Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Kirrberger Straße, 66421, Homburg, Saar, Germany.
Department of Obstetrics and Prenatal Medicine, Kantonspital Baden, Im Ergel 1, 5400, Baden, Switzerland.
Arch Gynecol Obstet. 2021 Aug;304(2):401-408. doi: 10.1007/s00404-021-06022-w. Epub 2021 Mar 22.
To assess changes in the pelvic floor anatomy that cause pelvic floor disorders (PFDs) in primigravidae during and after pregnancy and to evaluate their impact on women's quality of life (QoL).
POP-Q and translabial ultrasound examination was performed in the third trimester and 3 months after delivery in a cohort of primigravidae with singleton pregnancy delivering in a tertiary center. Results were analyzed regarding mode of delivery and other pre- and peripartal factors. Two individualized detailed questionnaires were distributed at 3 months and at 12 months after childbirth to determinate QoL.
We recruited 45 women, of whom 17 delivered vaginally (VD), 11 received a vacuum extraction delivery (VE) and 17 a Cesarean section in labor (CS). When comparing third-trimester sonography to 3 months after delivery, bladder neck mobility increased significantly in each delivery group and hiatal area increased significantly in the VD group. A LAM avulsion was found in two women after VE. Connective tissue weakness (p = 0.0483) and fetal weight at birth (p = 0.0384) were identified as significant risk factors for the occurrence of PFDs in a multivariant regression analysis. Urinary incontinence was most common with 15% and 11% of cases at 3, respectively, 12 months after delivery. 42% of women reported discomfort during sexual intercourse, 3 months after delivery and 24% 12 months postpartum. Although 93% of women engage a midwife after delivery, only 56% participated in pelvic floor muscle training.
Connective tissue weakness and high fetal weight at birth are important risk factors for the occurrence of PFDs. Nevertheless, more parturients should participate in postpartal care services to prevent future PFDs.
评估初产妇在妊娠期间和妊娠后盆底解剖结构的变化，这些变化导致盆底功能障碍（PFD），并评估其对女性生活质量（QoL）的影响。
对在一家三级中心分娩的初产妇队列，在妊娠晚期和产后 3 个月进行 POP-Q 和经阴道超声检查。分析分娩方式和其他产前和围产期因素的结果。在产后 3 个月和 12 个月时，发放了两份个体化详细问卷，以确定 QoL。
我们招募了 45 名女性，其中 17 名经阴道分娩（VD），11 名接受真空吸引分娩（VE），17 名剖宫产。与妊娠晚期超声相比，在每个分娩组中，膀胱颈移动度在产后 3 个月时显著增加，在 VD 组中，疝环口面积显著增加。VE 后有 2 名女性发现 LAM 撕裂。在多变量回归分析中，结缔组织薄弱（p=0.0483）和出生时胎儿体重（p=0.0384）被确定为发生 PFD 的显著危险因素。产后 3 个月和 12 个月时，尿失禁的发生率分别为 15%和 11%。42%的女性在产后 3 个月报告性交时不适，24%在产后 12 个月时报告。尽管 93%的女性在产后会寻求助产士的帮助，但只有 56%的女性参与了盆底肌肉训练。
结缔组织薄弱和出生时胎儿体重高是发生 PFD 的重要危险因素。尽管如此，更多的产妇应该参与产后护理服务，以预防未来的 PFD。
