The Pelvic Floor Function Status And Influencing Factors Of Postpartum Women Were Investigated By The Combination Of Pelvic Floor Ultrasound And POP-Q Assessment

Objective:The pelvic floor function of women at 6-8 weeks postpartum was investigated by the method of pelvic floor ultrasound combined with POP-Q evaluation.To study the factors affecting the pelvic floor function of postpartum women,and to provide scientific basis for the development of prevention and treatment of pelvic floor dysfunction diseases.Through the consistency and correlation study of POP-Q assessment and pelvic floor ultrasound in the diagnosis of POP,the application value of pelvic floor ultrasound in the quantitative evaluation of maternal pelvic organ prolapse and the advantages of combining the two methods.Methods:The parturients who underwent postpartum reexamination in Shanxi Maternal and Child Health Hospital from January to December 2020 were chosen as subjects for retrospective analysis.The postpartum outpatient medical record table designed by our hospital was used to collect the general data of the subjects,the conditions of delivery and neonates,and the pelvic floor color ultrasound data of the women.Epi Data 3.1 software was adopted to set up the database,and SPSS 26.0 software was employed to analyze the material.Describe the basic situation of the study object,delivery,newborn,pelvic floor ultrasound indicators;to describe the current situation of puerpera pelvic floor function.According to the occurrence of postpartum pelvic floor dysfunction(PFD),they were split into PFD group and non-PFD group to analyze the possible influencing factors of PFD occurrence in postpartum women.The influencing factors with P<0.05 in univariate analysis were used as candidate arguments,and multiple logistic regression was performed to analyze the risk elements of PFD in postpartum women.Compare the two groups of puerpera pelvic floor color ultrasound,analyze whether there are differences between the two groups of puerpera pelvic floor color ultrasound results.Kappa consistency test was performed for ultrasonic diagnosis results and POP-Q evaluation results,and Spearman correlation analysis was performed for ultrasonic measurement data and POP-Q evaluation data.The results showed that the test level wasα=0.05.If P<0.05,the difference was statistically significant.Results:(1)The electrophysiological results of pelvic floor showed that the occurrence rate of pelvic floor Class I myodynamia descend was 72.5%,that the occurrence rate of pelvic floor Class II myodynamia descend decline was 29.1%,the the occurrence rate of aberrant pelvic floor muscle fatigue of Class I and Class II was 69.0%and 11.7%respectively in postpartum women,the incidence of abnormal vaginal dynamic pressure in postpartum women was 94.3%.(2)The incidence of PFD in postpartum women was 72.2%,including9.2%for SUI and 71.5%for POP.The incidence of anterior vaginal wall prolapse in women with POP was 53.3%,posterior vaginal wall prolapse was 52.8%,and uterine prolapse was 51.3%.(3)Unifactor analysis of PFD of postpartum women showed that compared with non-PFD group,there were statistically significance in the aspect of delivery time,delivery mode,postpartum BMI≥24.0kg/m~2,and separation of rectus abdominis.(4)Multivariate logistic regression analysis of PFD in postpartum women showed that delivery times(≥2),vaginal delivery,postpartum BMI≥24.0kg/m~2,rectus abdominis separation were risk factors for PFD in postpartum women.(5)The comparison of pelvic floor ultrasound results of postpartum women in PFD group and non-PFD group showed that during Valsalva movement(s),the rotation Angle(degree)of urethra in PFD group was greater than that in non-PFD group,and the location of cervix vesicae in PFD group puerpera was lower than that in non-PFD group;the vertical dimension of ampulla recti to the inferior margin of symphysis pubica(ARVD)in PFD group was smaller than that in non-PFD group and perpendicular distance of cervical neck to the inferior margin of symphysis pubica(CNVD)in PFD group was smaller than that in non-PFD group,with statistical significance.The formation rate of the urethral endostoma funnel in PFD group(38.3%)was higher than that in non-PFD group(17.4%),and the occurrence rate of musculus levator ani injury in PFD group(27.3%)was higher than that in non-PFD group(1.8%),the incidence of anal sphincter injury in PFD group(27.5%)was higher than that in non-PFD group(0.6%),and the discrepancies were statistically significant.(6)Kappa consistency test results of maternal clinical POP-Q evaluation results and pelvic floor ultrasound diagnosis results showed that pelvic floor ultrasound diagnosis and clinical POP-Q evaluation in anterior,middle and posterior chambers had a moderate consistency,among which,middle pelvic prolapse had the highest consistency,followed by anterior pelvic prolapse,and finally posterior pelvic prolapse.(7)Spearman correlation analysis of clinical POP-Q evaluation data and pelvic floor ultrasound diagnosis data of postpartum women showed that the anterior pelvic cavity had the best correlation.The second was a weak positive correlation in the middle pelvic cavity.Finally,the posterior pelvic cavity showed a weak positive correlation.Conclusions:(1)The occurrence rate of pelvic floor type I myodynamia descend is higher,the occurrence rate of abnormal type I muscle fatigue is higher,and the occurrence rate of aberrant dynamic vaginal pressure is higher.Generally speaking,the abnormal rate of postpartum electrophysiological indicators is high,so it is necessary to do pelvic floor screening as early as possible,early detection and early intervention of abnormal changes in the pelvic floor.(2)Two or more births,vaginal delivery,postpartum BMI≥24kg/m~2and separation of rectus abdominis were positively correlated with the occurrence of PFD in postpartum women.(3)Pelvic floor ultrasound can observe the whole process of pelvic organ descending,displacement,starting and prolapse to the lowest point in real time and visually.In addition,pelvic floor ultrasound can also accurately capture the prolapse of pelvic organs and the maximum degree of prolapse,and provide reliable imaging and anatomical basis for the diagnosis of POP through clear images.It has a good correlation with clinical POP-Q evaluation,with medium consistency,among which,middle pelvic prolapse has the highest consistency,and anterior pelvic prolapse has the best correlation,the consistency and correlation of posterior pelvic prolapse were poor.(4)Pelvic floor ultrasound can detect more POP,and the combination of pelvic floor ultrasound with the POP-Q evaluation system can just make up for the deficiencies of the POP-Q evaluation system,decrease the misdiagnosis rate of POP,enhance the diagnostic rate of POP,and to some extent,provide a more exact reference for the early diagnosis of disease.It is helpful for the accurate application of POP-Q assessment system in the diagnosis of pelvic floor organ prolapse.