Sydney Medical School Nepean, Penrith, Australia.
Ultrasound Obstet Gynecol. 2012 May;39(5):569-73. doi: 10.1002/uog.10083.
To determine the prevalence of and to quantify the effect of reflex pelvic floor activation on coughing in nulliparous pregnant women, and to assess peripartal changes and any association with stress urinary incontinence.
Between April 2008 and March 2010, 131 nulliparous pregnant women were recruited from an antenatal clinic. All participants were interviewed and underwent four-dimensional translabial ultrasound examination at antepartum (35.8 (mean) weeks' gestation) and postpartum (4.6 (mean) months) visits. Four-dimensional ultrasound volume datasets of the pelvic floor during coughs were obtained at a minimum frame rate of 16 Hz, using a 10° volume acquisition angle. To quantify a reflex levator contraction we measured the midsagittal hiatal diameter at multiple time points. Levator integrity was determined using tomographic ultrasound imaging.
From 131 women recruited, 47 datasets were technically suboptimal, leaving 84. There was a visible pelvic floor reflex in 82 (98%) cases. At the postpartum visit this was reduced to 63/84, i.e. 75% (P < 0.001). The magnitude of a reflex contraction was markedly reduced postpartum, from 4.8 mm to 2.0 mm (P < 0.001), and this effect was associated with delivery mode (P = 0.042). There was a trend towards an association between lower reflex contraction magnitude and stress incontinence (0.87 ± 3.18 mm vs. 2.36 ± 3.5 mm; P = 0.08) at the postpartum follow-up visit.
Pelvic floor reflexes are altered by childbirth. This alteration may be associated with vaginal delivery. Reflex magnitude may be associated with postpartum stress urinary incontinence. The clinical significance of this finding is uncertain.
确定初产妇咳嗽时盆底反射激活的发生率和程度，并评估围产期的变化及其与压力性尿失禁的关系。
2008 年 4 月至 2010 年 3 月，我们从一家产前门诊招募了 131 名初产妇。所有参与者均接受了访谈，并在产前（妊娠 35.8 周）和产后（4.6 个月）进行了四维经阴道超声检查。使用 10°容积采集角度，以至少 16 Hz 的帧率获得咳嗽时盆底的四维超声容积数据集。为了量化反射性肛提肌收缩，我们在多个时间点测量中矢状裂孔直径。使用断层超声成像来确定肛提肌的完整性。
在 131 名招募的女性中，47 名女性的数据集技术上不够理想，留下 84 名女性。在产后访视中，这一比例降至 63/84，即 75%（P < 0.001）。产后反射性收缩幅度明显降低，从 4.8 毫米降至 2.0 毫米（P < 0.001），这种效应与分娩方式有关（P = 0.042）。产后随访时，反射性收缩幅度较低与压力性尿失禁之间存在一定趋势（0.87 ± 3.18 毫米 vs. 2.36 ± 3.5 毫米；P = 0.08）。
分娩会改变盆底反射。这种改变可能与阴道分娩有关。反射幅度可能与产后压力性尿失禁有关。这一发现的临床意义尚不确定。
