de Araujo Camila Carvalho, Coelho Suelene A, Stahlschmidt Paulo, Juliato Cassia R T
School of Medicine, University of Campinas (UNICAMP), R. Euclides de Moraes Rosa, 180. Jardim Itália. Itapetininga, Campinas, SP, 18.201-760, Brazil.
Int Urogynecol J. 2018 May;29(5):639-645. doi: 10.1007/s00192-018-3609-3. Epub 2018 Mar 21.
Pregnancy and delivery are well-established risk factors for pelvic floor dysfunction (PFD), but the physiopathology, such as the delivery route, is not well understood. This study evaluated the impact of delivery route on the pelvic floor muscles via 3D ultrasound.
This review is registered in the PROSPERO database. The criteria for inclusion were prospective studies with 3D translabial ultrasound assessment in primigravida women during pregnancy and postpartum published in English, Spanish or Portuguese between 1980 and 2016. We excluded studies that did not include the topic of urogenital hiatus measurement and literature reviews. The MeSH terms were obstetric delivery, postpartum period, labor, parturition, three-dimensional images, ultrasonography, pelvic floor, and pelvic floor disorders.
The search retrieved 155 articles. After analysis, 6 articles were included. Four studies showed that vaginal delivery (VD) was associated with a larger hiatal area. One study associated the hiatal area with levator ani muscle (LAM) defects in VD. Four articles evaluated the bladder neck, 3 of which showed a significant increase in bladder neck mobility associated with VD and 1 showed decreased bladder neck elevation, not associated with the delivery mode; the first 3 articles all evaluated LAM injuries and showed an association between VD and LAM injury. Women who underwent VD presented defects of the puborectalis muscle.
Vaginal delivery was associated with a higher number of LAM injuries, puborectalis defects, increased bladder neck mobility, and enlargement of the hiatal area.
妊娠和分娩是公认的盆底功能障碍（PFD）风险因素，但诸如分娩方式等生理病理学机制尚未完全明确。本研究通过三维超声评估分娩方式对盆底肌肉的影响。
本综述已在PROSPERO数据库注册。纳入标准为1980年至2016年间以英文、西班牙文或葡萄牙文发表的关于初产妇孕期及产后经阴唇三维超声评估的前瞻性研究。我们排除了未涉及泌尿生殖裂孔测量主题的研究和文献综述。医学主题词包括产科分娩、产后期、分娩、生产、三维图像、超声检查、盆底及盆底疾病。
检索到155篇文章。分析后纳入6篇文章。四项研究表明，阴道分娩（VD）与更大的裂孔面积相关。一项研究将裂孔面积与阴道分娩时肛提肌（LAM）缺陷相关联。四篇文章评估了膀胱颈，其中三篇显示与阴道分娩相关的膀胱颈活动度显著增加，一篇显示膀胱颈抬高降低，但与分娩方式无关；前三篇文章均评估了肛提肌损伤，并显示阴道分娩与肛提肌损伤相关。接受阴道分娩的女性存在耻骨直肠肌缺陷。
阴道分娩与更多的肛提肌损伤、耻骨直肠肌缺陷、膀胱颈活动度增加以及裂孔面积增大相关。
