| BackgroundPelvic floor dysfunction(female pelvic floor dysfunction,FPFD)is a common pelvic floor injury disease,the main manifestations are stress urinary incontinence(stress urinary incontinence,SUI)and pelvic organ prolapse(pelvic organ prolapse,POP)and so on.The main pathogenic factors are closely related to the mode of pregnancy and delivery.Research data show,Women who developed urinary incontinence within 3 months after birth had 92% SUI after 5 years;Women who had no incontinence after birth had a SUI incidence of about 19% during the 5 years postpartum.research has shown that,vaginal delivery may injure the perineal nerve and levator ani muscle,and the pelvic fascia and other supporting tissue,resulting in the occurrence of FPFD;The use of elective cesarean section(elective cesarean section,ECS)can reduce the incidence of FPFD,but whether through selective cesarean section to prevent pelvic floor tissue from injury is still controversial.Clinical evaluation of pelvic floor structure and function have CT,MRI,defecography,urinary tract imaging,but these methods still have some limitations and shortcomings.Pelvic floor ultrasonography is first developed in European and American countries,and now it has become the main means of female pelvic functional diseases.This article through to the second stage of labor vaginal delivery,cesarean section and cesarean section maternal perineal pelvic ultrasonography in diagnosis of FPFD.In addition,studies have shown that proper pelvic floor muscle exercise can prevent FPFD from occurring in women after delivery.Therefore,this study also analyzed ultrasound pelvic floor functional exercise of pelvic floor muscle and non maternal exercise,and provided the basis for clinical treatment.ObjectivesThrough transperineal pelvic floor ultrasonography,to observe the influence of different delivery methods on the recent pelvic structure of postpartum.Evaluation of pelvic floor structure in early postpartum pelvic floor rehabilitation exercise by ultrasonography,to explore the necessity of rehabilitation training for parturient women.MethodsFrom January 2016 to January 2017 in our hospital maternity single full-term delivery,and after 42 days of postpartum review of primipara was 60 cases,among them,vaginal delivery group was 20 cases,cesarean section group was 20 cases,selective cesarean section group was 20 cases.60 cases were examined by pelvic floor muscle strength at the time of 42 d reexamination,the pelvic floor muscle strength grade was less than or equal to40 cases of patients were randomly divided into rehabilitation group and control group,each group was 20 cases.The rehabilitation group started the pelvic floor rehabilitation treatment at 42 d postpartum,the control group were given general health education measures.GE Volusion E8 ultrasonic diagnostic instrument was used to detect the following situations of parturient women:(1)The position of bladder neck,inclination of urethra and the angle of back bladder were observed and measured in resting state.(2)The bladder neck movement and the urethral rotation angle were measured under the maximum Valsalva maneuver,and the presence of the urethral crater and the bulging of the bladder were observed.(3)Three dimensional ultrasound was used to measure the pelvic diaphragm hiatus,the anteroposterior diameter,transverse diameter,area of the diaphragm hiatus and the angle of the pubic visceral muscle after the deep breathing and breath holding state(Valsalva state),and there were comparative analysis.Results1 The group of vaginal delivery,cesarean section group and selective cesarean section group ultrasound results:1.1 In the resting state,the three groups were compared,the Ar in the selective cesarean section group was lower,and Dr was significantly increased,the difference was statistically significant(P<0.05),the difference of CV-VDr and ARJ-VDr between the three groups was not statistically significant(P>0.05).1.2 The maximum Valsalva action,the three groups were compared,the ultrasound As,?,UVJ-M in the selective cesarean section group were significantly decreased,and the Ds was significantly increased,the difference was statistically significant(P<0.05);the difference of CV-VDs and ARJ-VDs between the three groups was not statistically significant when the maximal Valsalva maneuver was performed(P>0.05).1.3 Selective cesarean section uterine prolapse,urinary incontinence,vaginal wall bulge,the total incidence of lumbosacral pain(10%)was significantly lower than that in vaginal delivery group(70%)and the second stage of labor cesarean section group(60%),the difference was statistically significant(P<0.05);the group of vaginal delivery and cesarean section were compared,there was no significant difference in the total incidence of uterine prolapse,urinary incontinence,vaginal wall swelling,and lumbosacral pain(P>0.05).2 Analysis of ultrasonic results in rehabilitation group and control group2.1 the horizontal angle of PHA,PHD,PHTD and levator ani hiatus in the rehabilitation group was significantly lower than that of the control group under the resting state,and the difference was statistically significant(P<0.05).2.2 Under the condition of Valsalva,the PHA,PHD and PHTD of the rehabilitation group were significantly lower than those of the control group,the difference was statistically significant(P<0.05);the horizontal angle of levator ani hiatus in the rehabilitation group was compared with that in the control group,the difference was not statistically significant(P>0.05).2.3 In the constriction state,The PHA,PHD and PHTD of the rehabilitation group were significantly lower than those of the control group,and the difference was statisticallysignificant(P<0.05);The horizontal angle of levator ani hiatus in the rehabilitation group was compared with that in the control group,the difference was not statistically significant(P>0.05).Conclusions1 Vaginal delivery and cesarean section on early postpartum pelvic floor function and pelvic structure effect is more obvious than selective cesarean section,selective cesarean section can reduce the incidence of pelvic floor dysfunction.2 Pelvic floor exercises can help restore pelvic floor structures in women. |
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