| ObjectiveTo discuss the difference of the morphous of levator hiatus and levator ani muscle among the primipara who had experience a different mode of delivery 6weeks to 8 weeks ago by transperineal ultrasound in order to provide clinical data for the pathogensis and prevention of pelvic floor dysfunction, as well as provide clinical basis for the early diagnosis of pelvic floor dysfunction and perform pelvic floor rehabilitation training in time at postpartum.Materials and methods Research objects:72 primipara who give birth at the First Affiliated Hospital of Nanchang University during August 2013 to May 2014 were recruited, including elective cesarean section group(40 cases) and normal vaginal delivery group(32cases), In the 6weeks~8weeks after childbirth, they were respectively given ultrasound examination. At the same time 30 healthy nulliparas with matched age, body mass index, height as control group during the same period. They all voluntarily participate in the study.Ultrasound examination project :1. All the participants are to be checked by transperineal two- dimensional ultrasound, measured the diameter of the levator hiatus(levator hiatal dimeter, LHD),the position of the bladder neck, levator-plate angle in the midsagittal plane at three different states(including rest, maximum valsalva manoeuvre and on maximum pelvic floor muscle contraction).2. All the participants are to be checked by transperineal three- dimensional ultrasound, measured transverse diameter of the levator hiatus(levator hiatal lateral diameter, LHLR), the area of the levator hiatus(levator hiatal area, LHA).3. To observe the normal levator ani muscle and puborectalis avulsion in the 72 primipara and 30 nlliparas by the Tomographic Ultrasound Imaging(TUI) of pelvic tree-dimensional ultrasound.Methods:1. Compare the parameter(levator hiatal dimeter, levator hiatal lateral diameter, levator hiatal area) of the tree groups that we measured by different states(including rest, maximum valsalva manoeuvre and on maximum pelvic floor muscle contraction) respectively.2. Compare two groups of primipara when resting, shrinkaging measured ultrasonic parameters and Levator trauma, reproduction in horizontal angle change amount, reproductive stage length change, the degree of the movement of the bladder neck, reproductive hiatal area changes with or without statistical significance.Statistical analysisAnalyse the data with SPSS17.0, the measured data were described as the mean and standard deviation, Using Univariate analysis of variance for the comparison during the three groups when the data accord Normal distribution, using one-factor ANOVA, then using independent samples T test for the comparison between the two groups, using the non- parametric test(Chi-square test) for the Count data, there was a significant difference as(P <0.05).Results:1. There were no significant differences during the age, height, body mass index,birth weight, neonatal height among groups.2. The comparison of normal vaginal delivery group and the control group: At rest, maximum Valsalva manoeuvre and on maximum pelvic floor muscle contraction state, LHD, LHA, LHLR of the levator hiatus in the normal vaginal delivery group were longer than that in the control group, there were significant differences,respectively(P<0.05), and at rest, levator ani muscle contraction state, comparing levator-plate angle of the levator hiatus in the two groups, there were significant differences(P<0.05).3. The comparison of normal vaginal delivery group and the elective cesarean section group: At maximum valsalva manoeuvre and maximum pelvic floor muscle contraction state, LHD, LHA, LHLR, the levator-plate angle of the levator hiatus in normal vaginal delivery group were longer than that in the elective cesarean section group, there were significant differences, respectively(P < 0.05). But at rest,comparing LHD, LHA, LHLR, the levator-plate angle of the two groups, there were no significant differences(P>0.05).4. The comparison of the elective cesarean section group and the control group:At rest, maximum valsalva manoeuvre and maximum pelvic floor muscle contraction,the dimension of LHD, LHA, LHLR of levator hiatus in normal vaginal delivery group were significantly larger than those in control group, respectively(P<0.05), and at the rest state comparing the levator-plate angle of the two groups, there was significant difference(P<0.05).5. To compare the changes in normal vaginal delivery group and the elective cesarean section group, we measured at rest and maximum pelvic floor muscle contraction state: comparing reproduction in horizontal angle change, reproductive stage length change, the movement of the bladder neck, reproductive hiatal area change of these two groups, the perineum ultrasound examination showed that there were statistical difference(P<0.05).6. Elective caesarean section group levator muscle injury rate was 10%(4/40),the normal vaginal delivery group levator muscle injury rate was 28.13%(9/32), there was significant difference(P<0.05).7. Comparing the LHA of the patients with or without prolapse that measured at maximum valsalva manoeuvre state demonstrated that when selecting 17.48cm2 as threshold, the sensitivity was 66.7% and specificity was 89.5%.Conclusion:1. There were different degrees of changes in early postpartum pelvic floor structure after childbirth whether vaginal delivery group or elective cesarean section group, but the influence on the structure of pelvic floor structure in the normal vaginal delivery group is more obvious than that in elective cesarean section group.2. Both the normal vaginal delivery group and the elective cesarean sectiongroup have an influence on the pelvic floor muscle contraction function, but the impact of the latter on the contraction is smaller.3. Both the pregnancy and the vaginal delivery would cause damage to pelvic floor structure, So it is necessary for puerpera to take part in rehabilitation training of pelvic floor muscle postpartum in time.4. After giving birth 6 weeks to 8 weeks, the primipara should be alert to pelvic organ prolapse when the LHA > 17.48cm2 at maximum valsalva state by transperineal three-dimensional ultrasound. |
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