| Objectives:The purpose of this study was to observe the dynamic changes in the thickness of the left and right rectus abdominis muscle,the angle of the medial edge of the left and right rectus abdominis muscle,and the distance between rectus abdominis muscle in prenatal and postpartum women,and to analyze the difference of ultrasonic manifestation of left and right rectus abdominis muscle thickness and medial margin angle between rectus abdominis separation group and non-separation group,to provide more imaging basis for early clinical evaluation of rectus abdominis separation and individualized treatment.Methods:Fifty primary pregnant women who underwent prenatal ultrasound examinations and delivered in our hospital from May 2020 to May 2021 were selected as the study subjects.Develop a questionnaire to collect the primary data on the issues.In the resting state,high-frequency ultrasound was used to measure the thickness of the left and right rectus abdominis,the angle of the medial edge of the left and right rectus abdominis,and the distance between the rectus abdominis muscle(Inter-recti distance,IRD)at 12 weeks of pregnancy,23 weeks of pregnancy,30 weeks of pregnancy,37 weeks of pregnancy,3 days after delivery,and 42 days after delivery by high-frequency ultrasound at specific abdomen positions(5 cm above the umbilical cord,edge of the umbilical cord,and 3 cm below the umbilical cord).All the subjects were not given any intervention within 42 days after delivery.At 42 days after delivery,the internal distance of rectus abdominis > 2.0 cm at any position was taken as the diagnostic criterion of rectus abdominis separation.The subjects were divided into the rectus abdominis separation group and the rectus abdominis non-separation group.Statistical analysis used version 25.0 of SPSS.If the measurement data accords with normal distribution,it is described by the mean and standard deviation((?) ± s),using the t-test;if it does not obey normal distribution,it is characterized by median and quartile spacing,using the z-test.The counting data are described by frequency and percentage.The longitudinal data were processed by a generalized estimation equation(Generalized estimating equation,GEE).The changes in rectus abdominis thickness,medial edge angle,and rectus abdominis internal distance with time were analyzed.Contemporary,it analyzed the incidence of rectus abdominis separation at different positions.Spearman rank correlation was used to analyze the correlation between rectus abdominis thickness,medial edge angle,and IRD.Results:1.There was no significant difference in age,height,pre-pregnancy weight,pre-pregnancy body mass index,third-trimester weight,third-trimester body mass index,weight gain during pregnancy,abdominal circumference during pregnancy,and birth weight between the DRA group and non-DRA group(P > 0.05).As there were only nine subjects undergoing cesarean section and the sample size was small,there was no statistical analysis on whether the mode of delivery impacted DRA.2.At 12 the week of pregnancy,there was no significant difference in the thickness of the left and right rectus abdominis between the DRA group and the non-DRA group at the upper 5 cm,the edge of the umbilical cord and the inferior 3cm of the umbilical cord(P > 0.05).There was no significant difference in the angle of the left and right rectus abdominis between the two groups in the superior 5 cm,the margin of the umbilical cord,and the distance between the rectus abdominis at the edge of the umbilical cord and the 3 cm below the umbilical cord(P > 0.05).Still,the angle of the medial margin of the left and right rectus abdominis at the inferior 3 cm of the umbilical cord in the DRA group was smaller than that in the non-DRA group.The medial distance between the rectus abdominis 5 cm above the umbilical cord was broader than that in the non-DRA group(P < 0.05).3.The results showed a significant difference in the thickness of the left and right rectus abdominis between the DRA and non-DRA groups at different positions and time points(P < 0.05).The rectus abdominis muscle was the thinnest at 37 weeks of pregnancy,and the thickness of the rectus abdominis muscle increased after delivery.The thickness of the rectus abdominis muscle at the edge of the umbilical cord in the DRA group was different from that in the non-DRA group at other time points(P <0.05).However,there was no significant difference in the thickness of the rectus abdominis muscle at superior 5 cm and inferior 3 cm between the two groups at different time points(P > 0.05).4.The results showed a significant difference in the medial edge angle of the left and right rectus abdominis between the DRA and non-DRA groups at different positions and different time points(P < 0.05).The changes in the two groups decreased at first and then increased with time,and the changes in various positions were the same(P > 0.05).The angle of the medial edge of the rectus abdominis was the smallest at 37 the week of pregnancy,and the rectus abdominis angle increased after delivery.There was a significant difference in the rectus abdominis muscle angle on the right side of 5 cm above the umbilical cord between the DRA group and non-DRA group at different time points(P < 0.05).However,there was no significant difference in other parts of the group(P > 0.05).5.The results showed that the distance between the rectus abdominis muscle in the DRA and non-DRA groups was in different positions and at other time points.There was a statistical difference in the measurement results(P < 0.05),and the changes in the two groups increased at first and then decreased with time.There was a significant difference in IRD between the DRA group and the non-DRA group at different time points(P < 0.05).6.The results study showed that the incidence of DRA of 5 cm above the umbilical cord,marginal umbilical cord,and inferior umbilical 3 cm was completely different at different time points,and the difference was statistically significant(P <0.05).The incidence was different at any two-time points of the three sites,and the difference was statistically significant(P < 0.05).7.There was no linear correlation between rectus abdominis thickness,medial edge angle,and IRD at different time points in the DRA and non-DRA groups(P >0.05).Conclusion:1.There was no significant difference in age,height,pre-pregnancy weight,pre-pregnancy body mass index,third-trimester weight,third-trimester body mass index,weight gain during pregnancy,abdominal circumference during pregnancy,and birth weight between the DRA group and non-DRA group.2.At 12 weeks of pregnancy,the angle of the medial edge of the left and right rectus abdominis at 3 cm below the umbilical cord in the DRA group was smaller than that in the non-DRA group.The distance between the rectus abdominis 5 cm above the umbilical cord was broader than that in the non-DRA group.It indicated that the risk of rectus abdominis separation in the DRA group was higher than that in the non-DRA group at 12 weeks of gestation so that clinicians can make an early intervention on women with potential risk according to the information provided by ultrasound.Guide the diet and exercise during pregnancy.3.In the absence of any intervention,the thickness and angle of the rectus abdominis muscle were the thinnest and smallest at 37 weeks of pregnancy,and the thickness and angle of the rectus abdominis muscle increased after delivery.The thickness and angle of the rectus abdominis decreased at first and then improved with time.At 42 days postpartum,the thickness and angle of the rectus abdominis in the non-DRA group were more prominent than in the DRA group.4.In the absence of any intervention,the distance between the rectus abdominis increased initially and then decreased with time.At 37 weeks of gestation,the internal length of the rectus abdominis was the most separated at the edge of the umbilical cord.It gradually decreased in the postpartum period,the maximum within 3 days after delivery,and slowed down.The internal distance of the rectus abdominis still did not return to the level of 12 weeks after delivery and 42 days after delivery.5.The time of onset of DRA was different in different parts.DRA appeared at the edge of the umbilical cord the earliest,5 cm above the umbilical cord took the second place,and DRA appeared the latest at 3 cm below the umbilical cord.The internal distance of the rectus abdominis muscle gradually recovered after delivery;the recovery of 3 cm under the umbilical cord was the fastest,the 5 cm above the umbilical cord was the second,and the recovery of the umbilical edge was the slowest.So umbilical marginal DRA was the most common.This study showed that the incidence of DRA at 42 days postpartum was 61%.6.There was no linear correlation between rectus abdominis thickness,medial edge angle of rectus abdominis,and internal distance of rectus abdominis.However,due to the individual differences in the function of rectus abdominis and the degree and position of rectus abdominis separation,and due to the different postures,growth,and development of the fetus,the process of rectus abdominis separation may be different during pregnancy.Therefore,the thickness of the rectus abdominis,the angle of the medial margin,and the distance between rectus abdominis can be observed and measured by high-frequency ultrasound during pregnancy and postpartum,so women with the risk of rectus abdominis separation can be found early. |
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