The Impact Of Different Delivery Mode On The Morphous Of Pelvic Diaphragm Hiatus In Transperineal Three-dimensional Ultrasonography

Objective:1．By the observation of postpartum women pelvic diaphragm hiatus changes withtransperineal three-dimensional ultrasonography.To understand Basin functionlost,Pelvic floor rehabilitation to be carried out as soon as possible.2．To understand Vaginal delivery on the pelvic floor injury is serious than Electivecesarean section，Elective cesarean section to protect the pelvic floor function，Theprevention of the occurrence of postpartum PFD.3．Learn postpartum main factors affect the pelvic floor functional recovery.Method：April2012to February2013the our hospital obstetrics and gynecologyoutpatient30patients.The study group was discharged from our hospital maternityward of maternal，3months and42days after delivery, patient review of20patients.10cases of vaginal delivery group（Perineal cut side）,10cases of electivecesarean section group.Control group:The women Undelivered to our hospital becauseof vaginitis in the same time.To measure the change of Pelvic diaphragm hiatusLevator hiatal anteroposterinr diameter、Levator hiatal lateral diameter、Levator hiatalarea、The angle between the pubovisceral muscles with transperineal three-dimensionalultrasonography in Resting state、levator ani muscle contraction state and Valsalva movements.To understand the impact of different types of delivery for pelvic diaphragmhiatus.Result：1． The comparison of42days postpartum vaginal delivery group and42dayspostpartum elective cesarean section group.The change of Pelvic diaphragm hiatusLHAP、LHLR、LHA in Resting state、levator ani muscle contraction state andValsalva movements。there was significant differences(P<0.05).2．The influence of vaginal delivery on the pelvic diaphragm hiatus：（1）Thecomparison of42days postpartum vaginal delivery group and Control group,theLHAP、 LHA in Resting state，LHAP、LHLR、LHA in levator ani muscle contractionstate，LHLR、LHA in Valsalva movements, there was significant differences(P<0.05).(2) The comparison of42days postpartum vaginal delivery group and3monthpostpartum vaginal delivery group.The change of LHLR、LHA in Resting state and inlevator ani muscle contraction state statistically significan（tP <0.05）.But measurementof the indicators of the pelvic diaphragm hiatus The difference was not statisticallysignificant （P>0.05）.（3）The comparison of3months postpartum vaginal deliverygroup and control group the change of LHAP、LHA in Resting state and LHA in inlevator ani muscle contraction state Difference was statistically significant.The changein the angle between the pubovisceral muscles in Valsalva movements have statisticallysignificant.3．The influence of elective cesarean section on the pelvic diaphragm hiatus：（1）The LHA of42days postpartum elective cesarean section group greater than controlgroup in Resting state and in levator ani muscle contraction state.The angle between thepubovisceral muscles in Resting state and Valsalva movements.there was significantdifferences(P<0.05)（.2）The comparison of3month and42days postpartum SelectiveCaesarean Section group,The change of LHAP、LHLR、LHA and the angle betweenthe pubovisceral muscles were difference was not statistically significant （P>0.05）.（3）The comparison of3months postpartum elective cesarean section group andcontrol group the LHA in Resting state Difference was statistically significant.The change in the angle between the pubovisceral muscles in Valsalva movements werestatistically significant.4．The influence of3months post partum different types of delivery pelvic diaphragmhiatus: The LHAP of3months postpartum vaginal delivery group greater than3months postpartum elective cesarean section group By the difference was statisticallysignificant.But in Valsalva movements and levator ani muscle contractionstate,difference was not statistically significant.5．By analyzing the influencing factors of pelvic diaphragm hiatus.The results showedAffect the pelvic floor functional recovery in the second stage of labor and fetalweight,P<0.05.6．Analysis3months postpartum female pelvic diaphragm hiatus indicators with ROCcurve.The largest area of variable as a diagnostic indicator.The results showed inResting state LHA variable area under the curve1,LHA>135.09mm~2as the criticalpoint,Diagnosis of pelvic floor functional recovery of the sensitivity of100%，Specificity of100%。 In Valsalva LHA variable area under the curve1,LHA>149.05mm~2as the critical point,Diagnosis of pelvic floor functional recovery ofthe sensitivity of100%,Specificity of100%.Conclusion：1. Either vaginal delivery or elective cesarean section,Postpartum had varying degreesof changes in the structure of the pelvic floor.Vaginal delivery on the pelvic floortructure is more obvious.2. Vaginal delivery on the pelvic floor injury in the3months postpartum recovery，Butnot fully recovered.While Selective Caesarean Section on the pelvic floor injury inthe3months Recovery is not obvious，Tip gestation itself pelvic floor damage，Andthe recovery is slower.3. May be the main factors of the affecting the post-partum recovery is the extension ofthe second stage of labor and fetal weight is too large.4. In3months of postpartum measuring with Perineum Three-dimensional ultrasoundLHA>135.09mm~2in Resting state Or LHA>149.05mm~2in Valsalva we think pelvic floor functional recovery poor, Further line of pelvic floor rehabilitation.