Effect Of Obstetric Factors And Different Delivery Modes On The Function Of The Pelvic Floor In The Early Postpartum

Objective To assess the status of pelvic floor function in the early postpartum period,investigate the effect of different delivery modes and related obstetric factors on the function of the pelvic floor after childbirth and provide a reference for the prevention and treatment of postpartum pelvic floor dysfunction.Methods 443 women who delivered and had the follow-up at 6～8 weeks postpartum in Subei People’s Hospital from September 2021 to September 2022 were retrospectively analyzed.According to the mode of delivery,the subjects were divided into 98 cases of the elective cesarean section group,38 cases of the transit cesarean delivery group,248 cases of the spontaneous vaginal delivery group and 59 cases of the episiotomy group.Surface electromyography(EMG)signal was used for comparison and the association of obstetrics factors with the damage of pelvic floor function after childbirth was used for analysis.Results 1.The median of the former resting EMG value,the maximum value of fast fiber EMG,the average value of slow fiber EMG,the average value of the synergetic fiber EMG and the latter resting EMG value among the four groups was 5.02,33.48,20.36,19.03,5.12 μV.2.The comparison of different delivery modes: There was significant difference among the four groups of EMG value(P<0.001).Compared with the elective cesarean section group,the spontaneous vaginal delivery group and the episiotomy group was associated with lower EMG value(P<0.05).The EMG value of episiotomy group was lower than that of spontaneous vaginal delivery group although this association was statistically significant only for the fast myofiber(P<0.05)There was no statistically significant difference when compared transit cesarean delivery group and elective cesarean section group in all the test indicators(P>0.05).3.Univariate analysis results:Women with older maternal age,more gained body mass index(BMI)during pregnancy and higher neonatal birth weight were more likely to damage type Ⅰ myofibers.Women with more gained BMI during pregnancy and higher neonatal birth weight were more likely to damage type Ⅰ myofibers(P<0.05).Damage of pelvic floor myofibers were not associated with the duration of second stage,vagina parity,labor analgesia,balloon cervical dilatation,the duration of oxytocin use and perineal laceration(P>0.05).Women who underwent balloon bionic midwifery to vaginal delivery(58.9%,53.3%)were at significantly lower risk of type Ⅰ or Ⅱ myofibers damage than those who did not(73.3%,65.4%)(P<0.05).4.Multivariate logistic regression analysis results: The higher neonatal birth weight was statistically associated with a higher risk of damage to type Ⅰ myofibers(OR=3.209,95% CI 1.819～5.660,P<0.001);the balloon bionic midwifery statistically reduced the risk of damage to type Ⅰ myofibers(OR=0.408,95% CI 0.228～0.733,P=0.003).Compared with spontaneous vaginal delivery,episiotomy(OR=4.390,95% CI1.833～10.513,P=0.001)was associated with significantly higher hazard of type Ⅰ myofiber damage,while elective cesarean delivery(OR=0.528,95% CI 0.290～0.959,P=0.036)and transit cesarean delivery(OR=0.217,95% CI 0.086～0.547,P=0.001)was associated with significantly lower hazard of type Ⅰ myofiber damage.More gained BMI during pregnancy(OR=1.385,95% CI 1.216～1.578,P<0.001)and neonatal birth weight(OR=7.427,95% CI 3.881～14.216,P<0.001)were statistically associated with higher risk of damage to type Ⅱ myofibers,and the use of balloon bionic midwifery(OR=0.469,95% CI 0.251～0.874,P=0.017)statistically decreases the risk of damage to type Ⅱ myofibers.Compared with spontaneous vaginal delivery,episiotomy(OR=5.223,95% CI 2.170～12.571,P<0.001)was associated with significantly higher hazard of type Ⅰ myofiber damage,while elective cesarean delivery(OR=0.383,95%CI 0.197～0.743,P=0.005)and transit cesarean delivery(OR=0.249,95% CI0.088～0.707,P=0.009)was associated with significantly lower hazard of type Ⅱ myofiber damage.Conclusions 1.Women in the early postpartum period generally have pelvic floor dysfunction.Compared with vaginal delivery,cesarean section may have less damage to the pelvic floor,meanwhile transit cesarean delivery may not aggravate the function of pelvic floor.2.Balloon bionic midwifery can be used to protect pelvic floor function in vaginal delivery.3.The neonatal birth weight,gained BMI during pregnancy and episiotomy are hazard factors for the damage of pelvic floor.Weight gain should be controlled during pregnancy,and surgical indications for episiotomy should be fully evaluated during labor.