Impact Of Different Factors Of Gravidity And Delivery On Pelvic Floor Function And Study On Short-term Curative Effect Of Postpartum Pelvic Floor Muscle Rehabilitation Therapy

Objectives:To explore the changes of pelvic floor muscle strength(PFMS) at postpartum and after pelvic floor muscle rehabilitation therapy,compare the impact of different factors of gravidity and delivery on pelvic floor muscle strength.To detect serum concentrations of relaxin,determin the content of typeⅠand typeⅢcollagen of connective tissue in puerperal,to approach the mechanisms of change with pelvic floor function and the etiopathogenisis of pelvic floor dysfunction(PFD),include postpartum stress urinary incontinence(SUI) and pelvic organ prolaps(POP).To appraise the short-term effect of postpartum pelvic floor muscle rehabilitation therapy.Methods:To random select Healthy puerperant who undergo regular prenatal checkup,allocated them to three group:Group 1(gravidity 37—40 weeks),Group 2(postpartum 6—8 weeks),and Group 3(postpartum 3—6 month),meanwhile bolted nulliparous and nonfertile women as control group.Study as follow:1.to appraise pelvic floor muscle strength,using biofeedback electrical stimulation device to gain electromyogram,myoelectricity and defatigation degree of pelvic floor muscle,and adopting vaginal palpation at the same time;2.to compare the effect of different factors of delivery on pelvic floor muscle strength,using questionnaire of pelvic floor dysfunction;3.to approach the mechanisms of change with pelvic floor muscle strength,detecting serum concentrations of relaxin in different period by enzyme-linked immuno-sorbent assay;4.to stochastically select subjects at late pregnancy,taking the tissue in paries posterior vaginase of spontaneous labor,Fusiform scissoring ligamentum teres of one side of uterine-incision delivery,every one about 50mg;taking the same place of the control group.HE stain was Used to observe histological changes.Picric-sirius red polarized light method was used to analyze the content of collagen typesⅠandⅢin these tissue.5.to stochastically select the puerperas of spontaneous labor and uterine-incision delivery for the treatment of biofeedback electrical stimulation and kegel training with pelvic muscle exercises;control group is the puerperas who were not treated.Result:1.Totally,117 women were enrolled,parity＜2time.Group1 had 78 cases,group 2 had 96 cases,group 3 had 71 cases,control group had 20 cases.Electromyogram and defatigation degree of pelvic floor muscle were positive corelation with pelvic floor muscle strength which acquired through vaginal palpation; Except the defatigation degree of pelvic floor typeⅡmuscle fiber,the other indicatrix of pelvic floor muscle strength of the women who had the symptom of stress urinary incontinentia were weaker than the asymptomatic women in the rest group.2 The pelvic floor muscle strength of group 1 was significantly different to group 2,group3 and control group.The incidence of SUI symptom in Group 1,2 and 3 were respectively 41.9%,31.3%,14.1%;If women who had SUI symptom in duration of pregnancy,the incidence of SUI symptom was 53.7%at postpartum 6-8 weeks.Vaginal delivery puerperas who reeled that vagina was flabby accounted 69.2%, and the elective caesarean puerperas only had 7.1%.The pelvic floor muscle strength of elective caesarean puerperas was better than the vaginal delivery puerperas at postpartum 6-8 weeks.The incidences of SUI symptom of the puerperas who were spontaneous labor or elective caesarean section were respectively 45.5%and 12.2%.Risk factor induced to SUI symptom in duration of pregnancy were parity,antepartum BMI,pre-pregnant BMI,if kegel training during duration of pregnancy, and the neonatal birth weight;Risk factor induced to SUI symptom after parturition were the neonatal birth weight,pre-pregnant BMI,if had SUI in duration of pregnancy,and the different way of delivery. In group 1,we got 15 examples of paries posterior vaginase;We got 5 examples of paries posterior vaginase in control group.Compared to control group,the contents of collagen typesⅠandⅢin the tissues of paries posterior vaginase and ligamentum teres of group 1 significantly decreased;In group1,group2,and group3,the contents of collagen typesⅠandⅢin the tissues of intrapartum paries posterior vaginase of the women who had the symptom of SUI were all significantly more than the asymptomatic one;Except the defatigation degree of pelvic floor typeⅡmuscle fiber in group3,the other indicatrix of pelvic floor muscle strength were positive corelation with the contents of collagen typesⅠandⅢin the tissues of intrapartum paries posterior vaginase;The contents of collagen typesⅠandⅢin the pelvic floor connective tissues of the women who carried out kegel training during duration of pregnancy were significantly more than that in not training group.The contents of collagen typesⅠandⅢin the pelvic floor connective tissues were negative corelation with the neonatal birth weight,antepartum BMI.4 In group 1,we got 36 blood samples,group 2 had 32 samples,group 3 had 22 samples.The equal concentration of serum RLX in group 1 was significantly different to group 2,group3 and control group,and there were no significant differences between other groups.The concentrations of antepartum serum RLX were negative corelation with the contents of collagen typesⅠandⅢin the tissues of intrapartum paries posterior vaginase.Except the defatigation degree of pelvic floor typeⅡmuscle fiber,the other indicatrix of antepartum and early postpartum pelvic floor muscle strength were negative corelation with the concentrations of serum;There were significant impact of the concentrations of antepartum serum RLX on the symptom of SUI before delivery and early postpartum;It is no significant difference to the puerperas who feeled that vagina was flabby after delivery;There were significant impact of the concentrations of antepartum serum RLX on the symptom of ache at waist and sacrum before delivery and early postpartum;There were no significant impact of the concentrations of postpartum serum RLX on the symptom of ache at waist and sacrum,vagina flabby,SUI,and the postpartum pelvic floor muscle strength.5 Group 3 had 71 samples,48 samples were vaginal delivery puerperas,and 23 samples were elective caesarean puerperas;there were 33 samples in vaginal delivery puerperas had carried through postpartum pelvic floor muscle rehabilitation therapy, and 6 samples in elective caesarean puerperas.The pelvic floor muscle strength of elective caesarean section and vaginal delivery were both better than group 1.No matter whether carrying through pelvic floor muscle rehabilitation therapy or not,the pelvic floor muscle strength of puerpera at postpartum 3-6 month was stronger than the postpartum 6-8 weeks's.The pelvic floor muscle strength of therapy group in vaginal delivery puerpera was significantly sronger than that in the not therapy group,and significantly sronger compared to before treatment.Except the difference of the defatigation degree of pelvic floor typeⅠmuscle fiber and the muscle strength that acquired through vaginal palpation had no statistics meanings,the other indicatrix of pelvic floor muscle strength of therapy group in elective caesarean puerperas were significantly sronger than that in the not therapy group;and except the defatigation degree of pelvic floor typeⅡmuscle fiber,the other pelvic floor muscle strength were significantly sronger compared to before treatment.The women who had carried through postpartum pelvic floor muscle rehabilitation therapy,the incidence of SUI symptom was significantly descended(43.6%to 10.3%).In the no curer group,the incidence of SUI symptom wasn't significantly descended in postpartum 3-6 months(28.1%to 18.8%).The symptom of ache at waist and sacrum,vagina flabby,vagina acerbity,frequent micturition and urgency were significantly improved after treatment.Conclusion:1.The relationship between the contractibility of pelvic floor muscle and PFD was close.The result of pelvic floor muscle strength can be used as a good indicatrix to evaluate functional status of pelvic floor muscle. 2.There were significant influence of gravidity to pelvic floor function.It was a independent high risk factor to PFD.Vaginal delivery could cause damage of pelvic floor tissue.Elective caesarean section had protection use to pelvic floor function,but could not completely avoid the happen of morning PFD.But gravidity and delivery would not cause permanent damages of pelvic floor tissue.3.The influence of obstertrical factors to the function of pelvic floor had comparatively large dispute,it was relatived with sample size,questionnaire technique,definition of SUI.4.Gravidity and delivery cause the changes of contents and morphous of pelvic floor collagen,were the one of pathomechanisms to PFD in duration of pregnancy and after parturition.5.The change of pelvic floor function was relatived to the change of hormone;the high-level serum RLX in duration of pregnancy affect the pelvic floor collagen,were the one of pathomechanisms to PFD in duration of pregnancy and after parturition.6.Pelvic floor muscle rehabilitation therapy could increase the contractibility of pelvic floor muscle,improve the impaired symptom of pelvic floor function,efficaciously prevent and treat light degree and midrange SUI.