| Objective:To explore the effects of different obstetric factors on postpartum pelvic floor muscle strength,and to compare the differences in biofeedback electrical stimulation therapy for different delivery methods,to provide some reference for early identific-ation of women with high risk of postpartum pelvic floor disease and subsequent prevention and treatment strategies.Subjects and Methods:A total of 268 female patients who underwent postpartum pelvic floor screening in the Department of Obstetrics and Gynecology of the Second Affiliated Hospital of Nanchang University from March 2021 to January 2022 were selected,including 183cases of vaginal delivery(including 13 cases of kiwi fetal suction;77 cases of intrapartum episiotomy);72 cases of direct delivery by lower uterine segment cesar-ean section and 13 cases of cesarean section after vaginal trial failure;57 cases of gestational diabetes;108 cases of epidural anesthesia and analgesia.Patient data were collected,and the obtained data were subjected to statistical analysis.Result:A total of 268 patients obtained complete clinical data and were included in the study.Among the 224 puerperae with unqualified muscle strength from pelvic floor screening,a total of 71 received biofeedback electrical stimulation therapy.The maternal age at delivery was 21-42 years old,with an average of 29.64±4.31 years;the pre-pregnancy BMI was 15.94-35.94kg/m~2,with an average of 21.18±2.98kg/m~2;the screening time was 6-8 weeks postpartum,with an average of 6.92±0.66 weeks.1.Among the puerperae who underwent postpartum pelvic floor screening,a total of 268 cases met the inclusion criteria and obtained pelvic floor screening data.After the baseline comparison of the general conditions of the natural delivery group,the direct cesarean section group and the transfer cesarean section group,it was found that there were no significant differences in age,pre-pregnancy BMI,increased BMI,neonatal birth weight and prevalence of gestational diabetes among the three groups.significance(P>0.05).2.There were significant differences in the overall distribution of class I muscle strength among the three groups of patients(P=0.003).Among them,only the muscle strength of the direct cesarean section group was greater than that of the natural delivery group,and the difference was statistically significant(P<0.05).There was no significant difference in the overall distribution of pelvic floor type II muscle strength and manual pelvic floor muscle strength between groups(P>0.05);3.In terms of the qualified rate of manual pelvic floor muscle strength measurement,the direct cesarean section group(11.1%)was higher than the transfer cesarean section group(7.7%)and the natural delivery group(3.3%),and the difference between the groups was statistically significant(P=0.04),in which there was a statistical difference between the natural delivery group and the direct cesarean section group(P<0.05);in terms of the qualified rate of class I muscle strength,the direct cesarean section group(16.7%)was higher than the transfer cesarean section group(7.7%)and the vaginal delivery group(5.5%),and the difference between the groups was statistically significant(P=0.016),and the difference between the vaginal delivery group and the direct cesarean section group was statistically significant(P<0.05);in II In terms of the qualified rate of muscle strength,although the direct cesarean section group(20.8%)was higher than the transfer cesarean section group(15.4%)and the natural delivery group(9.8%),the difference between the groups was not statistically significant(P=0.062).4.There was no statistical difference in the overall distribution of pelvic floor muscle strength class I between the perineal resection group and the non-resection group(P=0.673).There was no significant difference in the overall distribution of pelvic floor muscle strength class II between the two groups(P=0.774).There was no significant difference in the overall distribution of pelvic floor muscle strength between the two groups(P=0.952).5.There was no statistical difference in the overall distribution of pelvic floor type I muscle strength between the painless delivery group and the non-painless delivery group among women who were in vaginal delivery(P=0.317);the overall distribution of pelvic floor type II muscle strength was not statistically significant between the two groups.Statistical difference(P=0.113);there was no statistical difference in the overall distribution of pelvic floor muscle strength measured by hand between the two groups(P=0.311).6.In terms of the anterior vaginal wall prolapse rate,the vaginal anterior wall prolapse rate in the vaginal delivery group(90.7%)was higher than that in the transition cesarean section group(53.8%)and the direct cesarean section group(51.4%),and the difference between the groups was as follows.Statistical significance(P<0.05),among which there were statistically significant differences in the prolapse rate of the anterior vaginal wall between the natural delivery group,the cesarean section group,and the transition cesarean section group(p<0.05).In terms of prolapse rate,the vaginal posterior wall prolapse rate(15.8%)in the vaginal delivery group was higher than that in the direct cesarean section group(5.6%)and the conversion cesarean section group(7.7%),but the difference between the groups was not statistically significant(P>0.05);in terms of uterine prolapse rate,the uterine prolapse rate in the natural delivery group(46.4%)was higher than that in the direct cesarean section group(23.6%)and the transition cesarean section group(38.5%),and the difference between the groups was statistically significant(P<0.05),and only the difference between the natural delivery group and the direct cesarean section group was statistically significant(P<0.05).7.The results of multivariate logistic regression analysis showed that age(OR=1.19,95%CI 1.03-1.37,P=0.016)and increased BMI during pregnancy(OR=1.47,95%CI 1.03-2.10,P=0.035)were associated Risk factors for failure to measure pelvic floor muscle strength;additionally age(OR=1.08,95%CI 1.02-1.16,P=0.016)and birth weight(OR=1.99,95%CI 1.19-3.32,P=0.009)was a risk factor for type I muscle strength impairment;and gestational diabetes mellitus(OR=3.26,95%CI 1.05-10.15,P=0.041)was an independent risk factor for type II muscle strength impairment.8.In terms of myoelectric potential,the muscle potential of the cesarean section group(18.86±3.96 u V)before treatment was significantly higher than that of the natural delivery group(15.37±6.44u V),and the difference between the groups was statistically significant(P=0.015);after treatment,the myoelectric potential of the women in the vaginal delivery group was(21.82±8.03)u V,and the myoelectric potential of the women in the cesarean section group was(21.79±6.02)u V,and the difference was not statistically significant(P=0.987).The difference in myoelectric potential was statistically significant(P<0.05).Conclusion:1.Postpartum women have poor overall pelvic floor function;2.The qualified rate of I muscle strength and manual pelvic floor muscle strength of women in the vaginal delivery group was lower than that in the direct cesarean section group;3.The rates of pelvic organ prolapse were higher in the three delivery methods,and vaginal anterior wall and uterine prolapse were more likely to occur in the vaginal delivery group;4.Episiotomy or painless delivery does not increase the risk of pelvic floor muscle damage;5.Maternal age and increasing BMI during pregnancy will aggravate postpartum pelvic floor muscle damage;6.Parity,total labor time,second labor time,epidural anesthesia,pre-pregnancy BMI,episiotomy,etc.have no obvious damage to pelvic floor muscle strength;7.Postpartum pelvic floor type I muscle strength impairment is positively correlated with age at delivery and birth weight of newborns;8.Patients with gestational diabetes mellitus are at increased risk of type II muscle strength impairment;9.There was no significant difference in postpartum pelvic floor muscle strength between women in the transition cesarean section group and other delivery methods;10.The postpartum myoelectric potential of the women in the vaginal delivery group was lower than that in the cesarean section group.After the biofeedback electrical stimulation treatment,the myoelectric potential of the two groups increased. |
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