产后腹直肌分离高频超声特征及其与分娩方式的相关性研究

  目的  不同分娩方式女性腹直肌超声特征可能存在差异，本研究观察分析分娩方式对女性产后早期腹直肌超声特征的影响。  方法  以2020年8月—2022年10月于诸暨市妇幼保健院进行产后检查的200例女性为研究对象，均行腹直肌高频超声检查，统计研究对象腹直肌分离(DRA)发生率，比较不同分娩方式、不同位置、不同状态下DRA发生率、腹直肌厚度及腹直肌间距(IRD)差异，观察DRA与非DRA女性腹中线超声特征和腹直肌回声特征。  结果  产后6~8周，经阴道分娩组女性DRA总体发生率(62.12%，82/132)显著低于剖宫产组(82.35%，56/68)，P＜0.05，且脐上缘、脐下缘及脐上3 cm处DRA发生率均显著低于剖宫产组(均P＜0.05)。经阴道分娩组女性平卧、屈曲和直立状态下腹直肌厚度[(0.79±0.11)cm，(1.13±0.18)cm，(0.71±0.09)cm]均显著高于剖宫产组[(0.68±0.10)cm，(0.98±0.16)cm，(0.64±0.08)cm]，均P＜0.05，且平卧、屈曲和直立状态下不同位置IRD数值均显著小于剖宫产组(均P＜0.05)。DRA与非DRA女性腹中线超声特征和腹直肌回声特征比较差异均有统计学意义(均P＜0.05)。  结论  剖宫产女性产后早期DRA发生率较经阴道分娩女性更高，腹直肌厚度更小，IRD更大。DRA女性腹中线多表现增宽超声特征，腹直肌回声多表现增强特征。 

High frequency ultrasound characteristics of postpartum rectus abdominis separation after delivery and its correlation with delivery mode

  Objective  The ultrasonic characteristics of the rectus abdominis in women with different delivery methods may be different, however, the clinical experience is not rich. Therefore, this study aims to observe the influence of delivery methods on the ultrasonic characteristics of the rectus abdominis in women in the early postpartum period.  Methods  A total of 200 women who underwent postpartum examinations at Zhuji Maternal and Child Health Hospital from August 2020 to October 2022 were taken as the study subjects. All of them underwent high-frequency ultrasound examination of the rectus abdominis. The incidence of diastasis recti abdominis (DRA) in the study subjects was statistically analyzed. The incidence of DRA, the thickness of the rectus abdominis and the difference of inter-recti distance (IRD) values in different delivery modes, different locations and different conditions were compared. The ultrasound characteristics of the midline abdominis and the echo characteristics of the rectus abdominis in DRA women and non-DRA women were observed.  Results  Between 6 and 8 weeks postpartum, the overall incidence of DRA in the vaginal delivery group (62.12%, 82/132) was significantly lower than that in the cesarean delivery group (82.35%, 56/68), P < 0.05, and the incidence of DRA in the upper, lower and 3 cm above umbilicus was significantly lower than that in the cesarean group (all P < 0.05). The thickness of rectus abdominis muscle [(0.79±0.11) cm, (1.13±0.18) cm, (0.71±0.09) cm] in the supine, flexed and upright positions of women in the vaginal delivery group were significantly higher than in the cesarean delivery group [(0.68±0.10) cm, (0.98±0.16) cm, (0.64±0.08) cm], all P < 0.05, and the IRD values at different positions in the supine, flexed and upright positions were significantly lower than those in the cesarean delivery group (all P < 0.05). There were statistically significant differences between DRA and non-DRA women in mid-abdominal ultrasound characteristics and rectus abdominis echo characteristics (all P < 0.05).  Conclusion  The incidence of DRA in the early postpartum period is higher in women who have had a cesarean section than in women who have had a vaginal delivery. The rectus abdominis is thinner, and the IRD is larger. In women with DRA, the midline of the abdomen is wider, and the echo of the rectus abdominis is more enhanced.