The Significance Of Changes In Pelvic Floor Ultrasound Anatomy And Motor Function In Late Pregnancy And Postpartum Women

Objective: Studies have confirmed that pregnancy and childbirth are independent risk factors for pelvic floor dysfunction in women,but there is no relevant basic research.The purpose of this article is to compare and study the characteristic changes of pelvic floor anatomy and biomechanics in women in the third trimester and after childbirth by using pelvic floor ultrasound and motor function assessment technology.To clarify the characteristics of pelvic floor anatomy and kinematic changes that lead to pelvic floor dysfunction,and provide theoretical guidance for early detection of pelvic floor dysfunction and formulation of individualized plans for the prevention and treatment of pelvic floor dysfunction.Materials and methods: A prospective analysis was performed of women who were infertile,in the third trimester group,and 6-8 weeks postpartum(all of which meet the inclusion and exclusion criteria of each group)from March 2018 to March 2019 at the Pelvic Floor Urology Rehabilitation Center in our hospital.We collect basic demographic information including age,height,weight,etc.,as well as pelvic floor related medical history including obstetric history,gynecological-urinary history,anorectal history and past history,then collect pelvic floor pressure measurement,2D transperineal ultrasound and 3D transvaginal ultrasound related data.The clinical data were collected for statistical analysis.Results: A total of 52 married and infertile women,53 pregnant women in late pregnancy,and 66 women 6-8 weeks postpartum were collected.(1)There are no significant difference in age between the groups.Body mass index(BMI)in the third trimester group is significantly higher than the other two groups(P<0.05).(2)Comparison of pelvic floor pressure test data between the groups,the married and infertile group have stronger type Ⅰ and Ⅱ pelvic floor muscle strength and bigger vaginal pressure than the group of late pregnancy and postpartum(P<0.05).(3)Comparison of two-dimensional ultrasound data between groups.The anteroposterior diameter of the reproductive tract hole in the resting state and Valsalva state in the postpartum group are larger than that in the third trimester group and larger than the married unfertile group(P<0.05).After delivery,the mobility of the bladder neck and base of the bladder are greater than that of the married and infertile group and greater than that of the third trimester group(P<0.05).The area of the interpubic space after the vaginal delivery in the resting and Valsalva states are larger than the third trimester group and the married unfertile group(P<0.05).The length of the urethra in the married and infertile group are longer than that in the third trimester group and the postpartum group(P<0.05).The distance of rectal swelling under the resting and Valsalva state in the married and infertile group and the third trimester group are larger than that in the postpartum group(P<0.05).The posterior angle of the bladder and the angle of the urethra in the resting and Valsalva group after vaginal delivery are greater than those of the married and infertile group and the third trimester group(P<0.05).(4)Comparison of the three-dimensional ultrasound data between groups.The area of levator ani muscle rupture area and anteroposterior diameter in the third trimester group and the postpartum group are larger than those in the married and infertile group(P<0.05);the area of the levator ani muscle in the third trimester group is larger than that in the married and infertile group and larger than the postpartum group(P<0.05).Conclusion: Changes in the anteroposterior diameter of the genital tract hole and the area of the levator ani muscle during pregnancy and childbirth,as well as changes in the posterior angle of the bladder and urethral tilt are potential characteristic anatomical changes that lead to pelvic floor dysfunction;pregnancy and childbirth reduce the vagina stress and the power of the levator ani muscle.The anatomical changes of the pelvic floor support system caused by pregnancy and childbirth affect its biokinetics and are high-risk factors for the occurrence and development of pelvic floor dysfunction diseases.