Static and dynamic postural control of postpartum women of different delivery methods

ObjectiveThe aim of this study was to determine whether there is a difference in postural control between nulligravida women and women who have given birth by vaginal or cesarean section.MethodsWomen who had only vaginal delivery in the previous 1–3 years were included in the vaginal delivery group (n = 27), those who had only cesarean delivery in the previous 1–3 years were included in the cesarean section group (n = 28), and those who had never given birth were included in the control group (n = 32). Evaluations were administered 6–8 days after the ovulation phase. Postural control of the participants was evaluated with the computerized dynamic posturography device.ResultsA total of 87 women with a mean age of 29.4 ± 4 years and a mean body mass index of 24.1 ± 3.1 kg/m² were included in the study. Antero-posterior somatosensory organization test values of the vaginal delivery group were lower than the control group (p = 0.0016). The cesarean delivery group had statistically lower antero-posterior somatosensory (p < 0.001 and p = 0.0013) and medio-lateral somatosensory (p = 0.002 and p = 0.017, respectively) test scores compared to the control group and the vaginal delivery group.ConclusionsIt was observed that women who birthed with vaginal or cesarean delivery had impaired somatosensory postural control. There is definitely a need for further studies with a long-term follow-up examining the effects of postural control during pregnancy and the postpartum period.     

快速康复护理在腹腔镜下全子宫切除中的应用

目的探讨在腹腔镜下全子宫切除术中应用快速康复护理措施对患者围手术期指标和患者并发症的影响。方法将在本院行腹腔镜下全子宫切除术的70例患者随机分为两组,各35例,对照组35例给予常规护理,观察组35例给予快速康复护理,对比两组围手术期相关指标、手术前后VAS评分、并发症发生情况以及患者护理满意度。结果观察组胃肠蠕动时间[(9.32±1.67)h]、肛门排气时间[(4.67±1.37)h]、下床活动时间[(6.69±1.24)h]、术后进食时间[(6.21±0.55)h]和住院时间[(4.25±1.20)d]均显著短于对照组的[(12.87±2.08)h]、[(7.28±1.13)h]、[(9.75±3.29)h][(9.33±0.61)h]、[(7.25±1.38)d],P<0.05;观察组术后1 d和术后3 d的VAS评分分别为(4.01±1.28)分、(1.23±0.35)分,显著低于对照组的(6.80±1.32)分、(2.62±0.41)分,P<0.05;观察组和对照组术后并发症发生率(2.86%vs 17.14%)和患者护理满意度(97.14%vs.80.00%)比较,观察组均显著优于对照组P<0.05。结论对于行腹腔镜下全子宫切除术的患者,给予快速康复护理模式可促进患者早期康复,减少术后疼痛程度,降低术后并发症发生率。     

阴道锥体训练联合生物反馈盆底肌治疗尿失禁老年人盆底肌康复研究现状

目的研究阴道锥体训练联合生物反馈盆底肌治疗尿失禁老年人的临床疗效及对盆底肌的影响。方法选取84例从2016年9月至2018年3月本院收治的尿失禁老年患者进行研究,以随机抽签法将其均分为联合组及对照组,每组42例。对照组予以常规盆底肌训练治疗,联合组则予以阴道锥体训练联合生物反馈盆底肌治疗。对比两组在临床疗效、治疗前后盆底肌力情况、治疗前后尿动力学参数指标水平以及生活质量变化情况等方面的差异。结果联合组与对照组在总有效率方面比较,前者高于后者(P<0.05)。治疗后联合组盆底肌力分级为Ⅳ级、Ⅴ级的人数占比相比对照组较高(P<0.05)。治疗后联合组与对照组在VLPP、PMUC水平方面比较,前者高于后者(P<0.05)。治疗后联合组与对照组I-QOL评分相比治疗前较高,且联合组相比对照组较高(P<0.05)。结论阴道锥体训练联合生物反馈盆底肌治疗老年尿失禁患者的疗效显著,有利于促进盆底肌力的恢复,且有效改善患者尿动力学参数,提高生活质量,具有较高的临床推广应用价值。     

低频电刺激联合生物反馈治疗子宫切除术后盆底功能障碍的效果观察

目的 探讨低频电刺激联合生物反馈治疗(子宫全切或子宫次切)术后盆底功能障碍的临床效果。方法 选择2017年6月～2019年2月在我院诊断治疗的子宫全切或次全切术后盆底功能障碍的患者100例为研究对象,随机分为观察组与对照组,每组50例。对照组实施盆底肌功能训练,观察组实施低频电刺激治疗及生物反馈治疗。比较两组治疗前后PFDI-20评分、最大尿流率、平均尿流率、排尿时间、残余尿、盆底电生理功能。结果(1)治疗后,两组PFDI-20评分较治疗前低,差异有统计学意义(P0.05);观察组治疗后PFDI-20评分较对照组低,差异有统计学意义(P0.05)。(2)治疗后,两组最大尿流率、平均尿流率均显著提高,与治疗前比较差异有统计学意义(P0.05);两组排尿时间短于治疗前,残余尿量少于治疗前,差异有统计学意义(P0.05)。治疗后,观察组相较于对照组,排尿时间更短,残余尿量更少,差异有统计学意义(P0.05)。(3)治疗后,两组Ⅰ类肌纤维肌力、Ⅱ类肌纤维肌力均高于治疗前,差异有统计学意义(P0.05);观察组治疗后Ⅰ类肌纤维肌力、Ⅱ类肌纤维肌力优于对照组,差异有统计学意义(P0.05)。结论 低频电刺激联合生物反馈治疗子宫切除术后盆底功能障碍可显著改善盆底电生理功能,改善排尿情况,改善症状。     

Trial of Labor After Cesarean in Adolescents – A Multicenter Study

Study ObjectiveData regarding trial of labor after cesarean delivery (TOLAC) among young women are limited. The aim of this study was to assess the TOLAC success rate and its related factors among adolescent women who had never delivered vaginally.DesignA multicenter retrospective cohort study of all adolescent women aged ≤21 years with a history of 1 previous cesarean delivery, who delivered in 2 tertiary medical centers during 2007-2019. Women were allocated to 2 groups: 1) women who underwent TOLAC, and 2) women who had a repeat cesarean delivery with no trial of labor. Maternal and neonatal outcomes were compared between the two groups. In addition, perinatal outcomes were compared between women with successful and unsuccessful TOLAC.ResultsThe study cohort included 167 women who had a previous caesarean delivery; 117 underwent TOLAC and 50 underwent a repeat cesarean delivery with no trial of labor. Neonatal birthweight (median 2937 vs 3170 g, P = .03) and gestational age at delivery (median 38 weeks vs 39, P = .009) were lower in the repeat cesarean group as compared to those undergoing TOLAC. Overall, 97 of 117 participants (83%) had a successful TOLAC. Failed TOLAC was associated low birthweight as compared to successful TOLAC (5 [25%] vs 7 [7%], odds ratio [OR] 4.3, 95% confidence interval [CI] 1.2-15.3, P = .02), and birthweight difference between current and previous deliveries was higher in the failed TOLAC group (median 315 vs 197 g, P = .04). Rates of neonatal Apgar score at 1 minute < 7 and of neonatal intensive care unit admission were higher in the TOLAC failure group (4 [20%] vs 5 [5%], OR 4.6, 95% CI 1.1-19.0, P = .03, and 4 [20%] vs 4 [4%], OR 5.8, 95% CI 1.3-25.6, P = .02), respectively). In a multivariable logistic regression analysis, only low birthweight was independently associated with TOLAC failure (adjusted OR 9.9, 95% CI 2.1-45.4, P = .003). Two cases of uterine rupture occurred in the no trial of labor group, whereas none were encountered in participants undergoing TOLAC.ConclusionsTOLAC in adolescent women who had never delivered vaginally is associated with a relatively high success rate.