首次单胎妊娠期间盆底结构变化及压力性尿失禁的危险因素

Pelvic floor structural changes during the first singleton pregnancy and the risk factors of stress urinary incontinence.

作者信息

Sun Chuanqing, Yang Hongyu, Li Keting, He Ping

机构信息

Department of Ultrasound, Shanghai First Maternal and Infant Hospital East Courtyard Campus (Affiliated Obstetrics and Gynecology Hospital of Tongji University), 2699 West Gaoke Road, Pudong New Area, Shanghai, 200120, China.

出版信息

BMC Pregnancy Childbirth. 2025 May 9;25(1):552. doi: 10.1186/s12884-025-07666-1.

DOI:10.1186/s12884-025-07666-1

PMID:40346519

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12065137/

Abstract

BACKGROUND

Pelvic floor dysfunction (PFD) usually occurs due to issues with the pelvic floor muscle and fascia tissue. Although many studies have shown that vaginal childbirth is a risk factor, little is known about the effects of pregnancy. Stress urinary incontinence (SUI) is a common symptom of PFD, characterized by involuntary urine discharge when abdominal pressure increase, such as sneezing, coughing, laughing or exercising. We aimed to observe pelvic floor ultrasound parameters during pregnancy and assess the association with SUI.

METHODS

Pregnant participants were recruited from the Affiliated Obstetrics and Gynecology Hospital of Tongji University between March 2022 and December 2023. We assessed pelvic floor anatomy with three-dimensional ultrasound and administered standardized questionnaires to all participants. After conducting the assessments, we saved the volumetric data sets for standardized analysis.

RESULTS

A total of 385 pregnant women were included, with 131 in the first trimester group; 122 in the second trimester group, and 132 in the third trimester group. SUI occurred 7 cases (5.34%) in the first trimester group, 26 cases (23.31%) in the second trimester group, and 63 cases (47.72%) in the third trimester group, the incidence of SUI in different groups with statistically significant (P < 0.001). As the pregnancy advanced, there were significant differences in HA, hiatal anteroposterior diameter, transverse diameter at rest, PFMC and VM (P<0.05). There were significant differences in hiatal transverse diameter at PFMC in the third trimester between women with SUI and those without (P = 0.048). However, no differences were observed in ultrasonic pelvic floor parameters in the first trimester between women with SUI and those without (P>0.05). We performed logistics regression analysis to evaluate the likelihood of SUI, the model was statistically significant (P < 0.001, AUC = 0.778, 95%cl: 0.729-0.827). Our analysis identified BMI, hiatal area at rest, hiatal anteroposterior diameter at rest, and hiatal anteroposterior diameter at VM as independent risk factors for SUI.

CONCLUSIONS

Pelvic floor structure begin to change during pregnancy, as the pregnancy advanced, the hiatal area increased gradually.

摘要

背景

盆底功能障碍（PFD）通常由于盆底肌肉和筋膜组织问题而发生。尽管许多研究表明经阴道分娩是一个危险因素，但关于妊娠的影响知之甚少。压力性尿失禁（SUI）是PFD的常见症状，其特征是在腹压增加时，如打喷嚏、咳嗽、大笑或运动时不自主地漏尿。我们旨在观察孕期盆底超声参数，并评估其与SUI的相关性。

方法

2022年3月至2023年12月期间，从同济大学附属妇产科医院招募了孕妇参与者。我们用三维超声评估盆底解剖结构，并向所有参与者发放标准化问卷。评估完成后，我们保存容积数据集用于标准化分析。

结果

共纳入385名孕妇，其中孕早期组131名；孕中期组122名，孕晚期组132名。孕早期组发生SUI 7例（5.34%），孕中期组26例（23.31%），孕晚期组63例（47.72%），不同组SUI发生率有统计学意义（P<0.001）。随着孕周增加，HA、裂孔前后径、静息横径、PFMC和VM有显著差异（P<0.05）。孕晚期有SUI和无SUI的女性在PFMC时裂孔横径有显著差异（P = 0.048）。然而，孕早期有SUI和无SUI的女性在盆底超声参数上无差异（P>0.05）。我们进行了逻辑回归分析以评估SUI的可能性，该模型有统计学意义（P<0.001，AUC = 0.778，95%cl：0.729 - 0.827）。我们的分析确定BMI、静息裂孔面积、静息裂孔前后径和VM时裂孔前后径是SUI的独立危险因素。