of the two groups were 10.3% and 13.5%,the experimental group rate was significantly lower than the control group(P<0.05);4.The results of six months after delivery:the VRP and VSP of the experimental group and control group were 46.5±8.1cmH2 O ? 75.2±11.2cmH2 O and 43.6±7.3cmH2 O ?68.7±9.7cmH2 O,the SUI rates were 12.1% and 13.0%,There was no statistical significal difference between two groups(P>0.05).Respectively,the POP-Q-grade proportion were 55.7% and 46.9%,and the FSFI scoring were 21.1 ±3.5 and 16.3 ±2.6.The former was significantly higher than the controls(P<0.05).By stratification analysis(BMI=25)for the results of 6 months after delivery,no statistical significance was observed in POP-Q O-grade proportion,vaginal pressure measurement,SUI incident rate and FSFI scoring(P>0.05);however,for the subjects of BMI<25,the POP-Q O-grade proportion,vaginal pressure measurement and FSFI scoring in PFMT group were noticeably higher than the controls,conversely,the SUI rate was significantly lower than the control group(P<0.05).5.The results of twelve months after delivery: the VRP and VSP of the experimental group and control group were 49.1±6.9cmH2 O ? 80.3±12.6cm H2 Oand 46.0±7.8cm H2O?69.1±9.9cmH2 O,the SUI rates were 12.3% and 12.8%,there was no statistical significal difference between two groups(P>0.05).Respectively,the POP-Q-gradeproportion were 55.8% and 49.2%,and the FSFI scoring were 22.9 ±3.7and 17.5±2.9.The former was significantly higher than the controls(P<0.05).By stratification analysis(BMI=25)for the results of 12 months after delivery,no statistical significance was observed in POP-Q O-grade proportion,vaginal pressure measurement,SUI incident rate and FSFI scoring(P>0.05);however,for the subjects of BMI<25,the POP-Q O-grade proportion,vaginal pressure measurement and FSFI scoring in PFMT group were noticeably higher than the controls,conversely,the SUI rate was significantly lower than the control group(P<0.05).Conclusion:1.Regular PFMT begins from mid-pregnancy can reduce the incident rates of SUI and POP in the later period of pregnancy;2.Regular PFMT from mid-pregnancy can shorten the second stage of labor and reduce vaginal assisted delivery rate instead of cesarean section rate and the first stage of labor;3.Long-term and regular PFMT during pregnancy and postpartum can improve the pelvic floor organ function,enhance vaginal VRP and VSP,as well as reduce the incident rates of SUI or POP six weeks after delivery.4.For the subjects of BMI<25,the PFMT begins from pregnancy and postpartum can significantly improve the pelvic floor function six months or twelve months after labor,with reduced SUI or POP rates and more satisfied sexual life.For subjects of BMI?25,PFMT alone cannot improve pelvic function.