Effect Of PFMT On Early Pelvic Floor Function Rehabilitation Of Primipara With Vaginal Delivery

Objective:To investigate the incidence of pelvic floor muscle electrophysiological abnormalities and explore the influencing factors during the early postpartum in primipara who with vaginal delivery.To evaluate the effect of pelvic floor muscle training（PFMT）on the early postpartum pelvic floor function rehabilitation on the 2^nd day after vaginal delivery.Methods:1.This research is divided into 2 research parts.In the first part,we selected 664 primiparas who had gave birth at Gui Gang City People’s Hospital from January 2018 to June 2019,and checked pelvic floor rehabilitation examinations at 6～8 weeks after vaginal delivery.Collect pregnancy and childbirth related data,analysis the data to find out the influencing factors of pelvic floor electrophysiological abnormalities and establish predictive models.In addition,primiparas with vaginal delivery from July 2019 to March 2020 were selected for model testing.In the second part,the same cluster sampling method was adopted to divide the 223 women who had regular antenatal checkups and vaginal delivery at Gui Gang City People’s Hospital from January to October 2020.According to informed consent,the women were randomly divided into 2 groups.The experimental group（n=114）and the control group（n=109）depend on to the computerized randomization method.The control group was given postpartum normal care and with natural rehabilitation,and the observation group was given postpartum normal care+PFMT intervention on the 2^nd day after vaginal delivery,for a period of 3 months.Use the PFDI-20 questionnaire to evaluate pelvic floor function,and assess urinary incontinence,and anal incontinence in the third trimester of pregnancy at the 2^nd day after delivery through memories.After 42 days and 3months intervention,the changes of the PFDI-20 score,the incidences of urinary incontinence,anal incontinence,pelvic organ prolapse,and pelvic floor muscle electrophysiological changes should be evaluated.2.Use SPSS22.0 statistical software for data statistical analysis.The statistical methods used included descriptive statistics,t-test,χ² test,F-test,rank sum test,Pearson correlation analysis,binary logistic regression analysis,establish a prediction model based on the regression analysis results,and draw ROC curves.Calculate the area under the curve（AUC）value and other methods,and P<0.05 indicates that the difference is statistically significant.Results:1.Among 664 primipara with vaginal delivery,the incidence ofⅠandⅡtypes of pelvic floor muscle fiber strength abnormalities were with 465cases（70.03%）and 460 cases（69.27%）in the 6～8 weeks after vaginal delivery.The incidence ofⅠandⅡtypes of pelvic floor muscle fiber fatigue abnormalities were with 463 cases（69.73%）and 206 cases（31.02%）,there were 611 cases（92.02%）with abnormal vaginal dynamic pressure.2.The results of binary logistic regression analysis showed that the abnormalities typeⅠmuscle strength of pelvic floor muscles in the early stage of vaginal delivery were associated with the maternal delivery age,maternal height,perineal lateral incision,perineal laceration,weight gain in the third trimester,newborn birth weight,neonatal body length.Type II muscle strength abnormalities were related to perineal lateral incision and laceration.Type I muscle fatigue were related to neonatal gender（female）and weight gain over 10kg in the third trimester.TypeⅡmuscle fatigue were related to perineal laceration and the second stage of labor.Abnormality of vaginal dynamic pressure were related to perineal lateral incision and the duration of the second stage of labor.The model which the women with vaginal delivery about 6～8weeks postpartum validation showed that the AUC of typeⅠmuscle strength abnormality was 0.692;the AUC of type II muscle strength abnormality was 0.655;the AUC of typeⅠmuscle fatigue abnormality was0.765;the AUC of type II muscle fatigue abnormality was 0.807;the AUC of vaginal dynamic pressure abnormality was 0.779.There is a moderate-intensity positive correlation between pelvic floor muscle typeⅠmuscle strength and typeⅡmuscle strength（r=0.539）.3.At 42 day postpartum,there was no difference between the observation group’s and control group with typeⅠmuscle strength,typeⅠ,typeⅡmuscle fiber fatigue,anal incontinence（P>0.05）.The muscle strength recovery of typeⅡmuscle fibers in the experimental group recovered better than the control group,The incidence and PFDI score of the observation group of urinary incontinence were significantly lower than those of the control group（P<0.05）.Postpartum 3 months,the observation groupⅠandⅡmuscle fiber muscle strength and the recovery of typeⅠmuscle fiber fatigue and vaginal dynamic pressure were significantly better than those of the control group（P<0.05）.The incidence of urinary incontinence and the PFDI score of the observation group were significantly lower than the control Group（P<0.05）.There was no difference in anal incontinence and classⅡmuscle fiber fatigue between the two groups（P>0.05）.Conclusion（s）:1.The incidence of electrophysiological abnormalities in pelvic floor muscles is high in primiparous women after vaginal delivery.2.The myoelectric injury of the pelvic floor muscle of the primipara at6～8 weeks after vaginal delivery is related to the maternal delivery age,maternal height,perineal lateral incision,laceration,duration of the second stage of labor and the weight of the newborn,the length of the newborn and the weight gain during pregnancy.There is a correlation between pelvic floor electrophysiology.The prediction model of early postpartum electrophysiological abnormalities of pelvic floor has a certain degree of predictive science and practicality.There is a moderate-intensity positive correlation between pelvic floor muscle typeⅠmuscle strength and typeⅡmuscle strength.3.Compared with natural recovery,PFMT intervention started on the second day after delivery and intervention with 3 months can increase the muscle strength of the pelvic floor muscles in postpartum,better improve the firmness of the vagina,reduce the fatigue of the pelvic floor muscles,reduce the incidence of early postpartum Urinary incontinence,and improve the postpartum maternal health quality of life.