盆底超声评估初次经阴道分娩与剖宫产产后盆底功能

目的观察盆底超声评估阴道分娩与剖宫产初次产后盆底功能的价值。方法选取176名产妇,根据初次分娩方式将其分为经阴道分娩组(n=100)和剖宫产组(n=76);对比2组静息态及最大瓦尔萨尔瓦动作下超声各参数,包括肛提肌裂孔左右径、前后径及面积,左、右侧耻骨直肠肌厚度及膀胱颈移动度,观察盆底超声评估初次产后盆底功能的价值。结果静息态及最大瓦尔萨尔瓦动作下,经阴道分娩组肛提肌裂孔左右径、前后径及面积均大于剖宫产组(P均<0.05),左、右侧耻骨直肠肌厚度均小于剖宫产组(P均<0.05);阴道分娩组膀胱颈移动度大于剖宫产组(t=2.177,P=0.031)。结论盆底超声对评估初次产后盆底功能具有一定价值;初次经阴道分娩对盆底功能的影响大于剖宫产;肛提肌裂孔面积增大、膀胱颈移动度增大及耻骨直肠肌厚度变薄可早期提示产后盆底功能障碍可能。

Pelvic floor ultrasound for evaluating postpartum pelvic floor function of primiparas with vaginal delivery and cesarean section

Objective To observe the value of pelvic floor ultrasound for evaluating postpartum pelvic floor function of primiparae after vaginal delivery and cesarean section. Methods Totally 176 primiparas were enrolled and divided into vaginal delivery group (n=100) and cesarean section group (n=76) according to the condition of the first delivery. The ultrasonic parameters, including the left and right diameter, anterior and posterior diameter and area of levator ani muscle hiatus, the thickness of left and right puborectal muscle and the movement of bladder neck at resting-state and under the maximum Valsalva maneuver were compared between groups. The value of pelvic floor ultrasound for evaluating postpartum pelvic floor function of parturients was observed. Results The left and right diameter, anterior and posterior diameter and area of levator ani muscle hiatus of parturients at resting-state and under the maximum Valsalva maneuver in vaginal delivery group were all greater than those in cesarean section group (all P<0.05), while the thickness of left and right puborectal muscle were smaller than those in cesarean section group (both P<0.05). The movement of bladder neck in vaginal delivery group was larger than that in cesarean section group (t=2.177, P=0.031). Conclusion Pelvic floor ultrasound had certain value for evaluating postpartum pelvic floor function of primiparae after vaginal delivery and cesarean section. Compared with cesarean section, vaginal delivery had greater impact on pelvic floor function of primiparae. The increase of the left and right diameter, anterior and posterior diameter and area of levator ani muscle hiatus, as well as the movement of bladder neck and the decrease of the thickness of puborectal muscle might early indicate the possibility of postpartum pelvic floor dysfunction.