| Background and ObjectivesUse the biofeedback therapy apparatus track detection at 36?38 weeks/postpartum 6?8 weeks postpartum 3' 6 months the change of female pelvic floor muscle strength,the female pelvic floor functional disorder caused by three related factors are analyzed,two types of childbirth way,serum Relaxin(Relaxin,RLX)levels,pelvic floor type ? and ? collagen content in the organizations.To study the effect comparison of single and combined pelvic floor function recovery methods in puerpera.To investigate the factors affecting pelvic floor function in pregnant women and the causes of postpartum incontinence(UI)and pelvic organ prolapse(POP).To evaluate the short-term effect of comprehensive pelvic floor function restoration method on the prevention and treatment of postpartum pelvic floor injury-related diseases in women.Data and MethodsRandomly selected by the regular prenatal and maternal health delivery in our 117 cases as the research object.In late pregnancy(36 to 38 weeks of pregnancy),postpartum 6-8 weeks,postpartum 3-6 months for the following research;And there is no history of childbirth,filter structure without Pelvic floor functional disorder(PFD)non pregnancy women with a history of 20 cases as control group.1.Using biofeedback therapy apparatus,pelvic floor ?,? class muscle fibers and fatigue,muscle voltage simultaneously pelvic floor muscle hand measurement grading common comprehensive evaluation of pelvic floor muscle strength;2.The line structure of pelvic floor function disorder(PFD)clinical questionnaire,compare different associated with pregnancy,childbirth,obstetric factors on the effect of pelvic floor function;3.In the third trimester group randomly selected subjects,natural birth take its side cut or crack the wound after vaginal wall under the cuny membrane fascia tissue around 50 mg.The control group take the same position;Organize routine HE staining,by ordinary optical microscope to observe the morphological changes;Line picrate Sirius scarlet dye,polarized light microscopy collagen type I and III change;4.Venous blood was drawn 3 ml,using enzyme-linked immunosorbent method to detect different periods of RLX serum level;5.In 6-8 weeks of maternal postpartum vaginal delivery and cesarean section were randomly selected in postpartum maternal line 7 to 10 weeks Kegel biofeedback training++electrical stimulation therapy,with no treatment as a control,evaluate the recent efficacy of pelvic floor muscle rehabilitation treatment.Results1.A total of 117 maternal into research,late pregnancy,78 cases;Postpartum 6-8 weeks in 96 cases(including 57 cases of postpartum follow-up)late in pregnancy and postpartum 3-6 months in 71 cases,the follow-up rate was 74%.Biofeedback therapy apparatus of pelvic floor I,class II muscle fiber muscle voltage and pelvic floor muscle fatigue and hand test related straightly,correlation is higher;In addition postpartum 3-6 months there was no significant difference of pelvic floor H class fatigue of muscle fiber,the rest of the group with stress urinary incontinence(SUL)symptoms of pelvic floor muscles comprehensive strength are significantly lower than without symptoms.Third trimester pregnant women pelvic floor muscles comprehensive strength is obvious difference in postpartum 6-8 weeks and three to six months of lactation and childless;Late pregnancy,postpartum 6-8 weeks,the incidence of postpartum 3-6 months SUI symptoms are 41.9%,31.3%and 41.9%respectively;Pregnant women have SUI symptoms during pregnancy,the incidence of postpartum early SUI symptoms was 53.7%.Natural labor accounted for 69.2%of maternal postpartum vaginal relaxation consciously,and cesarean delivery is only 7.1%;Selective cesarean delivery is early postpartum pelvic floor muscles comprehensive strength significantly better than those natural birth;The incidence of vaginal delivery,postpartum SUI symptoms is 45.5%,selective cesarean section was 12.2%.Risk factors associated with SUI symptoms during pregnancy with production line,prenatal BMI,pre-pregnancy BMI,pregnancy through whether pelvic floor muscle training and newborn weight;After the SUI symptoms of risk factors for neonatal weight,BMI before childbirth,presence of SUI during pregnancy and childbirth way.2.Obtain eutocia puerpera vaginal wall and fascia tissue as example,the control to obtain the vaginal wall and fascia tissue in 5 cases.Intrapartum ?,? the collagen content in the vaginal wall tissue decreased significantly than childless.During pregnancy or postpartum 6-8 weeks or postpartum 3-6 months with SUI symptoms,intrapartum vaginal wall tissue collagen type I and type 111 levels were significantly lower than without symptoms;11 classes besides 3-6 months postpartum pelvic floor muscle fatigue,three times the pelvic floor muscles comprehensive strength and intrapartum type ? and ? collagen content in the vaginal wall tissue were positively correlated.Intrapartum type ? and ? collagen content in the vaginal wall tissue and negatively correlated with prenatal BMI and neonatal weight;Pregnancy in the production line of pelvic floor muscle training type I and III collagen content in the vaginal wall tissue is significantly higher than the trainer.Late pregnancy in blood specimens of 36 cases,32 cases of postpartum 6-8 weeks,22 cases of postpartum 3-6 months,control group 20 cases.Pregnancy RLX level obviously higher than that of postpartum periods and the control group,postpartum periods and the control group there was no difference in the serum level of RLX;Intrapartum type ? and ? collagen content in the vaginal wall tissue and negatively correlated with serum level of RLX when pregnant.When pregnant serum level of RLX besides has nothing to do with pelvic floor type II muscle fatigue,and pregnancy and postpartum pelvic floor muscle strength other indicators are negatively correlated;When pregnancy and postpartum early SUI symptoms of RLX were significantly higher than without symptoms;When pregnant and postpartum women with early back and pelvic skeleton department ache when pregnant serum levels of RLX obviously increased;Postpartum vaginal relaxation when pregnant serum RLX level is higher,but with no symptoms of the difference is not obvious.Postpartum serum RLX and skeleton postpartum waist pain,vaginal relaxation,SUI symptoms and pelvic floor muscles not comprehensive strength.4.Randomly selected from 71 cases with maternal postpartum 6-8 weeks,natural birth of 48 cases,23 cases of cesarean section;Natural birth is the bank of China in early rehabilitation treatment of the pelvic floor muscles in 33 cases,6 cases of cesarean section.Both selective cesarean section and natural birth,comprehensive 6-8 weeks postpartum pelvic floor muscle strength is stronger than the late pregnancy;Postpartum 3-6 months no pelvic floor rehabilitation comprehensive maternal pelvic floor muscle strength is still obvious than postpartum 6-8.Line of pelvic floor muscle rehabilitation eutocia puerpera,comprehensive treatment of pelvic floor muscle strength obviously stronger than before the treatment,is much stronger than the healer.Selective cesarean delivery of maternal line of rehabilitation therapy,in addition to the pelvic floor there was no significant difference of class II muscle fiber fatigue,after treatment of pelvic floor muscle all the indicators are significantly stronger than before the treatment,the treatment group of pelvic floor comprehensive strength is stronger than the untreated group,but the two groups in hand vaginal and pelvic floor muscle strength in cross-section type I muscle fibers has no statistically significant difference between the fatigue;No maternal pelvic floor muscle rehabilitation treatment,the incidence of postpartum 3 6 months a SUI symptoms declined,but the decline is not obvious(28.1%vs 28.1%),and the incidence of maternal SUI symptoms after treatment significantly decreased(43.6%vs 43.6%).Pelvic floor muscle rehabilitation,reduce the incidence of symptoms of urinary frequency,urgency,maternal waist skeleton ache,straining feeling,vaginal relaxation,dry symptoms were significantly less than the healer.Conclusion1.The change of the pelvic floor muscle contraction ability and PFD close;Pelvic floor muscles comprehensive strength test results can be used as a good indicator evaluation of pelvic floor muscle function status.The pregnancy itself is independent of the outside delivery lead to high risk factors of the PFD.Vaginal delivery can cause pelvic floor tissues,selective cesarean section on pelvic floor function has certain protective effect,but not completely avoid the occurrence of early postpartum PFD.Pregnancy and childbirth not cause pelvic floor permanent irreversible tissue damage.2.Pregnancy and childbirth caused by pelvic tissue collagen content and form of change,destroyed the structure and function of the pelvic support tissue integrity,is one of the pathological mechanism of pregnancy and postpartum PFD.3.Pregnancy appear pelvic floor functional changes associated with the change of hormone;High levels of serum RLX when pregnant but ACTS on the pelvic floor collagen tissue,may be one of the pathogenesis of pregnancy and postpartum PFD.4.Pelvic floor muscle rehabilitation therapy can enhance the ability of pelvic floor muscle contraction,and improve the symptoms of pelvic floor dysfunction,the early prevention and treatment of postpartum curative effect is light,moderate SUI. |
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