| Objectives High frequency ultrasound was used to observe the dynamic changes of the inter-rectus distance and pubic symphysis distance in the third trimester of pregnancy and postpartum,and to provide imaging basis for clinical prevention,diagnosis and postpartum rehabilitation of diastasis recti abdominis(DRA)and pubic symphysis diastasis(PSD).Methods The study is a prospective longitudinal study.The pregnant women in the third trimester(36~41 weeks)who underwent prenatal ultrasound examination in the Ultradiagnosis Department of Tangshan Workers Hospital and delivered in our hospital from January to December 2019 were selected as the research subjects for follow-up.From the observation cut-off point,a total of 101 pregnant women with complete data were included in the study group;another 80 females of infertile childbearing age(with no difference in age composition from the study group)were selected as the reference control group.Formulate a questionnaire,collect the basic data of the research subjects,and divide them into the vaginal delivery group and the cesarean section group according to the mode of delivery.The cesarean section group used high-frequency ultrasound to measure the interrectus distance and pubic symphysis distance,and other sonograms at three points in late pregnancy,42 days postpartum,and 6 months postpartum.The control group was measured once after being selected.At each time point,the clinical symptoms(low back pain,pelvic pain)of the study subjects were scored by Visual Analog Scales(VAS),and the correlation between inter-rectus distance,pubic symphysis distance and the degree of pain was studied.The inter-rectus distance is greater than 2cm as the diagnostic criteria for diastasis recti abdominis in the study,and it is divided into the DRA group and without DRA group according to whether the inter-rectus distance is greater than 2cm at the umbilical level at 6 months postpartum and the influencing factors of diastasis recti abdominis analyzed.SPSS24.0 statistical software was used to analyze and process the data.Measurement data that conformed to the normal distribution are represented by(sx ±),using t test;measurement data that do not conform to the normal distribution are represented by the median(interquartile range)Mann-Whitney U test;count data expressed as a rate,using chi-square test;repeated measurement data was analyzed by twofactor repeated measurement analysis of variance,and LSD-t test was used for pairwise comparison;correlation analysis using Spearman rank correlation analysis;Factor analysis Statistically significant variables were analyzed by multivariate logistic regression.Results 1 The study showed that the inter-rectus distance and pubic symphysis distance gradually decreased with time.By 6 months after delivery,the inter-rectus distance had not returned to normal,and the difference was statistically significant compared with the control group(P<0.05).The pubic symphysis distance returned to normal,and there was no statistically significant difference compared with the control group(P>0.05).2 The study showed that the recovery of inter-rectus distance is different in different delivery modes.The recovery rate of the inter-rectus distance at the umbilical level and 5 cm below the umbilicus is better than that of the cesarean section group(P<0.05).There was no statistically significant difference between the groups(P>0.05);there was no statistically significant difference in the recovery of pubic symphysis distance in different delivery modes(P> 0.05).3 There is no obvious correlation between the inter-rectus distance and low back pain,pubic symphysis distance and pelvic pain at different time points.4 Single factor analysis results show that: compared with primipara and vaginal delivery,the proportion of DRA after labor and cesarean delivery is significantly increased(57.45% vs 31.48%,68.42% vs 37.81%);the maternal age,neonatal weight,abdominal circumference,pre-pregnancy weight,pre-pregnancy body mass index(BMI),late pregnancy weight,late pregnancy BMI,and weight gain during pregnancy in the DRA group were all greater than those without DRA group,the difference was statistically significant(P<0.05);there was no significant difference in height and gestational age between the two groups of pregnant women(P>0.05).5 The results of multi-factor analysis showed that: the age of the pregnant woman,the mode of delivery,parity,the weight of the newborn and the weight gain during pregnancy are the influencing factors for the occurrence of postpartum DRA(P<0.05).Conclusions 1 Without any intervention,the degree of diastasis recti abdominis in the third trimester is the largest,and the inter-rectus distance tends to gradually decrease after delivery.The recovery rate is the fastest within 42 days after delivery,and the downward trend tends to be flat at 6 months after delivery.The recovery rate of inter-rectus distance is different in different delivery modes,and transvaginal delivery is better than cesarean delivery to normal.2 Without any intervention,the degree of pubic symphysis diastasis in the third trimester was the largest,and the post-partum pubic symphysis distance gradually narrowed.After 42 days postpartum,it basically returned to normal,and then the recovery rate was significantly slowed down;the speed of recovery of the pubic symphysis distance in different delivery modes is similar.3 There is no obvious correlation between the interrectus distance and low back pain,pubic symphysis distance and pelvic pain at different time points.4 The maternal age,delivery modes,parity,neonatal weight,and weight gain during pregnancy are influencing factors for diastasis recti abdominis.5 High-frequency ultrasound can dynamically observe the changes of diastasis recti abdominis and pubic symphysis diastasis,which provides a clear basis for its diagnosis,evaluation and treatment,and can accurately judge the recovery process,which is worthy of clinical application.Figure 10;Table 14;Reference 112... |
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