Risk Factors Of Postpartum Stress Urinary Incontinence And Analysis Of Pelvic Floor Ultrasonography Parameters

Objective：To explore the influencing factors of postpartum stress urinary incontinence(PSUI);To analyze the changes of pelvic floor structure in puerperae and explore the diagnostic value of pelvic floor ultrasound in PSUI.Methods：From March 2022 to November 2022,173 puerperae were examined in the First Affiliated Hospital of Chengdu Medical College for 6-10 weeks after delivery.60 puerperae diagnosed as stress urinary incontinence(SUI)were selected into the case group,and 113 puerperae excluding SUI were set as control group.The clinical data and ultrasonic parameters of the two groups were collected.The clinical data included: age,gestation days,times of gestation and deliverys,prenatal BMI of pregnant women,mode of delivery,neonatal weight,fetal head circumference before labor,placental weight,perineal lateral incision during delivery,birth canal laceration,length of second stage of labor and the use of forceps.Ultrasound examination of pelvic floor was performed on all puerperae,and the ultrasonic parameters were collected as follows:bladder wall thickness(BWT),bladder neck position at rest(BNP-R),bladder neck position at maximum Valsalva maneuver(BNP-V),bladder neck descent(BND),urethral rotation angle(URA),poster urethro vesical angle(PUVA),levator hiatus area(LHA),the number of people with urethral funnel formation(IUF).T-test or nonparametric test was used to compare the clinical and ultrasonic data of the two groups.The logistic regression method was further used to find the clinical influencing factors,and the ROC curve was used to analyze the diagnostic efficiency of ultrasound parameters for PSUI.Results：1.The comparison of clinical data between the case group and the control group shows that: the neonatal weight,placental weight,gestation days and vaginal delivery rate in the case group were higher than those in the control group,and the difference between the two groups was statistically significant(P < 0.05).There was no significant difference(P>0.05)in maternal age,times of gestation and deliverys,prenatal BMI of pregnant women,fetal head circumference before labor,perineal lateral incision rate,birth canal laceration rate and the length of the second stage of labor between the two groups.2.The results of pelvic floor ultrasound examination in the case group and the control group show that: BWT and BNP-V in case group were lower than those in control group,BND,URA,PUVA,LHA and the formation rates of IUF in the case group were higher than those in the control group.The above differences between the two groups were statistically significant(P<0.05).Using the receiver operating characteristic(ROC)curve analysis,the area under ROC curve of PSUI diagnosed by multi-parameter combination composed of BND,BNP-V,LHA and IUF is 0.812,with the sensitivity of 73.3% and the specificity of 78.6%.Conclusions：1.The influencing factors of PSUI are neonatal weight,placental weight,gestation days and vaginal delivery.Neonatal weight gain and vaginal delivery are risk factors for the increased prevalence of PSUI,the risk of PSUI in vaginal delivery is 6.142 times higher than that in cesarean section.2.Pelvic floor ultrasound can observe the changes of pelvic floor structure in patients with PSUI.The combined diagnosis of BND,BNP-V,LHA and IUF can improve the sensitivity and specificity of pelvic floor ultrasound in the diagnosis of PSUI.