Sonographic Studies On Structural And Functional Impacts In Female Pelvic Floor Upon Pregnancy, Vaginal Delivery And Elective Ceasarean Section

Purpose:1.To evaluate the associated different influences to the pelvic floor structure brought by different delivery methods at the post-natal early time through perineum vestibule three-dimensional ultrasonography,measuring the dynamic changes under diffenrent delivery methods to probe into the three-dimensional ultrasonography's clinical application and to provide clinical evidence for the early prevention of stress incontinence2.To detect the quantity of collagen typeⅠin the blood of early postpartum women; to probe into the association between collagen status and pregnancy, incontinence occurred on women adopting different delivery methods.Methods:1.To select 69 women with singleton fetus with cephalic presentation methods aged from 18 to 35,with the gestational age between 28 weeks to 36 weeks as the research subject at random,to collect the clinical history and to diagnose the clinical symptom.2.To detect the changes of the reproductive slit pores:anteroposterior diameter (AP)and lateral diameter(LD) of the above mentioned pregnant women when at resting and maximal strength,posterior urethra-vesical angle(α)and the flexibility of bladder neck(θ),the distance between the between the pubic symphysis midpoint and bladder neck(D) and so on through perineum 3D ultrasound convex probe.3.To divide the above mentioned cases into normal vaginal delivery group and selective caesarean group according to the natural childbirth standards;to detect the above data 6-8 weeks and 12-14 weeks after the delivery respectively.4.To detect the serum concentration of procollagen typeⅠ(PICP) in the venous blood on an empty stomach through ELISA method,to analyse the collagen change of the pelvic floor structure at pregnant,the early period after different delivery methods. 5.To collect the above data of another 20 health nulliparaResult:50 primiparous pregnant women were researched,including 24 normal vaginal delivery cases,22 selective caesarean cases,one low forceps delivery case and two non-selective caesarean cases(because of persistent occipitoposterior position and FIUD respectively).The visited rate at 6-8 weeks after the delivery is 100%.After 12-14 weeks,35 cases were visited and the visited rate is 71.4%.1.SUI affected comparison of different delivery methods at late trimester of pregnancy1.1 Simple clinical history SUI diagnosing:in accordance with the International Incontinence Questionnaire,there were 15 researched women suffered from SUI at the late trimester of pregnancy(15/49),accounting for 30.61%.7 researched subjects in normal vaginal delivery suffered from SUI(7/49),accounting for 14.29%while 5 in selective caesarean cases(5/49),accounting for 10.20%. Both were lower than the SUI proportion at the late trimester of pregnancy,with a statistical significance(P＜0.05).1.2 The diagnosing result comparison of the perineum vestibule three-dimensional ultrasonography at the late trimester of pregnancy:the result showed that compared with the normal control group,obvious increasing was noticed of the posterior urethra-vesical angle(α),the flexibility of bladder neck(θ),the distance between the between the pubic symphysis midpoint and bladder neck(D),the anteroposterior diameter(AP) and lateral diameter(LD) of the pelvic cavity reproductive slit pore,with a statistical significance(P＜0.05).1.3 PICP content in blood comparison at the late trimester of pregnancy and of different delivery methods:the average CIP content in the blood of the researched subjects at the late trimester of pregnancy lower than in the blood of the normal control group,with a statistical significance(P＜0.05).2.SUI comparison of different delivery methods at different stages of the post partum 2.1 Clinical history SUI diagnosing:in accordance with the International Incontinence Questionnaire,there were 4 researched subjects suffered from SUI during 6-8 weeks after delivery(4/49),accounting for 8.16%;l suffered from SUI during 12-14 weeks after delivery(1/37),accounting for 2.70%.SUI proportion decreased,with a statistical significance(P＜0.05).2.2 The diagnosing result comparison of the perineum vestibule three-dimensional ultrasonography:the anteroposterior diameter(AP) and lateral diameter(LD) of the pelvic cavity reproductive,the posterior urethra-vesical angle(α),the flexibility of bladder neck(θ),the distance between the between the pubic symphysis midpoint and bladder neck(D) of normal vaginal delivery are larger than those of elective caesarean during 6-8 weeks after delivery with a statistical significance(P＜0.05).Both of groups have no obvious difference during 12-14 weeks after delivery.2.3 PICP content in blood comparison at different stages The average PICP content in the blood of normal vaginal delivery lower than in the blood of elective caesarean during 6-8 weeks with a statistical significance (P＜0.05).Both of groups have no obvious difference during 12-14 weeks after delivery.Conclusion:1.Pelvic anatomic structural and functional conformation triggered by the physiological changes of pregnancy.2.Pelvic tissue damages under selective selective caesarean section is less than that of vaginal deliveris.Suggested that selective caesarean section have protective effect to pelvic structure.3.Pelvic damages under all method of deliveris are temporary,it could be recovered by natural cause.4.Protective effect to pelvic structure given by selective caesarean section is limited.