不同分娩方式对产后早期腹直肌分离的影响

目的 探讨不同分娩方式对产妇产后6～8周腹直肌分离（DRA）的影响。方法 收集1354例单胎产妇的临床资料。根据分娩次数和方式对产妇分组随访，初产妇775例[顺产组（A1组）546例，剖宫产组（B1组）229例]，第2次分娩产妇579例[第2次顺产组（A2组） 357例，第2次剖宫产组（B2组）222例]。所有产妇在产后6～8周均采用高频超声探头测量3个位点（脐上3 cm、脐部及脐下3 cm），计算腹直肌间距，比较2种分娩方式对产妇产后DRA的影响。结果 所有产妇在产后6～8周发生的DRA以脐部分离为主，其次为脐上3 cm和脐下3 cm。在初产妇或第2次分娩产妇中，剖宫产组产后DRA的发生率均高于顺产组（B1组92.1%vs. A1组77.6%,B2组95.5%vs. A2组90.8%,P均<0.05），且在3个位点的腹直肌间距比较中B1组均大于A1组、B2组均大于A2组（P均<0.001）。B2组3个位点的腹直肌间距均大于B1组（P均<0.001）。结论 剖宫产增加DRA的发生率；剖宫产增大产后早期腹直肌间距。

Effects of different delivery modes on diastasis recti abdominis in early postpartum period

Objective To evaluate the effects of different delivery modes on diastasis recti abdominis （DRA） in 6-8 weeks postpartum period. Methods Clinical data of 1354 singleton deliveries who had regular prenatal examination and delivery were collected. According to delivery times and delivery modes, 775 primiparous women [including 546 vaginal delivery （A1 group） and 229 caesarean section （B1 group）] and 579 multipara women [including 357 second vaginal delivery （A2 group） and 222 second caesarean section （B2 group）] were followed-up. The inter-rectus distance was examined by high-frequency ultrasound at three locations on the linea alba （3 cm above the umbilicus, umbilicus, 3 cm below the umbilicus） in 6-8 weeks postpartum. The effects of two delivery modes on DRA in postpartum period were evaluated. Results DRA mainly occurred at umbilicus, followed by at the 3 cm above the umbilicus and 3 cm below the umbilicus. The incidence of DRA in the caesarean section groups was higher than that of the vaginal delivery groups among primiparous or multipara women （92.1% vs. 77.6% and 95.5% vs. 90.8%, both P < 0.05）. The inter-rectus distance at three locations in the caesarean section groups was longer than that in the vaginal delivery groups among primiparous or multipara women （B1 group vs. A1 group and B2 group vs. A2 group, all P < 0.001）. The inter-rectum distance at three locations in B2 group was longer than that in B1 group （all P < 0.001）. Conclusion Caesarean section elevates the incidence of DRA and increases the inter-rectus distance in early postpartum period.