Marsoosi Vajihe, Jamal Ashraf, Eslamian Laleh, Oveisi Sonia, Abotorabi Shokohossadat
Assistant Professor of Perinatology, Department of Obstetrics and Gynecology, Faculty of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran.
Glob J Health Sci. 2014 Sep 28;7(1):267-73. doi: 10.5539/gjhs.v7n1p267.
To determine the effect of pregnancy and vaginal delivery on the pelvic floor and levatorani morphology and function.
Design. Cross-sectional study. Setting. Tertiary care teaching hospital. Population. 75 primigravid women were recruited for assessment at 6 weeks postpartum compared with 25 nulliparous women. Hiatal morphology and levator ani muscle avulsion were assessed by 4-dimensional translabial ultrasound examination. The volume achievement obtained by ultrasound was performed in supine position with empty bladder at rest, on maximum Valsalva maneuver, and on maximum pelvic floor muscle contraction. Main Outcome Measures. Hiatal diameter and area were measured at the plane of minimal hiatal dimension as defined in the midsagittal plane and Levator avulsion was assessed.
There were significant differences in hiatal area morphology at rest, on Valsalva maneuver and during contraction of muscles among the study groups, but there was no difference in pelvic diameter at rest, on Valsalva maneuver, and during contraction. There were 21 cases of puborectalis avulsion (42%) with no significant difference between non-progressive labor (8 cases) and Normal Vaginal Delivery (NVD) (13 cases) groups.
The results of the present study showed that non-progressive labor is the main risk factor for pelvic muscle injuries, indicating the necessity of a better management and timely cesareans in women with prolonged second stage of labor.
确定妊娠和阴道分娩对盆底及肛提肌形态和功能的影响。
设计。横断面研究。地点。三级护理教学医院。研究对象。招募75名初产妇在产后6周进行评估，并与25名未产妇进行比较。通过经阴唇四维超声检查评估裂孔形态和肛提肌撕裂情况。超声测量容量在静息时膀胱排空的仰卧位、最大瓦尔萨尔瓦动作时以及最大盆底肌肉收缩时进行。主要观察指标。在矢状面定义的最小裂孔平面测量裂孔直径和面积，并评估肛提肌撕裂情况。
各研究组在静息、瓦尔萨尔瓦动作时和肌肉收缩时裂孔面积形态存在显著差异，但静息、瓦尔萨尔瓦动作时和收缩时骨盆直径无差异。有21例耻骨直肠肌撕裂（42%），未进展性分娩组（8例）和正常阴道分娩组（13例）之间无显著差异。
本研究结果表明，未进展性分娩是盆底肌肉损伤的主要危险因素，提示对于第二产程延长的女性，有必要进行更好的管理并及时行剖宫产。
