| At present,accurate reports about effects of pregnancy and childbirth of female pelvis is still little,the previous research of pelvis measurement means such as external pelvic measurement and X-ray methods,they thought gestational pelvic size than non pregnant state increased and the symphysis gap widened;Glens.measured 18 cases of multiparous pelvic size by two-dimensional MRI,no significant difference was found between the front and rear part of the pelvis diameter line delivery without any time,they think of postpartum maternal pelvis measurement can replace prenatal pelvic size.Our team preliminary studies of analysis of female pelvic reconstruction by CT and MRI,we found that the proportion of clinical pelvis type by previous research was different,namely female type>ape type>flat type>male type;and Japanese scholars analyzed the X-ray examination of the pelvic bone recent 5 decades in Japan,they also found in pregnant women anthropoid pelvis in the pregnant women increased,flat pelvis reduction.Iris Eshed reseached late pregnancy and postpartum within half a year of low back pain and sacroiliac joint bone marrow edema by MRI,and they thought sacroiliac joint bone marrow edema and late pregnancy and postpartum lumbago;also some scholars found that some maternal symphysis occurred bone marrow edema and subcortical fracture phenomenon,and presumably after delivery of the pubic symphysis the pain.In summary,this study further analyzes the effects of pregnancy and childbirth of primipara pelvic pathology and physiology using MRI three-dimensional reconstruction technique:the influence of pregnancy and delivery on maternal pelvic morphology,size and bone marrow edema;there is no difference in the effect of different delivery methods on early maternal pelvis;the postpartum primipara in different time the recovery of the pelvis.Chapter 1Analysis of the effect of pregnancy and delivery on the pelvic morphology of the primipara based on MRI three dimensional reconstructionSection 1Analysis differences of pelvic between term pregnant women and nulliparous women based on magnetic resonance imaging three dimensional reconstruction techniqueObjective:To compare the differences in the size and shape of pelvis between term pregnant women and nulliparous women by means of MRI three dimensional reconstruction.Methods:Recruiting 240 cases of MRI raw data about singleton term primipara in the radiology department of Nanfang Hospital for pelvic MRI from January 2014 to January 2017,namely the late pregnant group;at the same time collected 120 cases of young unmarried women pelvic MRI raw data who were diagnosed for benign and malignant gynaecology disease,namely nonparous group;Put two groups MRI original data into MIMICS 10 software for 3D reconstruction of pelvis;After got 3D model of pelvis,we measured the entrance,middle and pelvic outlet plane of the transverse diameter and anteroposterior diameter and sacral length,curvature,sacral angle,pubic symphysis pubic arch width,sacroiliac joint gap width and pelvic inclination,and analysis clinical classification of pelvis two groups.At the same time,general data of two groups were collected and analyzed by independent sample T test and chi square test.Results:the late pregnant group and the nulliparous group comparison:?Comparison of general information,there are no significant difference between late pregnancy group and nulliparous group in age and height,but the weight of the late pregnant group was significantly greater than nulliparous group;? Clinical type of pelvic of two groups accounted the same:the female type>the ape type>the flat type>the male type;?Comparison of pelvic diameter:pubic symphysis and sacroiliac joint gap significantly increased in the late pregnancy group compared with nulliparous group,and pelvic diameter increased slightly(0.2-0.3cm)but the difference was statistically significant;pelvic inclination of late pregnancy group decreased(P<0.001)compared with nulliparous group,while the angle pubic arch increased(P<0.001);Conclusion:the effect of pregnancy on maternal pelvic pregnancy is mainly about the joint,and the pubic symphysis and sacroiliac joint space increase in late pregnancy.As well pelvic diameter increase,pubic arch angle becomes large,pelvic inclination decreases in the late pregnancy.All these changes are beneficial to vaginal delivery.Section 2Analysis of the effect of different delivery modes on the pelvic morphology of the primipara based on three dimensional reconstruction of magnetic resonanceObjective:To investigate the changes of maternal pelvic from prenatal to postpartum by MRI three-dimensional reconstruction technique.Methods:We recruited 97 cases of full-term singleton pelvic MRI raw data of primipara before and after delivery,from January 2014 to January 2017 in the radiology department of Nanfang Hospital.According to mode of delivery those patients were divided into the vaginal delivery group and the cesarean section group,and each group was divided into two sub groups according to their postpartum MRI examine time,that is 42 days postpartum and postpartum 6-8 months.Then we reconstructed the MRI three-dimensional model of pelvic and made the measurement of each pelvic.Paired samples T test was used to analyze the changes of the size of the pelvis from prenatal to postertum.Results:?The changes of primipara pelvic after different modes of delivery are different.Pelvic anteroposterior diameter increased slightly(0.2cm)after vaginal delivery on 42 days postpartum sub group of the vaginal delivery group,and those changes could recover to prenatal after half of a year of vaginal delivery,but the cesarean section group had no obvious change in postpartum on pelvic diameter.?The pubic symphysis and the sacroiliac joint space decreases after 42 days postpartum;and the pubic symphysis gap back to nonparous level after half of a year,while the sacroiliac joint gap had no obvious change with prenatal maternal pelvic;? The pelvic inclination of both groups decreased after birth.Conclusion:Primipara pelvic have stability and plasticity in the delivery process,the effects of different modes of delivery on pelvic is different,and primipara pelvic diameter could most recovered to the prenatal state after six months postpartum.Chapter 2Analysis the changes about pelvic bone marrow edema of primipara before and after delivery by magnetic resonance imaging and its clinical significanceObjective:To study the pelvic bone marrow edema of sacroiliac joint and pubic symphysis at full-term pregnant and postpartum of primipara based on MRI,and the relationship of the pelvic pain during pregnant to psetpartum,further more to explore the effects of pregnancy and childbirth on the primipara pelvis.Methods:We did a retrospective investigate from January 2014 to January 2017 about the 97 cases of full-term pregnant who underwent twice or three times of pelvic MRI scan in our hospital.Each maternal pelvic MRI examination were performed twice or three times on primipara,late term pregnancy,42 days postpartum and(or)6-8 months postpartum.According to the different modes of delivery they were divided into vaginal delivery group and the cesarean section group.If the sacroiliac joint and pubic symphysis of primipara have bone marrow edema and if pubic symphysis fracture on its MRI were recorded,and telephone follow-up of all patients about if their had history of pelvic pain were recorded before,during pregnancy and postpartum.The data of pelvic MRI in 120 nulliparous women were collected as blank control group.Results:? After vaginal delivery the percentage of pubic symphysis bone marrow edema on MRI of primipara was increased more than cesarean section primipara;? Bone marrow edema of the sacroiliac joint and pubic symphysis could recovery almostly in 6-8 months postpartum;? The bone marrow edema of the sacroiliac joint was significantly related to pain of primipara's sacroiliac joint,but the bone marrow edema of pubic symphysis had no obvious correlation with pubic symphysis pain,while the pubic symphysis fracture was significantly correlated with its pain.Conclusion:The bone marrow edema of sacroiliac joint is a joint inflammation,and it was significantly associated with primipara's sacroiliac joint pain in late pregnant and postpartum.So in the diagnosis and treatment of primipara's sacroiliac joint pain we should pay attention to the sacroiliac joint bone marrow edema. |
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