Department of Ultrasonography, The Second Affiliated Hospital of Harbin Medical University, No. 246, Xuefu Road, Nanggang District, Harbin, 150081, People's Republic of China.
Department of Ultrasonography, The Daqing Oilfield General Hospital, Daqing, People's Republic of China.
Int Urogynecol J. 2021 Jul;32(7):1839-1846. doi: 10.1007/s00192-021-04783-1. Epub 2021 Apr 17.
We hypothesized that differences in post-partum levator hiatus (LH) measurements, as well as the area of urethra and bladder (AUB), viewed under ultrasound, correlate with diastasis rectus abdominis (DRA) occurrence. The primary objective of this study is to determine ultrasound parameters available for diagnosing DRA in post-partum women. We compared LH and AUB measurements under ultrasound in primiparous women, with and without DRA, at 24-26 weeks postpartum.
One hundred ninety-four women underwent routine examination, including a self-made clinical symptoms questionnaire, DRA evaluation, and LH and AUB measurements. Independent samples t- and chi-squared tests were used to compare the differences between women with and without DRA.
DRA incidence was significantly higher among those who underwent cesarean section (CS) than for vaginal delivery (VD) (P = 0.038). DRA patients could potentially have urinary urgency, frequency, pain, dysuria, and perineal tears. Additionally, statistically significant differences were found between VD patients, with or without DRA, in the resting LH transverse diameter (TrD) (P = 0.032) and the area of the levator hiatus (ALH) (P = 0.048) as well as AUB at Valsalva (P = 0.049). No differences, however, were found between the DRA and no DRA groups for all those measurements among women who had cesarean deliveries.
DRA was more likely in post-CS women. Furthermore, the results showed a plausible association between DRA occurrence and LH expansion, especially in women with VD under rest and Valsalva. This could be useful for developing therapeutic plans based on these parameters for post-partum rehabilitation of women with DRA to avoid long-term complications.
我们假设产后会阴裂孔（LH）测量值以及尿道和膀胱面积（AUB）的差异，在超声下观察，与腹直肌分离（DRA）的发生相关。本研究的主要目的是确定产后妇女 DRA 诊断的超声参数。我们比较了产后 24-26 周时 DRA 阳性和阴性的初产妇的超声 LH 和 AUB 测量值。
194 名女性接受了常规检查，包括自制的临床症状问卷、DRA 评估以及 LH 和 AUB 测量。使用独立样本 t 检验和卡方检验比较 DRA 阳性和阴性女性之间的差异。
剖宫产（CS）后 DRA 的发生率明显高于阴道分娩（VD）（P=0.038）。DRA 患者可能有尿急、尿频、疼痛、排尿困难和会阴撕裂。此外，VD 患者中无论是否有 DRA，静息时 LH 横径（TrD）（P=0.032）和会阴裂孔面积（ALH）（P=0.048）以及 Valsalva 时 AUB 均存在统计学差异（P=0.049）。然而，对于接受 CS 的女性，DRA 组和无 DRA 组之间所有这些测量值均无差异。
CS 后 DRA 更常见。此外，研究结果表明 DRA 发生与 LH 扩张之间存在合理关联，尤其是在 VD 女性静息和 Valsalva 时。这对于制定基于这些参数的产后 DRA 妇女康复治疗计划可能有用，以避免长期并发症。
