The Influence Of Pregnancy And Delivery Modes On Postpartum Stress Urinary Incontinence And Clinical Observation Of Early Pelvic Floor Rehabilitation Training

Backgroud and Objective:Stress Urinary Incontinence is defined as “the involuntary leakage of urine on effort,such as exertion,exercise, cough and sneeze”by International Continence Society.It is common among women of all ages,and have a strong impact on their social activities and physical and mental health.Recently,as the development of Urogynecology,the pathophysiology and etiology of SUI are researched widely.Pregnancy and delivery are commonly thought as independent risk factors of SUI.The damage of pelvic floor muscle,ligament and pudendal nerve during delivery is the pathophysiolpgical basis of SUI.In recent years,pelvic floor ultrasound,as the diagnose of pelvic floor dysfunction and assessment after therapy,are widely used.The objective of this research is to measure the bladder neck mobility and urethral rotation angle of primiparous in 6 to 8 weeks after different delivey mode by translabial ultrasound and to discuss the influence of pregnancy and mode of different delivery on lower urinary tract function,compared with nulliparous.The purpose of the study is to investigate the prevalence of postpartum stress urinary incontinence,and to explore the impact of obstetric factors on SUI, such as maternal age,the body mass index antenatal,birth weight,vaginal delivery,SUIduring pregnancy,stage 2,forceps delivery and perineal lesion.We direct all women to conduct early pelvic floor rehabilitation training,and reappraise the pelvic floor structure.Methods:Selected 94 primiparous institutional deliveried among February to June,2014,and devided into vaginal delivery(VD) group of 50 and caesarean section(CS)group of 44.Encouraged primiparous to conduct pelvic floor rehabilitation training,and there were 19 enrolled in therapy group.As the control group,we choosed 30 nulliparous.All primiparous filled in international standard format incontinence questionnaire in Chinese,recorded general information, SUI duing pregnancy or not,and their obstetric information.In 6 to 8 weeks after delivery,we conducted them to filled questionnaire again,and measured the bladder neck mobility and urethral rotation angle by translabial ultrasound in rest condition and Valsalva maneuver. Encouraged primiparous to conduct pelvic floor muscle training combined with electrical stimulation and biofeedback for 1 to 2 course.And reappraise the bladder neck mobility and urethral rotation angle after therapy 2 weeks or so.Results:All 94 primiparous were divided into 50 of vaginal delivery(VD)group and 44 of caesarean section(CS)group.There was no statistically significant difference between two groups on age,delivery week,birth weight(P>0.05).While the body mass index(BMI) antenatal differented statistically between two groups(P<0.05).The prevalence of SUI in VD group was 15 of 50(30%),which significantly differented with 4 of 44(9.1%)in CS group(P<0.05).The bladder neck mobility and urethral rotation angle significantly statistically differented among VD,CS and nulliparou group(All P<0.05).Logistic regression analysis showed that SUI was strongly associated with vaginal delivery,SUI during pregnancy,forceps delivery and perineal lesion(P<0.05).The women after pelvic floor rehabilitation training in 6 weeks postpartum,had asubstantial improvement compared with before therapy group(P<0.05).Conclusion: Pregnancy and delivery are risk factors for stress urinary incontinence.Vaginal delivery increase the risk of postpartum SUI compared with cesarean section.Early pelvic floor rehabilitation training can improve the damage of lower urinary tract during pregnancy and delivery.