Evaluating The Effects Of Levator Ani Musle Injury On Postpartum Rehabilitation Efficacy By Transperineal Ultrasound

Objective: To measure the ultrasonic parameters of levator hiatus before and after rehabilitation treatment by transperineal three-dimensional ultrasound,and to analyze the correlation between the ultrasonic parameters and levator ani muscle strength,then to probe and assess the effects of levator ani muscle(LAM)on postpartum rehabilitation efficacy.Methods:(1)Totally 86 patients diagnosed with pelvic organ prolapsed and levator ani muscle strength grade 0–2 after vaginal delivery were collected.All the 86 patients were examined by transperineal ultrasound at rest,on maximum Valsalva maneuver,and on maximum LAM contraction between six to eight weeks after delivery.At 18 weeks postpartum,all the 86 patients would be examined by transperineal ultrasound again.Measuring levator hiatus area,left-right diameter and anteroposterior diameter were carried out by two ultrasonic practitioners double-blindly.(2)All the 86 patients were divided into two groups: rehabilitation group(43 patients)and control group(43patients);Three-dimensional tomographic ultrasonography imaging technology was applied to evaluate LAM injury condition by transperineal ultrasound,then divided the rehabilitation group and control group into LAM injury group and LAM non-injured group respectively.From the eighth weeks postpartum,patients in rehabilitation group started to get pelvic floor electrical stimulation and vaginal dumbbell exercise rehabilitation treatment for 8 weeks;patients in control group did kegel exercises by themself for 8 weeks.At 18 weeks postpartum,the pelvic organ prolaspe and the levator ani muscle strength would be evaluated again.Results:(1)There were 35 cases with LAM injury in 86 patients by transperineal three-dimensional tomographic ultrasonography imaging technology.After rehabilitation treatment,the rehabilitation efficient of recovery of pelvic organ prolapse and levator ani muscle strength of the LAM injured group and the LAM non-injured group in the rehabilitation group was better than that of the control group(P < 0.05).(2)In the rehabilitation group: after rehabilitation treatment,the levator hiatal area,left-right diameter,anteroposterior diameter for the patients in the LAM injured group under the condition of maximum Valsalva maneuver,LAM contraction and the hiatal area,anteroposterior diameter at rest were lower than those before rehabilitation(P < 0.05).The levator hiatal area,left-right diameter,anteroposterior diameter for the patients in the LAM non-injured group under the condition of rest,maximum Valsalva maneuver and LAM contraction were lower than those before rehabilitation(P < 0.05).The levator hiatal area,left-right diameter,anteroposterior diameter for the patients in the LAM non-injured group under the condition of maximum LAM contraction were lower than that of the LAM injured group.(3)In the control group: At 18 weeks postpartum,the anteroposterior diameter for the patients in the LAM injured group and the levator hiatal area,anteroposterior diameter for the patients in the LAM non-injured group under the condition of maximum LAM contraction were smaller than that those six to eight weeks after delivery(P<0.05).The levator hiatal area,left-right diameter and anteroposterior diameter for the patients in the LAM non-injured group under the condition of maximum LAM contraction were lower than those in the LAM injured group(P< 0.05).(4)Comparison between the two groups: after rehabilitation treatment,the levator hiatal area,anteroposterior diameter for the patients of the LAM injured group in the rehabilitation group under the condition of resting and maximum Valsalva maneuver and the levator hiatal area,left-right diameter,anteroposterior diameter under the condition of maximum LAM contraction were lower than those in the control group(P<0.05).The levator hiatal area,left-right diameter and anteroposterior diameter for the patients of the LAM non-injured group in the rehabilitation group under the condition of maximum Valsalva maneuver and LAM contraction and the levator hiatal area,anteroposterior diameter at rest were lower than those in the control group(P < 0.05).(5)There was a moderate to high negative correlation(R =-0.792,P < 0.01,R =-0.506, P < 0.01 and R =-0.714,P < 0.01)between the levator hiatal area,left-right diameter,anteroposterior diameter and the levator ani muscle strength under the condition of maximum LAM contraction.There was a moderate positive correlation(R = 0.426,P < 0.01,R = 0.406,P < 0.01)between the difference values of the levator hiatal area,left-right diameter and the levator ani muscle strength under the condition of resting and maximum LAM contraction.Conclusion:(1)Transperineal three-dimensional tomographic ultrasonography imaging technology can be used effectively to diagnosis postpartum LAM injury.(2)LAM injury is an important factor influencing the postpartum rehabilitation efficacy,and the pelvic floor rehabilitation effect can be predicted according to the injury condition of the levator ani muscle by transperineal three-dimensional tomographic ultrasonography imaging technology.(3)Transperineal three-dimensional ultrasound can be used to evaluate rehabilitation effect and assess quantitative levator ani muscle strength according to the dynamic changes of ultrasonic parameters,and the difference of LAM hiatus.And it also can provide reliable imaging basis for clinician to evaluae the pelvic floor rehabilitation efficacy.