Department of Female Pelvic Health Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki-Chuo, Tsuzuki-Ku, Yokohama City, Kanagawa, 224-8503, Japan.
Department of Obstetrics and Gynecology, Showa University Northern Yokohama Hospital, Kanagawa, Japan.
J Med Ultrason (2001). 2024 Jan;51(1):95-101. doi: 10.1007/s10396-023-01369-w. Epub 2023 Sep 23.
The risk of pelvic floor muscle injury is commonly considered to be higher in vaginal than in cesarean delivery. This study aimed to compare levator ani muscle (LAM) elasticity after vaginal and cesarean delivery using shear wave elastography (SWE).
Postpartum women who underwent a single SWE evaluation 1 month after their first delivery were divided into vaginal and cesarean delivery groups. The elastic moduli of both sides of the LAM were measured in a horizontal section and compared between the groups. In addition, a subgroup analysis was performed to compare LAM elasticity according to the delivery method within the vaginal delivery group-normal vaginal delivery, episiotomy, and operative vaginal delivery.
Sixty-two women were included (vaginal delivery, n = 47; elective cesarean section, n = 15). Multiple regression analysis revealed that the LAM elastic modulus was significantly lower in the vaginal delivery group than in the cesarean delivery group (right LAM: 44.2 vs. 72.7 kPa, p = 0.0036; left LAM 40.4 vs. 82.7 kPa, p < 0.0001). In the subgroup analysis, the right LAM elastic modulus was significantly lower in the operative vaginal delivery subgroup than in the normal vaginal delivery subgroup (p = 0.0131). However, there was no significant difference in the left LAM elastic modulus between the three subgroups.
LAM elasticity was significantly lower after vaginal delivery than after cesarean delivery. Furthermore, the elasticity of the right LAM was lower after operative vaginal delivery than after normal vaginal delivery. SWE has the potential to provide an objective quantitative assessment of postpartum pelvic floor muscle recovery.
通常认为阴道分娩比剖宫产更容易导致盆底肌肉损伤。本研究旨在使用剪切波弹性成像（SWE）比较阴道分娩和剖宫产分娩后肛提肌（LAM）的弹性。
分娩后 1 个月行单次 SWE 评估的初产妇分为阴道分娩组和剖宫产组。测量 LAM 水平切面两侧的弹性模量，并比较两组间的差异。此外，还进行了亚组分析，比较阴道分娩组（正常阴道分娩、会阴切开术和产道手术分娩）中根据分娩方式的 LAM 弹性差异。
共纳入 62 名产妇（阴道分娩 47 例，选择性剖宫产 15 例）。多因素回归分析显示，阴道分娩组 LAM 弹性模量明显低于剖宫产组（右侧 LAM：44.2 比 72.7 kPa，p = 0.0036；左侧 LAM：40.4 比 82.7 kPa，p < 0.0001）。亚组分析显示，产道手术分娩组右侧 LAM 弹性模量明显低于正常阴道分娩组（p = 0.0131）。然而，三组间左侧 LAM 弹性模量无显著差异。
阴道分娩后 LAM 弹性明显低于剖宫产，且产道手术分娩后右侧 LAM 弹性较正常阴道分娩更低。SWE 具有为产后盆底肌肉恢复提供客观定量评估的潜力。
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