Department of Gynecology, Affiliated Matern&Child Care Hospital of Nantong University, 399 Century Avenue, Chongchuan District, Nantong, Jiangsu, China.
Department of Ultrasound, Affiliated Matern&Child Care Hospital of Nantong University, 399 Century Avenue, Chongchuan District, Nantong, Jiangsu, China.
Sci Rep. 2024 Oct 14;14(1):23980. doi: 10.1038/s41598-024-75014-y.
To evaluate the effects of different delivery methods on the pelvic floor structure and function among primiparas by transperineal ultrasound, with a view to providing guidance for early postpartum intervention. Primiparas who underwent postpartum examination with transperineal ultrasound were recruited. Subjects were divided according to mode of delivery (vaginal and cesarean delivery). General information (including age, pre-pregnancy BMI and neonatal weight) were collected, and transperineal ultrasound was performed to measure such indicators as the levator hiatus areas in resting, constrictive anal and maximum Valsalva states, the posterior vesicourethral angles and distances between vesical neck and posterior inferior margin of pubic symphysis in resting and maximum Valsalva states, as well as the vesical neck mobility and urethral rotation angle in maximum Valsalva state. The inter-group differences in ultrasound indicators between the resting and Valsalva states were compared to analyze the postpartum incidences of pelvic floor dysfunctions like stress urinary incontinence, urethral funnel formation, bladder prolapse and uterine prolapse in primiparas. The levator hiatus areas in resting, constrictive anal and maximum Valsalva states were all larger in the vaginal delivery group than in the cesarean delivery group (P < 0.05). Compared to the cesarean delivery group, the vaginal delivery group exhibited larger posterior vesicourethral angles in resting and maximum Valsalva states (P < 0.05). The distances between vesical neck and posterior inferior margin of pubic symphysis were greater in the cesarean delivery group than in the vaginal delivery group at both resting and maximum Valsalva, with that at maximum Valsalva showing significant inter-group difference (P < 0.05). The vaginal delivery group exhibited greater vesical neck mobility and urethral rotation angle at maximum Valsalva compared to the cesarean delivery group (P < 0.05). The incidences of stress urinary incontinence, urethral funnel formation, bladder prolapse and uterine prolapse were all higher in the vaginal delivery group than in the cesarean delivery group, with the stress urinary incontinence and bladder prolapse incidences showing significant inter-group differences (P < 0.05). With transperineal ultrasound, various pelvic floor indicators of primiparas can be clearly measured and, through these ultrasound indicators, the effects of different delivery methods on the pelvic floor function can be evaluated, which is conducive to early clinical detection and intervention of postpartum pelvic floor dysfunctions, thus facilitating the early postpartum treatment.
为了通过经会阴超声评估不同分娩方式对初产妇盆底结构和功能的影响，为产后早期干预提供指导。招募了接受经会阴超声产后检查的初产妇。根据分娩方式（阴道分娩和剖宫产）进行分组。收集一般资料（包括年龄、孕前 BMI 和新生儿体重），并进行经会阴超声检查，测量静息、缩肛和最大 Valsalva 状态下会阴裂孔面积、静息和最大 Valsalva 状态下膀胱颈后尿道角和膀胱颈与耻骨联合后下缘的距离以及最大 Valsalva 状态下膀胱颈活动度和尿道旋转角度。比较静息和 Valsalva 状态下两组超声指标的差异，分析初产妇产后压力性尿失禁、尿道漏斗形成、膀胱膨出和子宫脱垂等盆底功能障碍的发生率。结果显示，阴道分娩组静息、缩肛和最大 Valsalva 状态下的会阴裂孔面积均大于剖宫产组（P<0.05）。与剖宫产组相比，阴道分娩组在静息和最大 Valsalva 状态下的膀胱颈后尿道角更大（P<0.05）。静息和最大 Valsalva 时，剖宫产组膀胱颈与耻骨联合后下缘的距离均大于阴道分娩组，最大 Valsalva 时差异有统计学意义（P<0.05）。阴道分娩组在最大 Valsalva 时的膀胱颈活动度和尿道旋转角度大于剖宫产组（P<0.05）。阴道分娩组压力性尿失禁、尿道漏斗形成、膀胱膨出和子宫脱垂的发生率均高于剖宫产组，压力性尿失禁和膀胱膨出的发生率差异有统计学意义（P<0.05）。经会阴超声可清晰测量初产妇的各种盆底指标，通过这些超声指标可评估不同分娩方式对盆底功能的影响，有利于产后早期发现和干预盆底功能障碍，从而促进产后早期治疗。
