| PART I Research of the impact of different delivery modes and cesarean section in different stages of delivery on pelvic floor by ultrasound1. ObjectiveThrough the use of perineal two-dimensional pelvic floor ultrasonography of vaginal delivery, cesarean section, cesarean section and cesarean section in second stage of delivery, to explore its value in the diagnosis of female pelvic floor dysfunction。Analysis the effects of different delivery modes and different stage of cesarean section on mothers in the early postpartum pelvic floor function.2. Method2.1. Cases data21women with elective cesarean section,21women with vaginal delivery and10women with cesarean section in second stage of delivery were enrolled in this study from2012.10to2013.10who were delivery in the hospital, at the age of20to35and averaged (28.28±3.51).They Shall meet the following criteria:primipara, singleton, through ultrasound confirmed with gestational weeks, palace hight and waist circumference in the normal range. And eliminated the women who had premature, abnormal amniotic fluid, placenta previa, gestational diabetes mellitus, hypertension of pregnancy, fetal intrauterine growth restriction and other complications. The other20women,married nulliparous women were randomly selected as the control group, at the age of20to25and averaged (22.90±1.55)2.2. Instrument and parametersUsing GE VIVID7color ultrasonic diagnostic instrument, abdominal two-dimensional probe, the probe type is4C, probe frequency is2.0～5.0MHz.2.3. Examination methodsPuerpera come back to hospital In6～8weeks after childbirth.They should have a questionnaire survey on urinary incontinence, then through1hour pad test and physical examination to understand whether they had stress urinary incontinence and pelvic organ prolapse. Then they accept the perineal pelvic ultrasonography. Perineum ultrasound was examined at both resting position and valsalva position and the following data were measured:bladder neck down distance(BND),the cervix down distance(CD),the rectal ampulla down distance(RAD),the difference of levator hiatal diameter(LHD-d) and the difference of levator hiatal lateral diameter(LHLR-d) between resting position and valsalva position. The measurement results will be recorded with graph.2.4. Statistical analysis methodsData were analyzed using SPSS18.0statistical software.All data were presented as the mean±SD.For statistical analysis,the Student t test,analysis of variance,and the x2test were used.2-sides p<0.05was considered statistically significant. Correlation by using Pearson correlation analysis method, the p<0.05difference has statistics significance.3. ResultsThe incidence of SUI is similar between the cesarean section in second stage of delivery group and the vaginal delivery group,and compared with the elective cesarean section group,SUI incidence of the two groups were both increased..Compared with the control group,all the data of vaginal delivery group and almost all data except RAD of the group of cesarean section in the second stage of delivery increased differently.Vaginal delivery group and the cesarean sections in the second stage of delivery group compared with elective cesarean section group,each index difference had statistical significance. Compared with the vaginal delivery group, all the data except RAD of the group of cesarean sections in the second stage of delivery shows no statistical significance.BND has significant correlation with SUI. Other datas has no significant correlation with SUI.4. ConclusionsThe incidence of SUI is similar between the cesarean section in second stage of delivery group and the vaginal delivery group,and elective cesarean section reduces the risk of postpartum SUI. The pelvic floor injury early after childbirth were similar the cesarean section in second stage of delivery group and the vaginal delivery group between.Cesarean section has a relatively protective effect on pelvic floor function early after childbirth. BND can demonstrate the extent of damage early anterior pelvic after childbirth. PART Ⅱ Analysis on the recovery effect of early maternal peripartum pelvic muscles exercise for pelvic floor function1. ObjectiveTo study whether early pelvic floor muscle training before and after childbirth is effective and its effect on the recovery of postpartum pelvic floor function by transperineal ultrasonography on pelvic floor. To explore the application value of pelvic ultrasound on maternal pelvic examination.2. Method2.1. Cases dataResearch objects were gestational age28weeks pregnant women from2012October to2013December, in our hospital for treatment.They were divided randomly into exercise group and control group. All subjects met the following criteria:primipara, singleton, confirmed with28weeks of gestation by ultrasound, the palace hight and abdominal circumference in the normal range. Excluded the cesarean delivery subjects, retain the vaginal delivery subjects. And eliminated the subjects who had premature, abnormal amniotic fluid, placenta previa, gestational diabetes mellitus, hypertension of pregnancy, fetal intrauterine growth restriction and other complications.Finally there were20cases of exercise group and21cases of control group retained by elimination. The exercise group at the age of22to33years old range, averaged (27.60±3.22) years old. The control group at the age of20to34years old range, averaged (27.52±3.23) years old.2.2. Instrument and parametersUsing GE VIVID7color ultrasonic diagnostic instrument, abdominal two-dimensional probe, the probe type is4C, probe frequency is2.0～5.0MHz.2.3. Examination methods Guide the exercise group women to do pelvic floor muscle systolic and diastolic motion, from28gestational weeks to6～8weeks postpartum,that is Kegel motion. The method is tightening the anal action, each tightening should not less than3S, then relax,for15～30min,2～3times a day. Guide the women exercise correctly, avoid false muscle exercise of abdominal muscle and thigh muscle movement. The exercise group were required to fill in the pelvic floor exercise daily record. During this time,many follow-up and check the records had been done, to ensure that subjects exercise.Puerpera come back to hospital In6～8weeks after childbirth.They should have a questionnaire survey on urinary incontinence, then through1hour pad test and physical examination to understand whether they had stress urinary incontinence and pelvic organ prolapse. Then they accept the perineal pelvic ultrasonography. Perineum ultrasound was examined at both resting position and valsalva position and the following data were measured:bladder neck down distance(BND),the cervix down distance(CD),the rectal ampulla down distance(RAD),the difference of levator hiatal diameter(LHD-d) and the difference of levator hiatal lateral diameter(LHLR-d) between resting position and valsalva position. The measurement results will be recorded with graph.2.4.Statistical analysis methodsData were analyzed using SPSS18.0statistical software.All data were presented as the mean±SD.For statistical analysis,the Student t test,analysis of variance,and the x2test were used.2-sides p<0.05was considered statistically significant.3. ResultsThe SUI incidence of the exercise group (5%)was lower than the control group(33.3%), The difference was statistically significant.Each data of exercise groups except RAD were lower than those in the control group. The difference was statistically significant.4. ConclusionsPregnant women began to do pelvic floor muscle training at28weeks of pregnancy can promote the recovery of postpartum pelvic floor and reduce the incidence of urinary incontinence. |
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