Peschers U, Schaer G, Anthuber C, Delancey J O, Schuessler B
Department of Obstetrics and Gynecology, Kantonsspital, Luzern, Switzerland.
Obstet Gynecol. 1996 Dec;88(6):1001-6. doi: 10.1016/s0029-7844(96)00338-9.
To assess changes in urethral movement during the Valsalva maneuver and pelvic floor muscle contraction following vaginal delivery.
In a prospective repeated-measures study, 25 primigravidas, 20 multiparas, and ten women who were to have elective cesarean delivery were examined sonographically at 36-42 weeks of pregnancy and 6-10 weeks after delivery. Vesical neck position at rest and excursion during Valsalva maneuver and maximum pelvic muscle contraction were measured with perineal ultrasound. Data about resting bladder neck position and bladder neck elevation at contraction were compared with findings in age-matched nulligravid volunteers.
The bladder neck was significantly lower at rest in women after vaginal delivery than in those who had an elective cesarean delivery and in nulligravid controls. Bladder neck mobility had increased during the Valsalva maneuver in 16 of 25 primigravidas and 15 of 20 multiparas 6-10 weeks after vaginal delivery. The ability to elevate the vesical neck during pelvic muscle contraction was decreased in six of 25 primigravidas and in two of 20 multiparas 6-10 weeks after birth. Two women, one primigravid and one para 2 (with a previous elective cesarean delivery), both of whom had forceps delivery, completely lost the ability to contract voluntarily the pelvic floor muscles.
Vaginal delivery alters vesical neck descent during the Valsalva maneuver, and the ability of the pelvic muscles to elevate the urethra in some women.
评估经阴道分娩后瓦尔萨尔瓦动作和盆底肌肉收缩期间尿道运动的变化。
在一项前瞻性重复测量研究中，对25例初产妇、20例经产妇和10例计划行择期剖宫产的女性在妊娠36 - 42周及产后6 - 10周进行超声检查。使用会阴超声测量静息时膀胱颈位置以及瓦尔萨尔瓦动作和最大盆底肌肉收缩期间的移动度。将静息膀胱颈位置和收缩时膀胱颈抬高的数据与年龄匹配的未孕志愿者的检查结果进行比较。
经阴道分娩后的女性静息时膀胱颈位置显著低于择期剖宫产的女性和未孕对照者。25例初产妇中的16例和20例经产妇中的15例在阴道分娩后6 - 10周进行瓦尔萨尔瓦动作时膀胱颈活动度增加。25例初产妇中的6例和20例经产妇中的2例在产后6 - 10周盆底肌肉收缩时抬高膀胱颈的能力下降。两名女性，一名初产妇和一名经产妇2（既往有择期剖宫产史），均为产钳助产，完全丧失了自主收缩盆底肌肉的能力。
经阴道分娩会改变瓦尔萨尔瓦动作期间膀胱颈下降情况，并影响部分女性盆底肌肉抬高尿道的能力。
