Ultrasound Assessment Of Pelvic Floor Morphology Based On The Integral Theory For Stress Urinary Incontinence During Pregnancy

BackgroundStress Urinary Incontinence(SUI)has a high prevalence during pregnancy and makes a significant impact on the quality of life of patients,and the pathogenetic mechanism of SUI during pregnancy is still unknown.There are some theories and hypothesis about the pathogenetic mechanism of SUI.The Integral Theory are the universally accepted theories Nevertheless,this theory was used in the surgical and non-pregnant population,whether it could be used in pregnant women with SUI remains to be explored.Objectives1.Exploratory factor analysis(EFA)was used to screen observation variables and factors used to evaluate the pelvic floor morphological changes for SUI during pregnancy.2.Based on the results of EFA,a structural equation model(SEM)for the pathogenetic mechanism of SUI during pregnancy from the perspective of pelvic floor morphological changes was constructed to explore the application of the Integral Theory in SUI during pregnancy.Methods1.A cross-sectional survey was performed among pregnant women from July to December 2016.In total,245 pregnant women from from Shenzhen Hospital,Southern Medical University and Shenzhen Maternal&Child Healthcare Hospital underwent an interview and pelvic floor transperineal ultrasound assessment.A questionnaire regarding sociodemographic and the diagnosis of SUI was used for the interview.Transperineal ultrasound examination was performed to assess pelvic floor.Homogeneity test and EFA was used for items screening and factors extracting,respectively.2.A 1:1 case-control study was conducted on 103 patients with SUI and non-SUI who presented in this two hospitals between May and September 2017.A questionnaire regarding sociodemographic and the International Consultation on Incontinence Questionnaire-Short Form(ICI-Q-SF)was used for the interview.survey and transperineal ultrasound examination were performed(the same as last step).The direct and indirect effects of each variable on SUI during pregnancy were analyzed based on the results of EFA.Results1.After excluding 29 women with invalid data,216 women were included.Thirty-four parameters were selected after the literature review and theoretical analysis.Twenty-four items were deleted after the homogeneity test and EFA.The results of Kasier-Meyer-Olkin(KMO)and Bartlett's Test of Sphericity were 0.762 and 1364.48(P<0.001),respectively,which means these data were suitable for EFA.Three factors were explored and defined after EFA,they were the motivation of urethrovesicopubic,including 6 items,?(v),??(vR),Dx(v),Dx(vR),Dy(v),?Dy(vR),the motivation of urine,including ?(v),Ay(vR),changes of HA,including 2 items,HA(v),?HA(vR).Factor accumulation contribution was 73.339%.2.Both case group and control group enrolled 103 cases respectively to construct a SEM.?(v),?y(vR)were deleted during the progress of model modification.The modified model was evaluated by some important fit indices.Its X2/df,goodness of fit index,(GFI),adjusted goodness of fit index(AGFI),normed fit index(NFI),non-normed fit index(NNFI),incremental fit index(IFI),comparative fit index(CFI),root mean square error of approximation(RMSEA),and standardized root mean square residual(SRMR),which were 2.107,0.960,0.904,0.976,0.975,0.987,0.987,0.074 and 0.032,respectively.3.The two main paths of the model were as follows:the motivation of urethrovesicopubic,changes of HA.The standardized coefficients of their total effects on SUI during pregnancy were 0.604(P<0.05),0.178(P<0.05),respectively.Conclusions1.As a whole,the model fitted well,and the theoretical model proposed is mainly adapted with the data provided in this study,which means the model is acceptable.EFA and SEM are feasible to explore the pathogenetic mechanism of SUI during pregnancy from the perspective of pelvic floor morphological changes.2.The contraction of SEM was based on the Integral Theory,which showed the the pathogenetic mechanism of SUI during pregnancy was related with the motivation of urethrovesicopubic,and the changes of HA.In other worlds,the Integral Theory can be used in pregnant women with SUI.