| Objectives Based on pelvic floor ultrasound to evaluate the changes of pelvic floor structure and function of women in the second trimester during different pregnancies,the best diagnostic indicators and diagnostic threshold of stress urinary incontinence（SUI）in women in the second trimester were sought,and the influence of different delivery methods on pelvic floor structure and function in the second trimester was evaluated.Methods Pregnant women（120 cases）who underwent routine obstetric examinations in our hospital from September 2019 to January 2021 were selected and divided into the first pregnancy group（60 cases）and the second pregnancy group（60 cases）.The first pregnancy women were divided into the first early pregnancy group（18 cases）,the first middle pregnancy group（19 cases）and the first late pregnancy group（23 cases）.The women with second pregnancy were divided into early pregnancy second pregnancy group（18 cases）,middle pregnancy second pregnancy group（25 cases）and late pregnancy second pregnancy group（17 cases）.The women in the second pregnancy group were divided into SUI group（33 cases）and non-SUI group（27 cases）according to stress urinary incontinence（SUI）or not.According to different delivery methods,the women in the second pregnancy were divided into two groups:vaginal delivery group（29 cases）and selective cesarean section group（31 cases）.Pelvic floor ultrasound examination was performed in all the women.The position of the bladder neck（D1,D2）,urethral inclination Angle（β1,β2）,posterior Angle of the bladder and urethra（PUVA1,PUVA2）,and the area of the levator ANI hiatus（LHA1,LHA2）were recorded under resting and tension conditions,respectively.The degree of movement of the bladder neck（BND）and the rotation Angle of the urethra（URA）were calculated.The ultrasonic parameters of the first pregnancy group and the second pregnancy group were compared in different pregnancy.To compare the difference of ultrasonic parameters of women in second pregnancy under different delivery modes;Taking the clinical diagnosis of SUI as the"gold standard",the ROC curve of each ultrasound index in the diagnosis of SUI in women in the second pregnancy was constructed to find the optimal diagnostic threshold.Results 1 The detection rates of D2,BND,URA,PUVA2,LHA1,LHA2 and urethral infundification in women of the second pregnancy group were higher than those of the first pregnancy group,and the difference was statistically significant（P<0.05）.2 The values of D2,BND,URA,PUVA2,LHA1 and LHA2 in the second trimester group were higher than those in the first trimester group.The values of D1,D2,BND,URA,PUVA2,LHA1 and LHA2 in the second trimester group were higher than those in the first trimester group.The values of URA,LHA1 and LHA2 in the second pregnancy group were higher than those in the first pregnancy group,and the difference was statistically significant（P<0.05）.3 There were statistically significant differences in the values of URA,LHA1 and LHA2 in women during the second pregnancy（P<0.05）.4 Comparison of ultrasonic parameters between SUI group and non-SUI group during the second pregnancy showed statistically significant differences in the detection rates of D2,BND,URA,LHA1,LHA2,and urethral infundification（P<0.05）.5 ROC curve analysis showed that:The area under the curve of D2,BND,LHA1 and funnelization of urethral orifice in the diagnosis of SUI in the second pregnancy were 0.790,0.742,0.793 and 0.737,respectively.The ROC curve for the diagnosis of SUI in women in the second pregnancy was constructed with the combined index of four factors.The area under the curve was 0.852,and the diagnostic threshold was0.432.The sensitivity and specificity were 85.2%and 75.8%.6 The D2 value in the vaginal delivery group was lower than that in the selective cesarean section group,and the BND,URA,PUVA2,LHA1 and LHA2 values were higher than those in the selective cesarean section group.The detection rate of urethral infunneling and the detection rate of SUI were higher than that in the selective cesarean section group,with statistical significance（P<0.05）.Conclusions 1 Women in the second pregnancy had less pelvic floor structure support than women in the first pregnancy,and women in the second pregnancy had increased pelvic floor organ activity in the early and middle trimesters.2 D2,BND,LHA1,funneling of the internal urethral orifice and the combination of the four indexes can all be used as diagnostic indicators for SUI in women of second pregnancy,and the diagnostic efficacy of the combined index is better than that of the single index,and the optimal diagnostic threshold of the combined index is 0.432.3 The changes of pelvic floor structure and function of women in the second pregnancy were related to the way of first delivery.Selective cesarean section had a protective effect on them,and intervention should be carried out as early as possible in the second pregnancy of women with vaginal delivery.Figure7;Table13;Reference 159... |
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