Ultrasonic Evaluation Of Pelvic Floor Structure And Function In Early Primiparous Women With Different Delivery Modes

Objective: This study was designed to observe the changes of the anatomical position of the pelvic floor and the thickening rate of the levator ani muscle in the early stage of postpartum,and to explore the effect of different delivery modes on the pelvic floor structure and function in primipara.Analyzing the correlation between pelvic organ activity and thickening rate of levator ani muscle,to further explore the pathogenesis of pelvic floor dysfunction and provide imaging reference for clinical early intervention.Methods: 100 cases of primipara postpartum 6-10 weeks in our hospital were selected as the study group,including 50 cases of vaginal delivery and 50 cases of selective cesarean section.30 cases of nulliparous women who matched age,height and weight were selected as the control group.Two-dimensional perineal pelvic floor ultrasonography was used to obtain the median sagittal plane of the pelvic floor,and the horizontal axis of the pubic symphysis axis was at an angle of 45 ° with the horizontal line of the lower edge of the pubic symphysis.The urethral tilt angel(UTA),posterior urethrovesical angel(PUA),bladder neck position(BNP)and cervical mouth position(CMP)were measured at rest and the maximum Valsalva,and the urethral rotation angel(URA),bladder neck descent(BND),cervix down distance(CDD)were calculated and at the same time observe the mouth of the urethra with or without funnel-shaped,whether the rectal prolapsed or not.The probe placed in the vagina 2-3cm,adjust the direction of the probe shows the long axis of the anus muscle,measure the left and right sides of the levator ani muscle thickness,respectively,in the resting and maximum contraction state and calculate the thickening rate(TR)of the middle of the levator ani muscle in the contraction state.Results:1.In the resting state,the BNP of the vaginal delivery group was smaller than that of the selective cesarean section group,the difference was statistically significant(p<0.05).There was no significant difference between the vaginal delivery group and the selective cesarean section group in UTA and CMP(p>0.05);The levels of BNP and CMP in the vaginal delivery group were significantly lower than those in the control group(p<0.05).There was no significant difference between the vaginal delivery group and the control group in UTA.The BNP of the selective cesarean section was less than that of the untreated group,the difference was statistically significant(p>0.05).There was no significant difference between UTA and CMP in the selective cesarean section group.In the resting state,the difference of PUA between all groups was not statistically significant.2.At maximum Valsalva action,there were significant differences in UTA,BNP and CMP between the vaginal delivery group and the selective cesarean section group.There were significant differences in UTA,BNP and CMP between the vaginal delivery group and the nulliparas group.The difference of BNP and CMP between selective cesarean section group was less than that of nulliparas group,but the CMP difference was not statistically significant(p>0.05).At the maximum Valsalva state,there was no significant difference in PUA among the groups.3.The URA and BND of the vaginal delivery group were significantly higher than those of the nulliparas group(p<0.05).The URA and BND of the selective cesarean section were not statistically significant compared with the vaginal delivery group and the control group(p>0.05).There was no significant difference in CDD among the three groups(p>0.05).4.The incidence rate of funnel in the vaginal delivery group,selective cesarean section group and unviable group was 12%,10% and 6.7% respectively,the difference was not statistically significant(p> 0.05).5.No patients with rectal prolapse were found in the three groups.6.(1)In the same group,the difference of the left and right sides TR was not statistically significant(p>0.05).The TR on both sides of the nulliparous women was higher than that of the selective cesarean section and vaginal delivery group,and the differences were statistically significant(p <0.05).Selective cesarean section group TR was greater than vaginal delivery group,but the difference was not statistically significant(p>0.05).(2)There was a negative correlation between URA,BND,CDD and TR in the model group and the selective cesarean section group.There was no significant correlation between URA,BND,CDD and TR in vaginal delivery group.Conclusion:1.The perineal pelvic ultrasonography can be used to dynamically observe the anatomical structure,location and function of female pelvic organs,and is simple and reproducible.It provides reliable imaging basis for early postpartum recovery.2.Pregnancy and childbirth mainly affect the structure and function of the anterior and middle compartment,the greatest impact on the anterior compartment,but with the posterior pelvic structure and dysfunction occurred almost nothing to do.3.The TR of levator ani muscle on both sides of primipara was lower than nulliparous women,and the main factor affecting the levator ani muscle contractility is pregnancy itself,rather than delivery mode.4.In the case of levator ani muscle without significant damage,the greater the rate of levator muscle thickening,pelvic organ activity is smaller.5.In the early postpartum,cesarean section compared with vaginal delivery has a protective effect on the structure and function of female pelvic floor,but it does not advocate cesarean section in order to reduce the occurrence of PFD.