Ultrasound Evaluation Of Pelvic Floor Muscles In Women After Vaginal Delivery And Analysis Of Injury-related Factors

ObjectiveBy collecting maternal data that are consistent with clinical diagnosis and transperineal pelvic floor ultrasound results,retrospectively analyze the influencing factors related to pelvic floor muscle injury in the early stage after vaginal delivery in primary women,find the best predictive value of variables with diagnostic value,provide clues for clinical formulation of personalized plans for maternal pelvic floor health,and reduce pelvic floor injury caused by pregnancy and childbirth.The simple and effective diagnostic methods and procedures for ultrasound diagnosis of pelvic floor muscle injury are summarized,which is conducive to clinical promotion and application.MethodsA total of 224 women who gave birth vaginally in our hospital from January2020 to December 2022 were selected as the study subjects,all of whom were singletons,full-term,first delivery,and complete clinical data,ultrasonography results are consistent with clinical diagnosis,and the damage to the pelvic floor muscles was observed and recorded by transperineal pelvic floor ultrasound at the follow-up 6-8weeks postpartum.Retrospective collection of maternal age,height,preconceptional weight,prenatal weight,pregnancy time,underlying diseases,pregnancy complications,fetal gestational age,fetal weight,fetal head circumference,fetal double parietal diameter,fetal orientation at delivery,labor stage,whether lateral incision,whether forceps are used,perineal laceration,and anesthesia use during delivery.SPSS26.0 statistical software was used for data processing and analysis,quantitative data were expressed as median ± standard deviation,and counting data were expressed as frequency(rate or composition ratio).Univariate analysis was analyzed by t-test or chi-square test,Logistic regression analysis was used for multivariate analysis,Spearman correlation analysis was used for correlation analysis.The ROC curve was plotted to analyze the diagnostic value,and the relevant influencing factors were found to predict the optimal cut-off value of pelvic floor muscle injury.P<0.05 is statistically significant.Results1 In transperineal pelvic floor ultrasonography,the diagnosis of pelvic floor muscle injury is made by observing two-dimensional and four-dimensional tomographic ultrasound images and measuring the levator urethra gap of the levator ani muscle,and the rate of early pelvic floor muscle injury in women after vaginal delivery is as high as 58%.2 Univariate analysis: pelvic floor muscle injury was associated with preconception body mass index,prenatal body mass index,second stage of labor,perineal laceration,lateral incision,underlying disease,bladder neck mobility,and urethral rotation angle,P<0.05.3 Multivariate Logistic regression analysis: prolonged second stage of labour,perineal laceration,and increased bladder neck mobility increased the risk of pelvic floor muscle injury,with odds ratios of 1.048(95% CI: 1.033 to 1.064),10.171(95%CI: 4.437 to 23.314),and 1.101(95% CI: 1.054 to 1.152),respectively,P<0.05.4 The area under the pelvic floor muscle injury ROC curve was predicted by prolongation of the second stage of labour was 0.556(95% CI: 0.470-0.643),the area under the pelvic floor muscle injury ROC curve was predicted by increased bladder neck mobility was 0.618(95% CI: 0.539-0.696),and the area under the pelvic floor muscle injury ROC curve was predicted by perineal laceration to 0.671(95% CI:0.587-0.754),P<0.05.The optimal cut-off values for predicting pelvic floor muscle injury by obtaining the second stage of labor and bladder neck mobility were 57 minutes and 17 mm,respectively.Conclusions1 Transperineal pelvic floor ultrasound can be a good observation of pelvic floor muscle injury in postpartum women.2 Women have a higher rate of pelvic floor muscle injury in the early stage after vaginal delivery,and pelvic floor muscle injury is related to preconception body mass index,prenatal body mass index,second stage of labor,perineal laceration,lateral incision,underlying disease,bladder neck mobility,and urethral rotation angle.3 Second stage of labour,bladder neck mobility,and perineal laceration are independent risk factors for postpartum pelvic floor muscle injury.When the second stage of labor reaches 57 minutes,the bladder neck movement reaches 17 mm,and the postpartum is accompanied by perineal laceration,great attention should be paid to pelvic floor muscle damage,and timely ultrasound examination is helpful for clinical diagnosis and treatment of pelvic floor diseases in pregnant women.