The Clinical Value Of Transperineal Two-dimensional Ultrasonography In Evaluating Postpartum Constipation In Women After Vaginal Deliver

Objectives To evaluate the parameters of pelvic floor ultrasound related to postpartum constipation in primipara women after vaginal delivery(VD)by using transperineal two-dimensional ultrasound.To understand the morphological changes of pelvic floor in postpartum constipation women,and to explore the value of anterio-posterior diameter(LHap)of levator ani hiatus and anorectal angle in the evaluation of postpartum constipation.Methods A total of 4903 cases of pelvic floor ultrasound examination were collected from the Department of Ultrasound in our hospital on January 1,2019,6-12 weeks postpartum,among which 455 cases of VD parturiens with constipation symptoms were collected.99 parturiens meeting the following criteria were included in the study and were classified as the constipation group.Inclusion criteria :(1)Single vaginal delivery;(2)Less than 3 times of defecation per week and/or obstructed defecation and hard stools within 6-12 weeks after vaginal delivery may require medication-assisted defecation.Exclusion conditions: 1)unable to complete the maximum effective Valsalva action author;2)Previous history of urinary incontinence,fecal incontinence,intractable constipation,abdominal hernia,rectocele and other pelvic dysfunction diseases;3)Previous history of pelvic floor injury,pelvic surgery,long-term history of chronic cough and neurological disorders.In order to exclude the influence of anterior pelvic organ prolapse on LHap 198 cases of VD primiparas with the same degree of anterior pelvic organ prolapse in the same period and in the same department and without symptoms of postpartum constipation were selected as the control group with a ratio of 2:1.The parameters of the two groups were retrospectively analyzed.LHap in resting and maximal effective Valsalva states was measured using two-dimensional transperineal ultrasound to obtain two-dimensional images of the midsagittal plane of the pelvic floor.The long axial section of the anal canal and the lower rectum under resting and maximum effective Valsalva was obtained on the median sagittal section of the posterior pelvic cavity,and the size of the anterior horn and posterior horn of the anal canal and rectum were measured.Intra-group correlation coefficient and Bland-Altman diagram were used to analyze the consistency of all parameters measured within and between observers.SPSS22.0was used for statistical analysis.Students’ t test and Mann Whitney U test were used for the difference analysis of all parameters between the two groups.Results The consistency analysis of LHap showed a good correlation between the intraobserver and inter-observer(ICC > 0.9).The reproducibility of anterior anorectal angle and posterior anorectal angle were poor,with largeinter-observer variability(ICC < 0.7).LHap in Valsalva state was significantly higher than that in control group(P < 0.05).There was no significant difference in LHap at resting state between the two groupsConclusions Two-dimensional transperineal ultrasound is a highly reproducible method to evaluate LHap and is easy to be applied in community-level hospitals In Valsalva state,the levator ani hiatal antro posterior diameter(LHap)in VD primipara with postpartum constipation increased significantly,which was helpful to evaluate the morphological changes of levator ani hiatus in VD primipara with postpartum constipation,.This provides an early clinical assessment for VD primipara with postpartum constipation.The reproducibility of anterior anorectal angle and posterior anorectal angle measurements were poor,and they are not suitable for the assessment of postpartum constipation in primiparas with VD.