Graduate Course of Midwifery, Teikyo University, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan.
Department of Nursing, Shonan Kamakura University of Medical Sciences School of Nursing, 1195-3 Yamazaki, Kamakura-shi, Kanagawa, Japan.
BMC Womens Health. 2021 Feb 6;21(1):53. doi: 10.1186/s12905-021-01203-w.
Pelvic floor muscles support the pelvic organs and control voiding. The first choice in the repair of pelvic floor function that is damaged during pregnancy and delivery is pelvic floor muscle training, which involves repeated muscle relaxation and contraction. However, as muscle contractions cannot be visualised, it is difficult to assess whether patients understand how to contract them. Therefore, we assessed patients' comprehension of pelvic floor muscle contraction by comparing two teaching methods, vaginal palpation and transabdominal ultrasound, following vaginal delivery. We hypothesised that vaginal palpation is better than transabdominal ultrasound in this regard.
This randomised controlled trial conducted in facilities in Tokyo, Japan between July 2018 and January 2019 included women aged ≥ 20 years at 4-6 weeks after vaginal delivery. The randomisation involved website-based centralised allocation. The primary outcome was a change in bladder base displacement during pelvic floor muscle contraction before and after training, which was measured using transabdominal ultrasound. Participants performed three contractions for 3 s, and the mean value was used for statistical analysis. The secondary outcome was a change in understanding the contraction before and after training, which was measured using a five-point Likert scale questionnaire. Outcomes were analysed using Welch's t-test.
Sixty-five participants were randomly allocated to the vaginal palpation group (n = 32) and transabdominal ultrasound group (n = 33). Baseline characteristics were similar between the groups. Changes in bladder base displacement were not significantly different between the groups (p = 0.181). Within-group analyses showed that bladder base displacement was large in both groups after the respective intervention. There were no significant differences in any of the outcomes between the two groups before and after the intervention.
Vaginal palpation and transabdominal ultrasound might be useful for comprehending pelvic floor muscle contraction after vaginal delivery.
UMIN 000032304. Registered 18 April 2018, https://upload.umin.ac.jp/cgi-open-bin/icdr_e/ctr_view.cgi?recptno=R000036820 .
盆底肌支撑着盆腔器官并控制排尿。在妊娠和分娩过程中受损的盆底功能修复中，首选方法是盆底肌训练，该训练涉及反复的肌肉放松和收缩。然而，由于肌肉收缩无法可视化，因此很难评估患者是否理解如何收缩。因此，我们通过比较阴道分娩后两种教学方法，即阴道触诊和经腹超声，来评估患者对盆底肌收缩的理解。我们假设在这方面，阴道触诊优于经腹超声。
这是一项在 2018 年 7 月至 2019 年 1 月期间在日本东京的医疗机构中进行的随机对照试验，纳入了年龄≥20 岁的阴道分娩后 4-6 周的女性。随机化采用基于网站的中央化分配。主要结局是经腹超声测量的盆底肌收缩前后膀胱底位移的变化。参与者进行 3 次持续 3 秒的收缩，然后使用平均值进行统计分析。次要结局是使用 5 分 Likert 量表问卷测量训练前后对收缩的理解变化。使用 Welch's t 检验进行结果分析。
65 名参与者被随机分配至阴道触诊组（n=32）和经腹超声组（n=33）。两组的基线特征相似。两组之间膀胱底位移的变化无显著差异（p=0.181）。组内分析显示，两组干预后膀胱底位移均较大。干预前后两组之间的任何结果均无显著差异。
阴道触诊和经腹超声可能有助于理解阴道分娩后的盆底肌收缩。
UMIN 000032304。注册于 2018 年 4 月 18 日，https://upload.umin.ac.jp/cgi-open-bin/icdr_e/ctr_view.cgi?recptno=R000036820。
