经会阴二维超声对压力性尿失禁女性患者盆底的动态观察与评估

目的 应用经会阴二维超声动态观察与评估压力性尿失禁(SUI)女性患者盆底形态.方法 选择32例SUI女性患者(SUI组)、35例生育后无盆底功能障碍女性(对照组),采用经会阴二维超声分别在静息、Valsalva及缩肛状态下观查盆底器官的位置、形态及运动,测量及分析比较盆底二维超声系列参数.结果 二维超声声像图动态观察结果:在静息至Valsalva状态的转变过程中,对照组及SUI组女性膀胱颈及尿道均向后下方移动;在静息至缩肛状态的转变过程中,对照组及SUI组女性膀胱颈及尿道均向前上方移动.对照组71.40%(25/35)尿道为直线型,在静息至Valsalva状态转变过程中,28.60%(10/35)尿道后倾,8.60%(3/35)形成漏斗状结构,SUI组在静息至Valsalva状态转变过程中,87.50%(28/32)尿道后倾明显,28.10%(9/32)形成漏斗状结构.二维超声参数测量结果:静息状态时,SUI组膀胱颈到耻骨联合下缘的水平距离x为(1.38±0.56) cm,大于对照组的(0.61±0.59)cm,差异有统计学意义(t=-5.467,P=0.000);SUI组膀胱颈到耻骨联合下缘的垂直距离y为-(2.01±0.47) cm,尿道膝部到X轴的距离为-(0.05±0.04)cm,尿道角为(137.48±22.26)°,均小于对照组的-(2.73±0.36)cm、-(0.50±0.44)cm、(157.41±18.07)°,且差异均有统计学意义(t值分别为7.075、5.760、4.038,P均=0.000);SUI组尿道长度、近段功能尿道长度均小于对照组,但差异均无统计学意义(t=1.724、1.702,P均＞0.05).Valsalva状态下,SUI组膀胱颈到耻骨联合下缘的水平距离x为(2.14±0.77)cm,大于对照组的(1.38±0.57)cm,差异有统计学意义(t=-4.618,P=0.000);SUI组膀胱颈到耻骨联合下缘的垂直距离y为-(1.04±0.52)cm,近段功能尿道长度为(1.28±0.32)cm,尿道角为(129.09±12.72)°,均小于对照组的-(2.13±0.51)cm、(2.02±0.27)cm、(144.66±14.92)°,且差异均有统计学意义(t值分别为1.259、8.657、4.574,P均=0.000);SUI组尿道膝部到X轴的距离为(0.36±0.34)cm(耻骨联合下缘上方),对照组尿道膝部到X轴的距离-(0.28±0.27)cm(耻骨联合下缘下方),差异有统计学意义(t=-8.568,P=0.000);SUI组尿道长度小于对照组,但差异无统计学意义(t=1.974,P=0.053).缩肛状态下,SUI组膀胱颈到耻骨联合下缘的水平距离x为(0.90±0.55)cm,大于对照组的(0.23±0.13)cm,且差异有统计学意义(t=-7.001,P=0.000);SUI组膀胱颈到耻骨联合下缘的垂直距离y为-(2.08±0.53)cm,近段功能尿道长度为(2.19±0.59)cm,尿道角为(142.78±22.56)°,均小于对照组的-(2.82±0.42)cm、(2.51±0.48)cm、(154.91±20.90)°,且差异均有统计学差异(t值分别为6.361、2.444、、2.285,P均<0.01或0.05);SUI组尿道膝部到X轴的距离为(0.04±0.03)cm(耻骨联合下缘上方),对照组尿道膝部到X轴的距离-(0.33±0.25)cm(耻骨联合下缘下方),差异有统计学意义(t=-8.312,P=0.000);SUI组尿道长度较对照组小,但差异无统计学意义(t=1.972,P=0.053).结论 经会阴二维超声能够清晰显示生育后无盆底功能障碍女性及SUI女性患者在静息、Valsalva及缩肛状态下的盆底形态结构的动态改变,提示SUI的发生可能与膀胱颈及尿道支持结构的缺陷有关.     

会阴三维超声观察生育后无盆底功能障碍女性盆膈裂孔的形态结构

目的 探讨会阴三维超声在观察生育后无盆底功能障碍女性盆膈裂孔结构及形态上的应用价值.方法 应用三维超声容积探头对35例生育后无盆底功能障碍女性患者经会阴部扫描,以矢状面取耻骨联合内下缘、直肠肛管连接部及尿道的平面,重建三维超声图像,观察盆膈裂孔的结构及形态.结果 35例受检者矢状面均能显示耻骨联合、膀胱、尿道及直肠肛管...     

Levator co-activation is a significant confounder of pelvic organ descent on Valsalva maneuver.

OBJECTIVE: A Valsalva maneuver is used clinically and on imaging in order to determine female pelvic organ prolapse. We have examined the potential confounding effect of levator co-activation at the time of a Valsalva maneuver and the impact of repetition with biofeedback instruction. METHODS: Fifty nulliparous women at 36-38 weeks' gestation received 3D/4D translabial ultrasound investigation in the dorsal resting position after bladder emptying. Valsalva maneuvers were recorded initially and after repeated attempts with visual biofeedback both during the maneuver and after, with the operator demonstrating findings on the ultrasound monitor, in order to abolish levator co-activation. Offline analysis was subsequently undertaken. RESULTS: Significant differences between first and optimal Valsalva maneuver were found for bladder neck position, bladder neck descent, hiatal sagittal diameter and hiatal area on Valsalva. In a minority of women (22/50) we observed a reduction in the sagittal hiatal diameter on first Valsalva maneuver, indicating levator co-activation. A reduction in sagittal diameter was seen in only 11/50 after instruction. Levator co-activation was associated with significantly lower bladder neck descent. CONCLUSION: The Valsalva maneuver is frequently accompanied by a pelvic floor muscle contraction. Levator co-activation may be a substantial confounder, reducing pelvic organ descent. Without repetition and digital, auditory or visual biofeedback, women may not perform a correct Valsalva maneuver. Biofeedback markedly reduces the likelihood of levator co-activation but does not abolish it completely.     

生物反馈电刺激及盆底肌锻炼对产后不同时期女性盆腔器官脱垂恢复的影响

目的:分析盆底肌锻炼联合生物反馈电刺激对产后不同时期女性盆底肌功能恢复的治疗效果。方法:采用回顾性分析,选取2020年9月～2021年11月我院康复科门诊收治的39例轻度盆腔器官脱垂产妇作为研究对象。根据治疗开始时间将产妇分为早期组(产后45天内)24例和晚期组(产后3个月及以上)15例。所有产妇均接受同样的盆底康复治疗,即盆底生物反馈电刺激、呼吸训练和凯格尔运动。通过分析治疗前后盆底表面肌电、三维盆底超声检查结果,比较康复治疗对2组产妇盆底功能恢复的影响。结果:通过8周的盆底康复治疗,2组产妇盆底肌慢肌平均值、耐力平均值升高(均P<0.05),2组产妇盆底肌慢肌得分、耐力得分、总得分均升高(均P<0.05),早期组快肌得分、耐力得分、总得分改善幅度大于晚期组(均P<0.05)。2组产妇的肛提肌裂口面积均缩小(均P<0.05)。早期组产妇的膀胱颈位置升高,膀胱颈移动度缩小,膀胱后角减小(均P<0.05),早期组的膀胱颈移动度改善幅度明显大于晚期组(P<0.05)。结论:产后早期进行生物刺激反馈仪联合盆底肌锻炼可更加有效地增强其产后盆底肌的肌力与耐力,...     

产钳助产术后女性盆底机能的三维超声评估

目的应用盆底三维超声评估产钳助产术后女性的盆底机能。 方法选取2019年4月至2019年12月在湖北省妇幼保健院行产后42~60 d常规检查的女性150例（分娩组）,其中产钳助产分娩组75例,自然阴道分娩组75例;同期于湖北省妇幼保健院选取无分娩史的女性100例为对照组。纳入对象均进行经会阴盆底三维超声检查。静息状态下测量膀胱颈的位置、膀胱后角、尿道倾斜角、肛提肌裂孔面积;最大Valsalva动作时测量膀胱颈移动度、尿道旋转角、膀胱最低点（膀胱颈或膀胱后壁）位置、尿道内口有无漏斗化、膀胱后角、肛提肌裂孔面积。采用独立样本t检验、方差分析、χ²检验对比分析静息状态及最大Valsalva动作时组间各测量指标的差异。 结果静息状态下,膀胱颈到参考线的距离,对照组、自然阴道分娩组、产钳助产分娩组依次减小,肛提肌裂孔面积,对照组、自然阴道分娩组、产钳助产分娩组依次增大,两两比较差异均有统计学意义（P均＜0.05）。最大Valsalva动作时,膀胱颈移动度、尿道旋转角及肛提肌裂孔面积,产钳助产分娩组、自然阴道分娩组、对照组均依次减小,两两比较差异均有统计学意义（P均＜0.05）。 结论产钳助产可能导致女性盆底机能受损,盆底三维超声可评估盆底结构及功能的改变,从而为临床提供诊断和治疗依据。     

分娩镇痛对足月初产女性产后盆底结构的近期影响

目的 观察分娩镇痛对足月初产女性产后盆底结构的近期影响。方法 回顾性分析230名于产后6～8周接受经会阴实时三维盆底超声检查的足月初产女性,根据是否接受分娩镇痛将其分为分娩镇痛组(n=70)和对照组(n=160);对比观察组间一般资料、产程、静息态、最大瓦尔萨尔瓦动作及盆底肌收缩状态下盆底超声参数,分析分娩镇痛对其盆底结构的影响。结果 分娩镇痛组与对照组受试者年龄、孕次、体质量指数(BMI)、新生儿体质量及产程差异均无统计学意义(P均>0.05)。静息态及最大瓦尔萨尔瓦动作下,组间膀胱颈位置、膀胱位置、子宫位置及直肠壶腹部位置差异均无统计学意义(P均>0.05);最大瓦尔萨尔瓦动作下,组间膀胱颈移动度及肛提肌裂孔面积差异亦无统计学意义(P均>0.05)。2组受试者肛提肌撕脱发生率及肛门内/外括约肌损伤率差异均无统计学意义(P均>0.05)。结论 分娩镇痛对足月初产女性产后早期盆底结构无明显影响。     

经会阴四维超声观察分娩方式对盆底结构的近期影响

目的 应用经会阴四维超声观察不同分娩方式引起盆底结构改变的图像特征。方法 对2016年5月至2016年10月在我院初产的产妇于产后第42天依照分娩方式不同分自然分娩组60例、剖宫产组50例,以及对照组50例（未孕,超声检查未发现盆底异常者）,均进行盆底超声检查,观察并记录静息、缩肛和Valsalva动作三个时态下膀胱颈、子宫颈、直肠肛管形态及活动度。四维图像重建后观察三个时态下肛提肌裂口形态及连续性,并测量肛提肌裂口面积,记录超声检查结果并进行比较。结果 静息状态时肛提肌裂口面积分别为对照组16.29±3.28cm2,自然分娩组18.6±3.54cm2,剖宫产组16.52±2.74 cm2。缩肛状态时肛提肌裂孔面积分别为对照组10.45±4.12 cm2,自然分娩组15.18±3.07cm2,剖宫产组12.83±2.51cm2。Valsalva动作时肛提肌裂口面积分别为对照组14.32±4.44cm2,自然分娩组22.15±6.10cm2,剖宫产组19.66±3.68cm2。膀胱颈活动度分别为对照组13.17±5.64mm,自然分娩组23.63±6.35mm,剖宫产组17.00±6.52mm。子宫下垂,对照组0例,自然分娩组9例（15%）,剖宫产组0例。直肠膨出者仅自然分娩组1例（1.67%）。静息状态、缩肛状态和Valsalva动作三个时态下肛提肌裂口面积、膀胱颈活动度均为自然分娩>剖宫产组>对照组。子宫脱垂及直肠膨出发病率均自然分娩>剖宫产组>对照组。结论自然分娩较剖宫产对产妇盆底近期影响大。会阴四维超声可评估不同分娩方式对盆底结构的影响     

盆底超声在不同分娩方式产妇盆底功能障碍诊断及盆底康复治疗效果评估中的作用

目的 探讨盆底超声在不同分娩方式产妇盆底功能障碍诊断及盆底康复治疗效果评估中的作用.方法 选取2019年1月至2021年2月我院妇产科70例阴道自然分娩产妇与70例剖宫产分娩产妇作为研究对象,分别设为阴道分娩组、剖宫产组,产后均实施盆底超声检查.比较阴道分娩组与剖宫产组的盆底超声检查指标、盆底功能障碍发生情况.以盆底肌...     

The 'iris effect': how two-dimensional and three-dimensional ultrasound can help us understand anti-incontinence procedures.

OBJECTIVE: The objective of this prospective, observational study in patients after tension-free vaginal tape (TVT) implantation was to describe the spatial relationship between suburethral sling implants, urethra and bony pelvis with the help of translabial two-dimensional and three-dimensional (3D) ultrasound. METHODS: A total of 141 women were examined by translabial ultrasound, supine and after voiding. The TVT sling is highly echogenic and easily identified posterior to the urethra. Tape location was described in the mid-sagittal plane relative to bladder neck and inferoposterior symphyseal margin, at rest and on Valsalva maneuver. In a subset of 83 women, 3D volume ultrasound was performed. RESULTS: The cranial tape margin was situated on average 9.3 mm above and 16.5 mm posterior to the symphyseal margin (Valsalva: 3.9 mm below and 9.6 mm behind the symphysis); the average tape movement on Valsalva was 16 (range, 2-34.2) mm. The distance between tape and inferoposterior symphyseal margin narrowed highly significantly from 20.4 +/- 4.3 mm at rest to 12.9 +/- 3.9 mm on Valsalva (P < 0.001). When a fitted line plot was placed through tape coordinates on an x-y coordinate system, it became evident that tape movement occurs in an arc around the fulcrum of the posterior symphysis pubis. The result is an increasing reduction in the gap between tape and symphysis pubis (termed the 'iris effect'), implying mechanical compression of the urethra. CONCLUSIONS: The curative effect of the TVT on stress incontinence is likely to be due to mechanical compression of the urethra between implant and symphysis pubis. A large variation in tape location and movement explains its wide margin of clinical safety and efficacy.     

Pelvic floor function in elite nulliparous athletes.

OBJECTIVE: There is preliminary evidence linking long-term participation in high-impact exercise with poor performance in labor and increased incidence of stress urinary incontinence, which may be due to altered pelvic floor function. Recent work has shown that HIFIT (high-impact, frequent intense training) athletes have an increased cross-sectional area of the levator ani muscle group as visualized using magnetic resonance imaging (MRI). The aim of this study was to further characterize pelvic floor muscle function and pelvic organ descent in a nulliparous athletic population and compare it with non-athletic controls matched for age and body mass index, using three-dimensional/four-dimensional (3D/4D) pelvic floor ultrasound imaging. METHODS: In this prospective comparative study translabial ultrasound imaging was used to assess pelvic floor anatomy and function in 46 nulliparous female volunteers (aged 19-39 years), 24 HIFIT and 22 controls. Two-dimensional (2D) and 3D translabial ultrasonography was performed on all subjects, after voiding and in the supine position. Descent of the pelvic organs was assessed on maximum Valsalva maneuver, whilst volume datasets were acquired at rest, during pelvic floor muscle contraction and during a Valsalva maneuver. Participants performed each maneuver at least three times and the most effective was used for evaluation. RESULTS: HIFIT athletes showed a higher mean diameter of the pubovisceral muscle (0.96 cm vs. 0.70 cm, P < 0.01), greater bladder neck descent (22.7 mm vs. 15.1 mm, P = 0.03) and a larger hiatal area on Valsalva maneuver (21.53 vs. 14.91 cm(2), P = 0.013) compared with the control group. There were no significant differences in hiatal area at rest or on maximal voluntary contraction between the two groups. CONCLUSION: HIFIT athletes show significant differences in several of the measured parameters for both function and anatomy of the pelvic floor. Further research into the impact of this altered function on childbirth and continence mechanisms is needed.     

经会阴三维超声对正常未育妇女盆膈裂孔的研究

目的通过经会阴三维超声对正常未育妇女盆膈裂孔的观察,探讨盆腔器官下降与Valsalva动作时盆膈裂孔面积之间的关系。方法选择年龄20~36岁未育妇女65例,应用经会阴三维超声获取静息状态及Valsalva动作时盆膈裂孔容积数据成像。离线分析测量肛提肌平均厚度(Tm-PR),盆膈裂孔前后径(AP)、左右径(LR)、面积(HA)及盆腔器官至耻骨联合下缘的距离。结果①静息状态下肛提肌的厚度为0.58~1.15 cm[平均(0.89±0.13)cm],Valsalva动作时其厚度为0.56~1.11 cm[平均(0.76±0.11)cm];静息状态下AP、LR及HA分别为3.31~5.31 cm[平均(4.56±0.54)cm]、3.03~4.29 cm[平均(3.62±0.36)cm]、7.16~15.64 cm2[平均(12.59±2.77)cm2];Valsalva动作时AP、LR及HA分别为3.62~6.40 cm[平均(5.25±0.89)cm]、3.32~4.77 cm[平均(3.92±0.45)cm]、7.40~28.51 cm2[平均(15.70±4.68)cm2];②Valsalva动作时AP、LR及HA均较静息状态下增大,肛提肌平均厚度较静息状态下减小,差异均有统计学意义(均P0.05);③膀胱颈、宫颈及直肠壶腹部下降与HA的相关系数分别为0.682、0.484、0.487,呈中度相关(P0.05)。结论盆腔器官下降与Valsalva动作时HA呈中度相关;经会阴三维超声对盆膈裂孔各参数的测量可靠性高、重复性好,是观察女性盆底结构的一种有效的新影像学技术。     

Ultrasound assessment of pelvic organ prolapse: the relationship between prolapse severity and symptoms.

OBJECTIVE: At present little information is available to help define whether a certain degree of pelvic organ prolapse is clinically relevant. We performed a retrospective study to define cut-offs for significant pelvic organ descent on the basis of prolapse symptoms. METHODS: At a tertiary urogynecological center, 735 women with symptoms of lower urinary tract dysfunction and prolapse were seen for interview, clinical examination, multi-channel urodynamics and ultrasound imaging, while supine and after voiding, for prolapse quantification. Women with multi-compartment prolapse, i.e. those in whom no compartment was clearly dominant were excluded. Receiver-operator statistics were used to test pelvic organ descent as a predictor of prolapse symptoms. RESULTS: Mean age was 55.1 years, mean parity 2.8 (range, 0-12). Symptoms of prolapse were reported by 188 women (25.6%). Seventy-four showed a symptomatic multi-compartment prolapse and were excluded, 56 symptomatic women had cystoceles and 48 had rectoceles. Symptomatic cystoceles descended on average to 23.8 mm below the symphysis pubis and symptomatic rectoceles to 21.4 mm below the symphysis pubis. Descent was strongly associated with symptoms of prolapse (both, P < 0.001). Receiver-operating characteristics (ROC) statistics suggested a cut-off of 10 mm below the symphysis pubis for cystocele, and 15 mm below the symphysis pubis for rectocele. ROC curves were similar for both compartments (area under the curve, 0.857 and 0.821, respectively). CONCLUSIONS: Descent of the bladder to > or = 10 mm and of the rectum to > or = 15 mm below the symphysis pubis are strongly associated with symptoms, and these values are proposed as cut-offs for the diagnosis of significant prolapse on the basis of ROC statistics.     

Measurement reliability and cooperative movement of the pelvic floor and transverse abdominal muscles

[Purpose] This study examined the measurement reliability and cooperative movement of the pelvic floor and transverse abdominal muscles. [Participants and Methods] The participants were seven healthy adult females. Transverse abdominal muscle thickness and bladder floor elevation were measured under the following conditions during active exercise and during resistance exercise: the resting state, maximum contraction of the transverse abdominal muscle, maximum contraction of the pelvic floor muscle, and maximum co-contraction of the transverse abdominal and pelvic floor muscles. Measurements were taken at rest and under each exercise condition. [Results] The intraclass correlation coefficients of transverse abdominal muscle thickness and bladder floor elevation showed high reproducibility under all conditions. The maximum contraction of the pelvic floor muscle showed a high correlation with the maximum co-contraction of the transverse abdominal muscle and pelvic floor muscle during resistance exercise. A significant regression line was found between transverse abdominal muscle thickness and bladder floor elevation under all conditions. The regression equation was as follows: transverse abdominal muscle thickness=0.113 bladder floor elevation+0.377 (r²=0.21). [Conclusion] This study demonstrated that the measurement reliability of the transverse abdominal and pelvic floor muscles is high, and that both muscles exhibit cooperative movement.     

三维盆底超声可动态观察初产妇早期盆底结构及功能的变化

  目的  分析利用会阴三维盆底超声观察产后早期盆底结构及功能受到不同分娩形式所产生的影响,为盆底功能障碍性病症的治疗及预防提供参考。  方法  选取2019年12月~2020年6月在我院产科门诊产后6~8周复查的初产妇67例,根据不同分娩方式,将患者分为剖宫产组（n=23）和经阴道顺产组（n=44）。利用经会阴三维盆底超声对两组患者分别在静息状态下及最大Valsalva状态下,膀胱颈位置、尿道倾斜角、膀胱尿道后角及宫颈外口位置进行观察,计算最大Valsalva动作状态下的膀胱颈移动度、尿道旋转角、宫颈移动度,比较尿道漏斗形成率、膀胱膨出形成率以及类型、子宫脱垂形成率,对比最大Valsalva动作状态、缩肛及静息状态下的肛提肌裂孔面积及左右侧肛提肌的厚度,在缩肛情况下,对肛门内外括约肌及肛提肌是否存在撕裂进行观察。  结果  静息状态下的膀胱颈位置水平远低于剖宫产分娩组（t=-3.43,P < 0.05）,Valsalva状态膀胱颈移动度及尿道旋转角大于剖宫产分娩组（t=3.53、3.82,P < 0.05）,膀胱膨出发生率高于剖宫产分娩组（t=11.075,P < 0.05）,静息、缩肛以及Valsalva状态下的肛提肌裂孔面积均大于剖宫产分娩组（t=4.17、2.95、2.80,P < 0.05）。两组间在膀胱膨出类型上,Ⅱ型膀胱膨出发生率均高于其他两个类型,且经阴道顺产组膀胱膨出三种类型发生率均高于剖宫产组（χ2=13.39,P < 0.05）。而静息状态下的宫颈外口位置、膀胱尿道后角,Valsalva状态下宫颈移动度、尿道漏斗形成、子宫脱垂、直肠膨出以及会阴体过度运动等发生率差异无统计学意义（P>0.05）。3种状态下左右侧肛提肌厚度无明显差异,两组产妇均未发现肛门内外括约肌损伤及肛提肌撕裂。  结论  经会阴三维盆底超声能很好的动态观察到前、中、后盆腔脏器的各项指标,无论哪种分娩方式均可对盆底造成不同程度的损伤,相对于经阴道分娩,早期剖宫产分娩组在前盆腔以及肛提肌裂孔面积方面较经阴道顺产组程度轻。      

Reliability of measuring pelvic floor elevation with a diagnostic ultrasonic imaging device

[Purpose] The purpose of this study was to investigate the reliability of measuring the amount of pelvic floor elevation during pelvic and abdominal muscle contraction with a diagnostic ultrasonic imaging device. [Subjects] The study group comprised 11 healthy women without urinary incontinence or previous birth experience. [Methods] We measured the displacement elevation of the bladder base during contraction of the abdominal and pelvic floor muscles was measured using a diagnostic ultrasonic imaging device. The exercise was a four-part operation undertaken with the subjects in the lateral position. The reliability analysis included use of the interclass correlation coefficient (ICC) was used to assess the reliability. [Results] ICC (1.1) values for the pelvic floor elevation measurement with a diagnostic ultrasonic imaging device were 0.98 [contraction of the transversus abdominis (TrA) muscle], 0.99 [contraction of pelvic floor muscles (PFMs)], 0.98 (co-contraction of the TrA and PFMs), and 0.98 (resistance of the TrA and PFMs). This study proved the reliability of the method because the coefficient of reliability was 0.97 or more for all of the measurements, even for those during exercise. [Conclusion] The diagnostic ultrasonic imaging device measures pelvic floor elevation with high reliability.Key words: Bladder base, Pelvic floor muscles (PFMs), Stress urinary incontinence     

New imaging method for assessing pelvic floor biomechanics.

OBJECTIVES: The investigation of female pelvic floor biomechanics is attracting attention due to its importance in pelvic floor dysfunction and childbirth. To date, there are no established means of assessing pelvic floor elasticity. We propose the use of translabial ultrasound to estimate strain, one element of pubovisceral muscle elasticity. METHODS: Ultrasound datasets of 98 women seen at a tertiary urogynecology clinic were reviewed using proprietary software. Data were processed to estimate muscle fiber strain during Valsalva and contraction by measuring hiatal circumference and deducting bony arc length. Clinical assessment included levator palpation during maximal contraction (modified Oxford grading scale) and at rest, with tone recorded on a new six-point scale. Analysis of imaging data was performed without knowledge of clinical data. RESULTS: Mean age was 52.2 (range, 19-87) years and mean parity was 2.4 (range, 0-8). Mean (SD) hiatal area during contraction, rest and Valsalva was 15.4 (3.8) cm(2), 18.9 (5.0) cm(2) and 27.3 (8.9) cm(2), respectively. There was a moderate association between strain during contraction and Oxford grade (r = 0.439, P < 0.0001), and a weak but significant association between strain during Valsalva and resting tone (r = - 0.224, P = 0.033). CONCLUSIONS: Translabial ultrasound can be used to measure strain, a component of pubovisceral muscle elasticity, and we have validated the technique against clinical assessment. Pubovisceral strain during contraction correlates positively with Oxford grade. Pubovisceral strain during Valsalva correlates negatively with resting tone grade. This new non-invasive ultrasound technique may be of value for assessing patients with pelvic floor dysfunction.     

经会阴四维超声观察新生儿体重及不同的分娩方式对产妇盆底结构的近期影响

【摘要】目的 应用经会阴四维超声观察新生儿体重及不同的分娩方式引起盆底结构改变的图像特征。方法 对2016年5月至2016年12月在我院初产的产妇于产后第42天依照新生儿体重及分娩方式不同分：巨大新生儿自然分娩组40 例、巨大新生儿剖宫产组55 例,以及对照组：正常体重新生儿自然分娩组150 例、正常体重新生儿剖宫产组150 例（均初产,于产后第42天）均进行盆底超声检查,观察并记录静息、缩肛和Valsalva动作三个时态下膀胱颈、子宫颈、直肠肛管形态及活动度。四维图像重建后观察三个时态下肛提肌裂口形态及连续性,并测量肛提肌裂口面积,记录超声检查结果并与进行统计分析。结果 经自然分娩的巨大新生儿组与自然分娩正常新生儿组比较膀胱颈活动度和三个状态下的肛提肌裂口均明显增大,子宫下垂发病率也增加,而直肠膨出发病率和Valsalva状态下膀胱后角、膀胱颈倾斜角和膀胱颈旋转角均没有明显统计学差别。剖宫产 的巨大新生儿组与剖腹产的正常体重新生儿组比较仅膀胱颈活动度和膀胱颈旋转角增大,余各指标无统计学差别。巨大新生儿自然分娩组与剖宫产组比较,仅Valsalva状态下膀胱后角和直肠膨出发病率无统计学差异,余各指标均明显增大。结论 与正常体重新生儿组比较,巨大新生儿组对产妇盆底结构的近期影响较明显,尤其是自然分娩的巨大新生儿组。     

经会阴二维超声观察未育女性前盆腔

目的采用腔内探头经会阴二维超声观察年轻未育女性前盆腔。方法对60例年轻未育女性,以耻骨联合下缘为参考点,分别在安静状态下、最大Valsaval动作时观察尿道和膀胱的运动变化,测量膀胱颈距耻骨联合下缘的垂直距离(BSD)和膀胱尿道后角,计算膀胱颈下降度(BND),并通过计算组内相关系数评估不同观察者间各数据结果的一致性。结果盆底正中矢状切面由腹侧至背侧依次显示耻骨联合、耻骨后间隙、尿道、膀胱颈、膀胱后壁。正常年轻未育女性在安静状态下BSD为(26.20±3.49)mm,膀胱尿道后角为(107.54±13.68)°;最大Valsaval动作时BSD为(14.05±4.32)mm,膀胱尿道后角为(110.97±14.96)°;BND为(12.74±4.48)mm。不同观察者测量安静状态下和最大Valsaval动作时BSD及计算BND的一致性非常好,组内相关系数分别为0.90、0.91和0.87。结论应用腔内探头经会阴二维超声可动态观察女性前盆腔器官的运动变化,方法简单,重复性和可比性好,值得推广。     

Management of symphysis pubis dysfunction during pregnancy using exercise and pelvic support belts

BACKGROUND AND PURPOSE: Symphysis pubis pain is a significant problem for some pregnant women. The purpose of this study was to investigate the effects of exercise, advice, and pelvic support belts on the management of symphysis pubis dysfunction during pregnancy. SUBJECTS: Ninety pregnant women with symphysis pubis dysfunction were randomly assigned to 3 treatment groups. METHODS: A randomized masked prospective experimental clinical trial was conducted. Specific muscle strengthening exercises and advice concerning appropriate methods for performing activities of daily living were given to the 3 groups, and 2 of the groups were given either a rigid pelvic support belt or a nonrigid pelvic support belt. The dependent variables, which were measured before and after the intervention, were a Roland-Morris Questionnaire score, a Patient-Specific Functional Scale score, and a pain score (101-point numerical rating score). RESULTS: After the intervention, there was a significant reduction in the Roland-Morris Questionnaire score, the Patient-Specific Functional Scale score, and the average and worst pain scores in all groups. With the exception of average pain, there were no significant differences between groups for the other measures. DISCUSSION AND CONCLUSION: The findings indicate that the use of either a rigid or a nonrigid pelvic support belt did not add to the effects provided by exercise and advice.     

Relationship among vaginal palpation,vaginal squeeze pressure, electromyographic and ultrasonographic variables of female pelvic floor muscles

Background:

The proper evaluation of the pelvic floor muscles (PFM) is essential for choosing the correct treatment. Currently, there is no gold standard for the assessment of female PFM function.

Objective:

To determine the correlation between vaginal palpation, vaginal squeeze pressure, and electromyographic and ultrasonographic variables of the female PFM.

Method:

This cross-sectional study evaluated 80 women between 18 and 35 years of age who were nulliparous and had no pelvic floor dysfunction. PFM function was assessed based on digital palpation, vaginal squeeze pressure, electromyographic activity, bilateral diameter of the bulbocavernosus muscles and the amount of bladder neck movement during voluntary PFM contraction using transperineal bi-dimensional ultrasound. The Pearson correlation was used for statistical analysis (p<0.05).

Results:

There was a strong positive correlation between PFM function and PFM contraction pressure (0.90). In addition, there was a moderate positive correlation between these two variables and PFM electromyographic activity (0.59 and 0.63, respectively) and movement of the bladder neck in relation to the pubic symphysis (0.51 and 0.60, respectively).

Conclusions:

This study showed that there was a correlation between vaginal palpation, vaginal squeeze pressure, and electromyographic and ultrasonographic variables of the PFM in nulliparous women. The strong correlation between digital palpation and PFM contraction pressure indicated that perineometry could easily be replaced by PFM digital palpation in the absence of equipment.