阴道助产对初产妇产后早期盆底功能的影响

目的 探讨阴道助产对初产妇产后早期盆底功能的影响。方法 收集345例阴道分娩初产妇的临床资料，根据分娩方式分为自然分娩组170例、胎头吸引器助产组130例、产钳助产组45例，在产妇产后6~12周进行盆底肌力和盆底三维超声检查。比较3组产妇的盆底肌力异常率、膀胱颈移动度增大率、膀胱膨出率、肛提肌裂孔面积增大率、肛提肌损伤率及肛门括约肌损伤率。结果 3组产妇的年龄、BMI、孕期增重、孕周、新生儿出生体质量比较差异均无统计学意义（P均> 0.05）。产钳助产组盆底肌力的异常率高于自然分娩组（P < 0.017），其余两两比较差异均无统计学意义（P均> 0.017）。产钳助产组的肛提肌损伤发生率高于自然分娩组及吸引器助产组（P均< 0.017），吸引器助产组的肛提肌损伤发生率高于自然分娩组（P < 0.001）。3组产妇的膀胱颈移动度增大、膀胱膨出、肛提肌裂孔面积增大及肛门括约肌损伤发生率比较差异均无统计学意义（P均> 0.05）。盆底超声提示盆底肌肉损伤的52例产妇中，产后盆底肌力筛查示正常9例，2种检查方法的一致性检测结果为Kappa = 0.061，P = 0.029。结论 与自然分娩的产妇相比，产钳助产对盆底肌力的损伤最大，接受产钳助产者的肛提肌损伤发生率最高;2种产后盆底肌力检查方法相互独立，盆底超声能清晰显示盆底肌损伤状况，在产后盆底筛查中起重要作用。

Impact of operative vaginal delivery on early postpartum pelvic floor function in primipara

Objective To evaluate the effect of operative vaginal delivery on early postpartum pelvic floor function in primipara. Methods Clinical data of 345 parturients with vaginal delivery were collected. According to the mode of delivery， all cases were divided into the natural delivery group （n = 170）， vacuum-assisted delivery group （n = 130） and forceps-assisted delivery group（n = 45）. The pelvic floor muscle strength and three-dimensional ultrasound of the pelvic floor were examined 6-12 weeks after delivery. The abnormal rate of pelvic floor muscle strength， bladder neck mobility rate， cystocele rate， enlargement rate of levator hiatal area， levator ani muscle injury rate， anal sphincter injury rate were statistically compared among three groups. Results There were no significant differences in the maternal age， body mass index， gestational weight gain， gestational age and newborn birth weight among three groups （all P > 0.05）. The abnormal rate of pelvic floor muscle strength in the forceps-assisted delivery group was higher than that in the natural delivery group （P < 0.017）， whereas there were no significant differences in the remaining pairwise comparison （both P > 0.017）. The levator ani muscle injury rate in the forceps-assisted delivery group was higher than those in the natural delivery and vacuum-assisted delivery groups （both P < 0.017）， and the levator ani muscle injury rate in the vacuum-assisted delivery group was higher than that in the natural delivery group （P < 0.001）. There were no significant differences in the abnormal rate of bladder neck mobility， cystocele rate， enlargement rate of levator hiatal area and anal sphincter injury rate among three groups （all P > 0.05）. Pelvic floor ultrasound indicated that among 52 women with pelvic floor muscle injury， 9 cases had normal pelvic floor muscle strength. The results of consistency test between two methods were Kappa = 0.061 and P = 0.029. Conclusions Compared with the natural delivery group， the pelvic floor injury is the most severe and the levator ani muscle injury rate is the highest in the forceps-assisted delivery group. These two methods are independent of each other. Pelvic floor ultrasound can clearly show pelvic floor muscle injury after delivery， which plays an important role in the postpartum screening of pelvic floor.