Clinical Data Analysis And Study Of Levator Ani Hiatus Area At 42 Days Postpartum

Objective: To statistically analyze the values of anal fissure area in women at 42 days postpartum,to find the factors that cause the increase of anal fissure area,to explorethe relationship between anal fissure area and PFD(pelvic floor dysfunction disease)and pelvic floor electrophysiological data,and to provide a reference for the clinical application and interpretation of anal fissure area measurement data at 42 days postpartum.This study provides a reference for the clinical application and interpretation of anal fissure area data in the 42-day postpartum examination.METHODS: From July 2022 to January 2023,418 women who were examined 42 days postpartum and underwent pelvic floor 4-dimensional ultrasound examination at Dalian women’s and children’s medical center(group)Maternity Hospital District(Chang Jiang Road Branch)were selected as the study subjects.The general data,maternal data,anal fissure area values,PFD examination results and pelvic floor electrophysiological indexes of the study subjects were collected,and the data obtained were statistically analyzed using SPSS25.0 software,and the results were compiled,analyzed and discussed.Results: 1.The median value of the fissure area of the levator ani muscle was 25 cm~2.2.The area of the fissure of the anal raphe was greater than that of the fissure of the anal raphe for cesarean delivery,the area of the fissure of the anal raphe for≥2 deliveries was greater than that of the fissure of the anal raphe for 1delivery,the areaof the fissure of the anal raphe for a newborn weighing ≥4 kg was greater than that ofthe fissure of the anal raphe for a newborn weighing <4 kg,and the area of the fissure ofthe anal raphe for a full-term delivery was greater than that of the fissure of the anal raphe for a newborn weighing <4 kg.The area of anal fissure for full-term delivery was greater than the area of anal fissure for non-fullterm delivery.3.Statistical analysis of the relationship between the POP-Q score and the area of the fissure of the levator ani muscle was performed.The results showed that the area of the fissure of the levator muscle increased with the increase of the pelvic organ prolapse score,and there was a statistically significant difference between the groupsin the post hoc comparison(P < 0.05),i.e.the area of the fissure of the levator muscle was significantly different between the no POP group and the POP I group,the POP I group and the POP II group,and the no POP group and the POP II group(P < 0.001).Therefore,the ROC(receiver operating characteristic curve)curve was used to determine the cut-off value: 100 cases in the no POP group had an anal raphe area<23.5 cm~2;187 cases in the I degree POP group had an anal raphe area≥23.5 cm~2.The area of the fissure of the anal raphe was ≥23.5 cm~2 in 187 cases in the I degree POP group,and the area of the fissure of the anal raphe was ≥26.5 cm~2 in 131 cases in the II degree POP group.4.Statistical analysis of the relationship between vaginal laxity and the area of fissure of the levator ani muscle.The results showed that the area of the fissure ofthe anal raphe increased with the increase of vaginal laxity,and there was a statistical difference between the groups in the post hoc comparison(P<0.05),i.e.between the non-vaginal laxity group and the mild vaginal laxity group,between the mildvaginal laxity group and the moderate vaginal laxity group,and between the non-vaginal laxity group and the moderate vaginal laxity group.The ROC curve could be applied to determine the cut-off values.Among them,188 cases in the nonvaginal laxity group had an anal raphe area <26.5 cm~2;147 cases in the mild vaginal laxity group had an anal raphe fissure area ≥26.5 cm~2;83 cases in the moderate vaginal laxity group had an anal raphe fissure area ≥24.5 cm~2.5.Stress urinary incontinence(SUI)was statistically analyzed in relationto the area of the fissure of the anal raphe.The results showed that the fissure area ofthe anal raphe was larger than the fissure area of the anal raphe without SUI in the study subjects.The ROC curve could be applied to determine the cut-off value,in which 284 cases in the group without SUI had an anal raphe fissure area <25.5 cm~2;134 cases in the group with SUI had an anal raphe fissure area≥25.5 cm~2.6.The relationship between the pelvic floor electrophysiological indexes and the area of the fissure of the anal raphe muscle was statistically analyzed.The results showed that there was a statistical difference(P<0.05)between class I and class II pelvic floor muscle strength and the fissure area of the anal raphe muscle,but there was a statistical difference between class 0 and class 5 muscle strength,class 1 and class 5 muscle strength,and class 2 and class 5 muscle strength in the post hoc comparison of class I muscle strength;there was no statistical difference in class II muscle strength in the post hoc comparison.Inflation in pelvic floor electrophysiology was negatively correlated with the area of the anal raphe fissure,i.e,the larger the area of the anal raphe fissure,the smaller the inflation.Conclusions: 1.The median value of the fissure area of the levator muscle was 25cm~2.2.There was a positive correlation between the size of the fissure area of the levator ani and age.The area of the fissure of the levator ani muscle was larger in women with 42 days postpartum who had an intrauterine delivery,≥2deliveries,were pregnant with a huge baby,and had a full-term delivery than in women who had a cesarean delivery,had 1 delivery,had a newborn weighing <4 kg,and had a non-full-term delivery.3.The size of the fissure area of the levator ani is closely related to the severity of POP,vaginal laxity and SUI.4.The pelvic floor electrophysiology showed no significant correlation between the muscle strength and resting pressure of the pelvic floor and the fissure area of the anorectalis muscle,in which the amount of inflation was negatively correlated with the size of the fissure area of the anorectalis muscle.