| Objectives This study aims to apply the transperineal ultrasound to observe the pelvic floor structure of the pregnancy and the early postpartum women dynamically, measure and analyse all the ultrasonic parameters, assess the effect of pregnancy and childbirth on female pelvic floor structure, to provide imaging basis for diagnosing and preventing female pelvic floor functional of the pregnancy and the early postpartum women.Methods We selected 107 cases of pregnancys who were 23 to 30 years old in Affiliated Hospital of He Bei United University during September in 2013 to February in 2015. All were divided into three groups, namely early pregnancy group(ie Pregnancy 10~14 weeks)35patients, middle pregnancy group(ie Pregnancy 24~28 weeks)32 patients, late pregnancy group(ie Pregnancy 36~40 weeks) 40 patients, all of them were single pregnancy. At the same time we selected 42 cases of healthy physical examination childless women who were aged 21 to 28 years old as the control group. All women during pregnancy to postpartum 6~8 weeks follow-up, we selected 81 cases, 42 cases were selective cesarean section, 39 cases by vaginal delivery, all women of selective cesarean section has not been trial-produce, all through the vaginal delivery women has not been related instrument midwifery, and labor smoothly, all postpartum women has not do pelvic floor muscle exercise recovery training. Collected the general data of selected objects by using the unified questionnaire. Assist the SUI detection rate of the early, middle and late pregnancy and the early postpartum women in different childbirth way by clinical professionals. Apply ZONARA color doppler ultrasonic diagnostic apparatus which is equipped with a built-in digital image management system(e- DMS),Lumen probe(frequency of 4 ~ 9 MHZ)was used observing and recording the ultrasonic parameters by the perineum dynamically, including during resting period and tension period the position of bladder neck in X axis and Y axis((Djx,Dzx,Djy,Dzy),vesicourethral angle(αj,αz),Bladder angle(βj,βz);Calculated the moving of the bladder neck in X axis(ΔDx=Dzx-Djx),in Y axis(ΔDy=Dzy-Djy),bladder rotation angle(Δβ=βz-βj),and measured the movement of the bladder neck(ΔD),recorded and stored images. Excel 2007 to establish a database, using SPSS(17.0) statistical analysis software for statistical analysis,all data were tested for normality, the frequencies comparison used chi-square test; all normal distribution of measurement data as mean ± standard deviation( sx ±),the means comparison between the two groups used Independent-Samples T test; multiple groupsmeans were compared with single factor analysis of variance. There was statistical significance as P<0.05.Results 1All ultrasonic parameters under the resting state:(1)Pregnancy: Djy, Djx, βj andαj in terms of the middle and the late pregnancy women were all greater than normal control group,the differences were statistically significant(P<0.05).There was no significant increase of Djy, Djx, βj and αj between women in early pregnancy and normal control group(P>0.05).Comparison among the pregnancy women groups,Djy,Djx, βj andαj in terms of the middle and the late pregnancy women were all greater than the early pregnancy women,Djy, βj and αj in terms of the late pregnancy women were greater than the middle pregnancy women,the differences were statistically significant(P<0.05), There was no significant increase of Djx between women in the middle and the late pregnancy(P>0.05). The results show that pregnancy women with gestational weeks, uterine volume and overall quality increase gradually, the pressure on the pelvic floor increase gradually,which lead to pelvic floor support structure become weak gradually, pelvic organ shift under the backward position, until late pregnancy to give priority to with downward shift.(2)The early postpartum period:Djy,Djx, βj and αj in the early postpartum women were significantly greater than the normal control group, the differences were statistically significant(P<0.05).Comparison between the early postpartum women groups,Djy, βj andαj in terms of the through vaginal delivery women were significantly greater than the selective cesarean section, the differences were statistically significant(P<0.05).There was no significant increase of Djx between women through vaginal delivery and selective cesarean section(P>0.05). The results show that the early postpartum period of female pelvic floor structure has not yet returned to normal, the position of their pelvic organ after more direction than the childless women; the damage of the pelvic floor of the through vaginal delivery women is more serious than the women of selective cesarean section, and the injury is longitudinal axis along the human body mainly.2 All ultrasonic parameters under the tension state:(1)Pregnancy: Dzy, Dzx, βz and αz in terms of the middle and the late pregnancy women were all greater than normal control group, the differences were statistically significant(P<0.05).There was no significant increase of Dzy, Dzx, βz and αz between women in early pregnancy and normal control group(P>0.05).Comparison among the pregnancy women groups, Dzy, Dzx, βz and αz in terms of the middle and the late pregnancy women were all greater than the early pregnancy women, Dzy,βz and αz in terms of the late pregnancy women were greater than the middle pregnancy women, the differences were statistically significant(P<0.05), There was no significant increase of Dzxbetween women in the middle and the late pregnancy(P>0.05). The results show that pregnancy women with gestational weeks, overall quality of uterine increase gradually,under the tension state, the stress to pelvic floor increase relative gradually, pelvic organ under the backward position shift, due to uterine volume increase, bladder neck downward priority of the late pregnancy women.(2)The early postpartum period: Dzy,Dzx,βz and αz in the early postpartum women were significantly greater than the normal control group,the differences were statistically significant(P<0.05).Comparison between the early postpartum women groups, Dzy, βz and αz in terms of the through vaginal delivery women were significantly greater than the selective cesarean section, the differences were statistically significant(P<0.05).There was no significant increase of Dzx between women through vaginal delivery and selective cesarean section(P>0.05). Results show that during the tension state the position of pelvic organ of the early postpartum women is more biased than the childless women, and the position of the bladder neck of women by vaginal delivery is more lower than selective cesarean section. 3 Move and rotate in each direction of bladder neck:(1)Pregnancy: ΔDy,ΔDx,ΔD and Δβ in terms of women in middle pregnancy were greater than the normal control group,while that of women in late pregnancy were less than the normal control group, the differences were statistically significant(P<0.05). There was no significant increase of ΔDy, ΔDx, ΔD and Δβ between women in early pregnancy and normal control group(P>0.05). Comparison between the pregnancy women groups, ΔDy, ΔDx, ΔD and Δβ in terms of women in late pregnancy,in middle pregnancy and in early pregnancy were increase gradually, the differences were statistically significant(P<0.05). The results show that due to the volume and quality of uterine of women in early pregnancy did not increase obviously than childless women, the mobility of bladder neck did not increase significantly either; as the volume and quality of uterine of the middle pregnancy women were increased to a certain degree, pelvic floor support structure becomes weak, the space of pelvic organs is bigger, the mobility of their bladder neck is the biggest; To the late pregnancy, the volume and the quality of uterine achieves the biggest, the space of pelvic organs become smaller relatively, the mobility of their bladder becomes smaller relatively either.(2)The early postpartum period: ΔDy, ΔDx,ΔD and Δβ in the early postpartum women were significantly greater than the normal control group, the differences were statistically significant(P<0.05). Comparison between the early postpartum women groups, ΔDy, ΔDx, ΔD and Δβ in terms of the through vaginal delivery women were significantly greater than the selective cesarean section, the differences were statistically significant(P<0.05). The results show that the earlypostpartum period of female pelvic floor muscle, fascia and ligament upward force support structure has not yet returned to normal, that is weak, the activity of bladder neck of the early postpartum women is greater than the childless women; the damage on the female pelvic floor of selective cesarean section is less than women by vaginal delivery, and their bladder neck motion is smaller than women by vaginal delivery.4The detection of SUI:The SUI detection rate of the women in late pregnancy is higher than the women in middle pregnancy than women in early pregnancy, the differences were statistically significant(P<0.05), show that with the increase of gestational weeks of pregnancy women,the detection rate of SUI is higher. The SUI detection rate of women through vaginal delivery is higher than the selective cesarean section(P<0.05),show that selective cesarean section has certain protective effect on female pelvic floor.Conclusions 1 We find that with the increase of gestational weeks of pregnancy women,the detection rate of SUI is higher.2With the increase of gestational weeks of pregnancy women, the support of pelvic floor waning gradually, especially women in middle and late pregnancy.3The pelvic floor structure of the early postpartum female has not yet returned to normal, the damage of the pelvic floor of the through vaginal delivery women is more serious than the women of selective cesarean section,although selective cesarean section has certain protective effect on female pelvic floor,that can’t completely avoid the happening of SUI.4The transperineal ultrasound can show the pelvic floor structure of the early postpartum women and the pregnancy women clearly, which has the advantages of simple, no radiation and repeatable,et al.The transperineal ultrasound has important clinical value in assessment of the effects of pregnancy and childbirth on female pelvic floor structure. |
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