Chantarasorn Varisara, Shek Ka Lai, Dietz Hans Peter
Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Penrith, NSW, 2750, Australia.
Int Urogynecol J. 2012 Jun;23(6):729-33. doi: 10.1007/s00192-012-1672-8. Epub 2012 Jan 27.
The perineal body is an important structure which is often injured during labor. It is believed to play a role in pelvic organ support. Vaginal delivery is likely to increase the mobility of perineal body and anorectal junction. The aim of this study was to determine changes in the mobility of perineal body and anorectal junction before and after delivery using pelvic floor ultrasound.
Two hundred nulliparous women were enrolled and underwent pelvic floor ultrasound at 36-38 weeks gestation and 3-6 months postpartum. Levator hiatal dimensions and mobility of the perineal body and anorectal junction were measured in volume ultrasound datasets using postprocessing software, blinded against all clinical data, before and after childbirth.
Ultrasound measures of mobility of perineal body and anorectal junction were shown to be reproducible (ICC 0.74 and 0.76). After delivery, mobility of both structures had increased significantly (both P < 0.001), and postpartum perineal mobility was associated with delivery mode (P = 0.015). A significant correlation was found between these outcome measures and levator hiatal area on Valsalva, both before and after delivery. Perineal trauma, episiotomy, epidural block, augmentation of labor, and length of first and second stage of labor were not associated with postpartum mobility of perineal body and anorectal junction.
Vaginal delivery increases the mobility of perineal body and anorectal junction. Perineal mobility may be partly determined by distensibility of the levator hiatus.
会阴体是分娩过程中常受损伤的重要结构。人们认为它在盆腔器官支撑中发挥作用。阴道分娩可能会增加会阴体和肛管直肠连接部的活动度。本研究的目的是使用盆底超声确定分娩前后会阴体和肛管直肠连接部活动度的变化。
招募200名未生育女性，在妊娠36 - 38周和产后3 - 6个月接受盆底超声检查。使用后处理软件在容积超声数据集中测量提肌裂孔尺寸以及会阴体和肛管直肠连接部的活动度，测量时对所有临床数据保密，分别在分娩前后进行。
会阴体和肛管直肠连接部活动度的超声测量结果显示具有可重复性（组内相关系数分别为0.74和0.76）。分娩后，这两个结构的活动度均显著增加（均P < 0.001），且产后会阴活动度与分娩方式相关（P = 0.015）。在分娩前后，这些结果测量指标与瓦尔萨尔瓦动作时的提肌裂孔面积之间均存在显著相关性。会阴创伤、会阴切开术、硬膜外阻滞、引产以及第一和第二产程的时长与产后会阴体和肛管直肠连接部的活动度无关。
阴道分娩会增加会阴体和肛管直肠连接部的活动度。会阴活动度可能部分由提肌裂孔的扩张性决定。
