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Effect of different delivery modes on pelvic floor structure and elasticity in primiparasObjective: The morphological parameters of levator hiatus in primiparas were quantitatively evaluated by transperineal three-dimensional ultrasound(3DUS).The elastic parameters of puborectalis(PR)in primiparas were quantitatively evaluated by shear wave elastography(SWE).To explore the effect of different delivery modes on pelvic floor structure and elasticity in primiparas.Methods: 140 primiparas with full-term single birth(2.5-4.0kg newborn weight)who came to the First Affiliated Hospital of Nanchang University to examine at postpartum 6-8 weeks from December 2016 to December 2018 were enrolled.According to the mode of delivery,they were divided into 70 spontaneous vaginal delivery cases and 70 elective cesarean section cases.At the same time,70 healthy nulliparous women were selected as the control group.The anteroposterior diameter,lateral diameter,area of levator hiatus and bilateral levator ani thickness were measured by 3DUS at rest,maximal contraction and maximal valsalva state.The Young's modulus of bilateral PR were measured by SWE at rest and maximal contraction state,and the differences before and after contraction were calculated.Results:1.At rest,maximal contraction and maximal valsalva state,the anteroposterior diameter,lateral diameter,area of levator hiatus among the three groups were statistically significant(P <0.05).These morphological parameters in the control group,elective cesarean section group and spontaneous vaginal delivery group increased in turn,and the differences were statistically significant between each two groups(P <0.05).2.At rest,maximal contraction and maximal valsalva state,the bilateral levator ani thicknesses of the elective cesarean section group and the spontaneous vaginal delivery group were less than those in the control group,and the differences were statistically significant(P <0.05).There was no significant difference in bilateral levator ani thicknesses between selective cesarean section group and spontaneous vaginal delivery group at three states(P > 0.05).3.There was no significant difference in PR Young's modulus at rest and maximal contraction state and difference before and after contraction between the selective cesarean section group and the control group(P > 0.05).The PR Young's modulus at rest and maximal contraction state and difference before and after contraction in the spontaneous vaginal delivery group were lower than those in the control group and the selective cesarean section group,and the difference were statistically significant(P <0.05).Conclusion:1.Pregnancy and delivery can lead to morphological changes of levator hiatus.The degree of change varies with different delivery modes.The spontaneous vaginal delivery is more likely to lead to the enlargement of levator hiatus than selective cesarean section.2.Pregnancy and delivery can result in levator ani thinning,but there is no significant difference in levator ani thickness between different delivery modes.Among the factors that result in levator ani thinning,pregnancy is more important than delivery mode.3.The elective cesarean section had certain protective effects on PR elasticity and contract function.The spontaneous vaginal delivery was more likely to damage PR elasticity and contract function.4.Ultrasonographic examination can be an effective and non-invasive method for evaluating the effect of pregnancy and delivery on pelvic floor structure and elasticity.Part ? Effect of newborn weight on pelvic floor structure and elasticity in primiparasObjective:The effect of newborn weight on the morphology of levator hiatus in primiparas was evaluated by 3DUS.The effect of newborn weight on the elasticity and contractility of PR in primiparas was evaluated by SWE.Methods: During the same period from December 2016 to December 2018,25 primiparas(group A1,newborn weight ?4.0 kg)with macrosomia delivered by selective cesarean section who came to our hospital to examine at postpartum 6-8 weeks were enrolled.The morphological parameters of levator hiatus and PR elasticity parameters were compared with those of 70 primiparas(group A2,newborn weight 2.5-4.0 kg)who delivered normal weight infants by selective cesarean section in the part one.During the same period,18 primiparas(group B1,newborn weight ?4.0 kg)with macrosomia delivered by spontaneous vaginal delivery who came to our hospital to examine at postpartum 6-8 weeks were enrolled.The morphological parameters of levator hiatus and PR elasticity parameters were compared with those of 70 primiparas(group B2,newborn weight 2.5-4.0 kg)who delivered normal weight infants by spontaneous vaginal delivery in the part one.Results:1.At rest,maximal contraction and maximal valsalva state,there was no significant difference in the anteroposterior diameter,lateral diameter,area of levator hiatus and bilateral levator ani thickness between group A1 and group A2(P > 0.05).There was no significant difference in Young's modulus of PR between group A1 and group A2 at rest state(P > 0.05).The PR Young's modulus at maximal contraction state and difference before and after contraction in group A1 were lower than those in group A2,and the difference were statistically significant(P <0.05).2.At rest,maximal contraction and maximal valsalva state,the anteroposterior diameter,lateral diameter,area of levator hiatus in group B1 were larger than those in group B2,the bilateral levator ani thickness were thinner than those in group B2,and the difference were statistically significant(P <0.05).The PR Young's modulus at rest and maximal contraction state and difference before and after contraction in group B1 were lower than those in group B2,and the difference were statistically significant(P <0.05).Conclusion:1.Macrosomia delivered by selective cesarean section had little effect on the morphology of levator hiatus in primiparas,but mainly affecting the elasticity at contraction state and contract function of puborectalis.2.Macrosomia delivered by transvaginal had significantly effect on the morphology of levator hiatus and the elasticity of puborectalis in primiparas.Macrosomia delivered by transvaginal are more likely to cause enlargement of levator hiatus,thinning of levator ani thickness,and decrease of puborectalis elasticity and contract function.3.Ultrasonographic examination can be an effective and non-invasive method for evaluating the effect of newborn weight on pelvic floor structure and elasticity of primiparas.Part ? Study and analysis of postpartum POP and SUI in primiparas with different delivery modesObjective:To study and analyze the incidence of POP and SUI in primipara with different delivery modes.Methods: The study subject were 140 primiparas with full-term single births(2.5-4.0kg newborn weight)at postpartum 6-8 weeks in the first part of the dissertation.According to the mode of delivery,they were divided into 70 spontaneous vaginal delivery cases and 70 elective cesarean section cases.The incidence of postpartum POP and funnelization of intraurethral orifice were evaluated by transperineal two-dimensional ultrasound.The incidence of postpartum SUI was evaluated according to clinical symptoms.Results:1.The total incidence of primiparas POP was 32.1% at postpartum 6-8 weeks.The postpartum POP incidence of spontaneous vaginal delivery and selective cesarean section were 42.9% and 21.4% respectively.There was significant difference between the two groups(P <0.01).2.The total incidence of primiparas SUI was 16.4% at postpartum 6-8 weeks.The postpartum SUI incidence of spontaneous vaginal delivery and selective cesarean section were 22.9% and 10% respectively.There was significant difference between the two groups(P <0.05).3.At rest,the funnelization of the intraurethral orifice was not found in primiparas in the spontaneous vaginal delivery group and the selective cesarean section group.At maximal valsalva state,the incidence of funnelization of intraurethral orifice in spontaneous vaginal delivery group and selective cesarean section group were 18.6% and 7.1 % respectively.There was significant difference between the two groups(P <0.05).Conclusion:1.The spontaneous vaginal delivery was more likely to lead to POP,SUI and funnelization of intraurethral orifice in the early postpartum period of primiparas.2.The incidence of POP,SUI and funnelization of intraurethral orifice in early postpartum period of selective cesarean section were low.However,the protective effect of selective cesarean section on pelvic floor is limited,and the long-term protective effect is not clear. |
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