Evaluation Of Pelvic Floor Rehabilitation By Transperineal Gray-scale Ultrasound Combined With Shear Wave Elastography

Objective:This study aimed to evaluate the effect of postpartum pelvic floor rehabilitation treatment by evaluating the early postpartum feminine pelvic floor,pelvic organs(bladder,uterus,urethra,rectum)position changes,and the differences of puborectalis’ s elasticity before and after rehabilitation treatment,using the transperineal gray-scale ultrasound combined shear wave elastography,and comparing the ultrasound findings before and after rehabilitation.Methods:Selected 30 primiparas who received postpartum physical examination and postpartum rehabilitation treatment in Jingdezhen No.1 People’s Hospital from January 2021 to December 2021 at 6-8 weeks after delivery as the research objects(rehabilitation group).Selected another 30 primiparas who met the inclusion criteria but did not receive rehabilitation treatment during 6-8 weeks postpartum as the control group.Observed and measured the relative positions of urethra,bladder neck,cervix and rectum by transperineal gray scale ultrasound in resting state and maximum Valsalva state.A horizontal line across the posterior and inferior margin of the symphysis pubis as a reference line.Measured the following data in the resting state and the maximum Valsalva state:Vertical distance from bladder neck,lowest point of cervix and rectal ampulla to reference line(BSD,C-VD,RA-VD),Urethral tilt angl,Retrovesical angle(RA).Measured the above data three times after 6-8 weeks postpartum and 12-14 weeks postpartum(one course of rehabilitation treatment over in rehabilitation group),than took the average value.We could calculate the bladder neck descent(BND)and urethral rotation Angle(URA)based on the changes of bladder neck position and Urethral tilt Angle at rest and maximum Valsalva.At the same time,the formation of infundibular orifice was observed under maximum Valsalva condition.Used Shear-wave Elastography(SWE)to measure the young’s modulus values of the anterior part of bilateral puborectalis(PR)at rest and at maximum anal contraction.Measured 3 times,took the mean value,and calculated the difference of bilateral PR before and after contraction.Results:1.Study on two groups’ s subjects of pelvic floor structure by transperineal gray scale ultrasound:The parameters of transperineal gray scale ultrasound in the two groups were compared at 12-14 weeks postpartum and 6-8 weeks postpartum respectively: In a resting state,C-VD of 12-14 weeks postpartum(after treatment in the rehabilitation group)and 6-8 weeks postpartum were compared,respectively,there was no statistically significant difference(P > 0.05).Other parameters were better than 6-8weeks postpartum.Especially in maximum Valsalva: Compared the data of rehabilitation group after or before rehabilitation treatment and compared the data of the control group between 12-14 weeks postpartum or 6-8 weeks postpartum.The differences were statistically significant(P < 0.05).Comparison of perineal gray scale ultrasound parameters between the rehabilitation group and the control group at 12-14 weeks postpartum:In the resting state,BSD,C-VD and RA-VD in the rehabilitation group were slightly higher than those in the control group.RA in the rehabilitation group was significantly lower than that in the control group.Two groups of RA were compared,The difference was statistically significant(P < 0.01).There were no significant differences in BSD,C-VD and RA-VD(P >0.05).Maximum Valsalva state,All indexes of the rehabilitation group were better than those of the control group.The data of each group were compared,the differences were statistically significant(P < 0.01).2.Use SWE study on bilateral PR elasticity parameters of two groups of subjects:In the rehabilitation group,the elastic parameters of bilateral PR in the resting state and maximum anal contraction state increased after treatment compared with before treatment.There were statistically significant differences among all groups(P <0.01).In the control group,the Young’s modulus of bilateral PR at 12-14 weeks postpartum in the resting state and the maximum anal contraction state increased compared with 6-8 weeks postpartum.The differences were statistically significant(P< 0.01).The difference of left PR before or after contraction also increased compared with 6-8 weeks postpartum.There was no significant difference(P > 0.05).The difference before or after PR contraction on the right side was slightly smaller than that at 6-8 weeks.The difference was statistically significant(P < 0.05).The two groups were compared at 12-14 weeks postpartum:The parameters of rehabilitation group in resting state and maximum anal contraction state were higher than those of control group.In addition,the young’s modulus of bilateral PR under the condition of maximum anal contraction and the difference between the two groups before and after bilateral PR contraction were compared respectively.The difference was statistically significant(P < 0.05).3.Study on funnelation of the urethral orifice in the two groups:The incidence of funnelation of the urethral orifice in the rehabilitation group decreased significantly after rehabilitation treatment.Decreased from 43.33% to 10%,the difference was statistically significant(P < 0.01).In the control group,the incidence of infundibulation of the urethra at 12-14 weeks postpartum was also slightly lower than that at 6-8 weeks postpartum.Decreased from 46.67% to 36.67%,with no statistical significance(P > 0.05).At 12-14 weeks postpartum,the incidence of funnelation of the urethra orificium between the two groups was compared(10% in the rehabilitation group and 36.67% in the control group),and the difference was statistically significant(P < 0.05).Conclusion:1.The pelvic floor structure of primiparas in the early postpartum period has certain self-recovery ability.Timely postpartum rehabilitation treatment can better help the pelvic floor viscera return.It also increases the stiffness and contractility of the pelvic floor muscles,thereby promoting their recovery.2.Timely postpartum rehabilitation can increase the stability of bladder neck and proximal urethra,thus preventing the occurrence of postpartum SUI to a certain extent.3.The transperineal gray scale ultrasound combined with SWE can quantitat-ively evaluate the pelvic floor structure and function of postpartum women,providing objective basis for the effect of clinical postpartum rehabilitation therapy.