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

Effects of delivery modes on pelvic floor structures by

Objective To determine the morphological changes of pelvic floor in the postpartum women with various delivery modes by transperineal 4D ultrasound. Methods 60 cases of natural labor group, 50 cases of cesarean section, and 50 cases of no pregnancy control group with normal pelvic floor structures were examined between May 2016 and October 2016. Data were collect at the 42nd day of postpartum, and pelvic floor ultrasonography were performed to record the shape and activity of bladder neck, cervix, rectum and anal canal in resting, contraction and Valsalva movements. Four-dimensional images were reconstructed to observe the shape and continuity of the pelvic diaphragm hiatus in the three temporal states. The area of the pelvic diaphragm hiatus was measured, and the results were recorded and compared. Results The area of the pelvic diaphragm hiatus was 16.29 ± 3.28cm2 in the control group, 18.6 ± 3.54cm2 in the natural labor group and 16.52 ± 2.74 cm2 in the cesarean section group respectively at rest. With pelvic floor contraction, this area change to 10.45 ± 4.12 cm2 in the control group, 15.18 ± 3.07 cm2 in the natural labor group and 12.83 ± 2.51 cm2 in the cesarean section group. In Valsalva, the area of pelvic diaphragm hiatus was 14.32 ± 4.44 cm2 in the control group, 22.15 ± 6.10 cm2 in the natural labor group and 19.66 ± 3.68 cm2 in the cesarean section group, respectively. The activities of bladder neck were 13.17 ± 5.64mm in the control group, 23.63 ± 6.35mm in the natural labor group and 17.00 ± 6.52mm in the cesarean section group. Uterine prolapse, control group 0 cases, natural childbirth group 9 cases (15%), cesarean section 0 cases. Rectal prolapse was only found 1 cases (1.67%) in natural childbirth group. The crack area and bladder neck activity under resting state, pelvic floor contraction state and Valsalva action were natural childbirth> cesarean section> control group. Uterine prolapse and the incidence of rectal prolapse were spontaneous delivery> cesarean section group> control group. Conclusion Natural childbirth has more influence on pelvic floor than cesarean section. Transperineal four-dimensional ultrasound can evaluate the different modes of delivery on the pelvic floor structures.