选择性剖宫产和阴道分娩对产后盆底功能的影响

目的:探讨不同分娩方式对产后早期盆底功能的影响。方法:随机抽取2011年1～5月在荣成市妇幼保健院分娩的产妇65例,根据不同分娩方式分为选择性剖宫产组(32例)和阴道顺产组(33例)。分别于产后6周及12周行POP-Q评分、尿垫试验、超声检测残余尿以及会阴超声检查,比较两组产妇压力性尿失禁(SUI)、盆腔器官脱垂(POP)的发生率及膀胱颈移动度情况。结果:产后6周和产后12周随访时,SUI发生率选择性剖宫产组3.13%(1/32)和0(0/19),顺产组24.24%(8/33)和27.78%(5/18),两组比较差异无统计学意义(P>0.05);POP发生率选择性剖宫产组37.50%(12/32)和36.84%(7/19),顺产组72.73%(24/33)和77.78%(14/18),差异有统计学意义(P<0.05)。产后6周和产后12周会阴超声显示选择性剖宫产组与顺产组膀胱颈角度及膀胱颈旋转角度比较差异有统计学意义(P<0.05)。结论:选择性剖宫产可降低产后早期POP的发生率,并可减少发生SUI的风险。

Effects of selective cesarean section and vaginal delivery on postpartum pelvic floor function

Objective:To explore the effects of different delivery modes on early postpartum pelvic floor function.Methods:Sixty-five pregnant women who deliveried in the hospital from January to May in 2011 were selected randomly,then they were divided into selective cesarean section group(32 cases) and vaginal delivery group(33 cases) according to different delivery modes.POP-Q score,pad test,residual urine detection by ultrasonography and perineal ultrasonography were carried out at six and twelve weeks after delivery;the incidences of stress urinary incontinence(SUI) and pelvic organ prolapse(POP),and the degree of bladder neck mobility were compared between the two groups.Results:During follow-up at six and twelve weeks after delivery,the incidences of SUI in selective cesarean section group were 3.13%(1/32) and 0(0/19),respectively,while the incidences of SUI in vaginal delivery group were 24.24%(8/33) and 27.78%(5/18),respectively,there was no significant difference between the two groups(P>0.05);the incidences of POP in selective cesarean section group were 37.50%(12/32) and 36.84%(7/19),respectively,while the incidences of POP in vaginal delivery group were 72.73%(24/33) and 77.78%(14/18),respectively,there was significant difference between the two groups(P<0.05).The results of perineal ultrasonography showed that there was significant difference in bladder neck angle and bladder neck rotation angle between the two groups at six and twelve weeks after delivery(P<0.05).Conclusion:Selective cesarean section can reduce the incidence of early POP after delivery and cut down the risk of SUI.