妊娠和分娩对女性盆底支持组织的影响

目的 探讨妊娠和分娩对产后早期盆底功能和盆底功能障碍性疾病（PFD）发生的影响。方法 以568例产后6～8周复查的足月初产妇为研究对象，通过徒手和机器检测盆底肌力、疲劳度和阴道压力以评估产后盆底功能；采用一般问卷调查和盆底器官脱垂定量（POP Q）分期法评分了解产后早期PFD发生情况及影响因素。结果 产后盆底Ⅰ类和Ⅱ类肌纤维肌力正常率分别为29.40%、33.10%，疲劳度正常率分别为52.82%、89.08%，阴道最大压力正常率为72.54%，不同分娩方式间差异无统计学意义（P>0.05）；妊娠期压力性尿失禁（SUI）发生率为27.82%，不同分娩方式之间差异无统计学意义（P>0.05）；产后6～8周SUI和阴道前、后壁，子宫脱垂的发生率分别为9.86%、79.40%、21.13%、12.50%，阴道顺产组>剖宫产组，差异有统计学意义（P<0.05）；Logistic回归结果显示，阴道分娩、会阴侧切和新生儿出生体质量（≥4000g）是产后SUI和POP共同的危险因素，而妊娠期SUI是产后SUI重要危险因素。结论 妊娠和分娩相关因素会使盆底功能下降，出现产后SUI和POP,应在早期予以重视。

Effects of pregnancy and childbirth on female pelvic support floor

Objective To explore the effects of pregnancy and childbirth on postpartum early pelvic floor function and the occurrence of pelvic floor dysfunction disease（PFD）. Methods A total of 568 full-term primipara, who had the follow-up at 6~8 weeks after delivery were included. Test pelvic floor muscle strength, fatigue strength and pelvic floor pressure by digital vaginal palpation and equipment to explore pelvic floor function; general questionnaires and pelvic organ prolapse quantitive examination (POP Q) scoring were used to know early postpartum PFD and influencing factors. Results The normal rate of typeⅠand typeⅡ-muscle fiber strength was 29.40% and 33.10%; the normal rate of fatigue strength was 52.82% and 89.08%; the normal rate of pelvic floor pressure was 72.54%. There were no significant difference between the different delivery groups（P>0.05）. The incidence of stress urinary incontinence (SUI) in pregnancy was 27.82 %. There was no significant difference between the different delivery groups（P>0.05）.The incontinence of SUI, vaginal anterior and posterior prolapse , uterine prolapse at 6~8 weeks after delivery was respectively 9.86%, 79.40%, 21.13%, 12.50% .And the incontinence was vaginal delivery group>cesarean section group, with significant difference between them（P<0.05）. It showed that vaginal delivery, lateral episiotomy and newborn birth weight（≥4000g）were risk factors of postpartum SUI and POP. SUI during pregnancy was also the risk factor of postpartum SUI. Conclusion Pregnancy and childbirth make pelvic floor function decline and postpartum SUI and POP appear, which should be paid attention to early.