正常阴道分娩和选择性剖宫产对初产妇下尿路解剖位置的影响

目的探讨正常阴道分娩和选择性剖宫产对初产妇下尿路解剖位置的影响,以及选择性剖宫产是否对产后压力性尿失禁有预防作用。方法正常阴道分娩组孕妇(16例)和选择性剖宫产组孕妇(15例)于孕38~40周、产后6~8周、产后2年分别进行会阴超声及尿动力检查,分析尿道膀胱连接部移动度(UVJ-M)的变化,及其在两种分娩方式间的差异。无分娩史的非妊娠女性20名为对照组,于排卵期行会阴超声及尿动力检查。结果妊娠晚期的UVJ-M较对照组明显增加(P<0.01),并持续到产后2年。两种方式分娩后6~8周的UVJ-M均较妊娠晚期轻度下降,但差异均无统计学意义(P>0.05);仅选择性剖宫产组的UVJ-M在产后2年较妊娠晚期下降明显(P<0.05)。两种分娩方式相比,UVJ-M在产后6~8周和产后2年的差异均无统计学意义(P>0.05)。结论初产妇在妊娠晚期膀胱颈活动度明显增加,并持续到产后2年,选择性剖宫产对其并无明显的保护作用;妊娠本身可能是产后压力性尿失禁的主要致病因素。

Anatomical Changes of Female Lower Urinary Tract after Spontaneous Vaginal Delivery and Selected Caesarean Section in Primigravidae

Objective To investigate the impact of spontaneous vaginal delivery and selected caesarean section on anatomical site of female lower urinary in primigravidae,and to analyse the effect of selected caesarean section on the postpartum stress urinary incontinence. Methods Thirty-one primigravidae(spontaneous vaginal delivery,n=16;selected caesarean section,n=15) at 38-40 gestational weeks and 20 nulliparous women(control group) were recruited for perineal sonographic urodynamics measurement.The primigravidae were examined by perineal sonographic urodynamics in the third trimester,6-8 weeks postpartum and two years postpartum.The mobility of urethrovesical junction(UVJ-M) was determined and analysed between the groups. Results Compared with the control group,the UVJ-M was increased significantly in the third trimester,6-8 weeks and two years after two models of delivery((P<)0.01).The UVJ-M of 6-8 weeks after delivery was decreased compared with that in the third trimester,with no significant difference (P>0.05).However,compared with the parameter in the third trimester,the UVJ-M decreased significantly two years after selected caesarean section(P<0.05).There was no significant difference of UVJ-M between the two models of delivery in early postpartum and long-term follow-up(P>0.05). Conclusion(There exists) hypermobility of bladder neck in the third trimester in primigravida,which persists as long as two years after delivery.This kind of changes is regarded as a key risk anatomical factor to develop stress urinary incontinence after childbirth.