Study On Effects Of Pregnancy And Childbirth On Pelvic Floor Function And Short-term Therapeutic Effect Of Early Pelvic Floor Rehabilitation

ObjectiveTo explore the effects of pregnancy and childbirth on postpartum early pelvic floor function and the occurrence of pelvic floor dysfunction disease (PFD) and analyze the short-term therapeutic effect of early pelvic floor muscle rehabilitation, thus to provide a theoretical basis for early prevention and intervention.MethodsFrom January to May2012, a total of568full-term primipara, who visited the antenatal clinics, delivered and had the follow-up at6-8weeks after delivery in Qianfoshan Hospital Affiliated to Shandong University were included. Their average age was (28.91±3.26) years and they were divided into3groups:vaginal delivery group (n=311), cesarean section after vaginal trial-delivery group (n=91) and elective cesarean section group(n=166). Test pelvic floor muscle strength, fatigue strength and pelvic floor pressure by digital vaginal palpation and electrodiagnosis to explore early pelvic floor function; general questionnaires and POP-Q scoring were used to know early postpartum stress urinary incontinence (SUI) and pelvic organ prolapse (POP) and their main influencing factors and to analyze the effects of modes of delivery and other obstetric factors on it. Primipara whose pelvic floor muscle strength<4or who have symptoms of POP or SUI of80cases are chosen to do pelvic floor muscle rehabilitation for a course of treatment.The method of treatment is electrical stimulation and biofeedback combined with pelvic floor muscle training using French PHENIX therapeutic apparatus to compare pelvic floor muscle strength and muscle voltage before and after treatment,POP-Q staging and the change of the incontinence symptoms,thus to evaluate treatment efficacy.Results1.The normal rate of type I and type II muscle fiber strength after delivery was29.40%and33.10%; the normal rate of fatigue strength was52.82%and89.08%; the normal rate of pelvic floor pressure was72.54%. There were no significant difference between the different delivery groups (P>0.05).2. The incidence of SUI in pregnancy was27.82and of VD group,cesarean section after vaginal trial-delivery group and ECS group was respectively28.94%,28.57%.25.30%.There were no significant difference between the three groups (P>0.05).The incontinence of SUI at6-8weeks after delivery was9.86%and it was15.43%,3.30%,3.01%in these three different groups, respectively, with significant difference among them (P<0.05). It showed that vaginal delivery, lateral episiotomy, newborn birth weight (≥4000g) and SUI during pregnancy were risk factors of SUI after delivery.3.The incontinence of vaginal anterior and posterior prolapse, uterine prolapse at6-8weeks after delivery was respectively79.40%,21.13%,12.50%.And the incontinence was vaginal delivery group>cesarean section group, with significant difference between them(P<0.05).The incontinence of POP-Q-0～Ⅲis respectively20.42%,50.53%,28.34%,0.70%.It showed that vaginal delivery, lateral episiotomy, newborn birth weight(>4000g) were the important risk factors of postpartum POP.4.After postpartum pelvic floor muscle rehabilitation, the average of type I and type Ⅱ muscle fiber strength was respectively (4.11±1.01) lever and (4.04±1.01) lever.The average of muscle voltage was (14.14±5.09) uv. The treatment compared to before, there was significant increase at least2levels of muscle strength and more than50%of muscle voltage, with significant difference between them(P<0.05). The total effective rate of patients with POP was92.81%. And the total effective rate with POP-Q Ⅰ and Ⅱ was respectively85.19%and95.83%.The markedly effective rate of patients with POP-Q-Ⅲ was100%.The total effective rate of postpartum SUI was100%.ConclusionsPregnancy and childbirth can make pelvic floor muscle strength and pelvic floor pressure decline and make fatigue strength occurred and postpartum SUI and POP appear, which should be paid attention to early. Pelvic floor rehabilitation earlier after delivery,which is mainly electrical stimulation and biofeedback combined with pelvic floor muscle training can improve pelvic floor muscle strength and vaginal muscle voltage, and improve the symptoms of POP and SUI after delivery, which has important clinical significance and should be worthy of promotion.