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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(≥4 000 g)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。
Objective To investigate the effect of pregnancy and childbirth on pelvic floor function and pelvic floor dysfunction (PFD) in early postpartum period. Methods 568 postpartum 6 to 8 weeks postpartum for the review of full-term primiparous women as the research object, by hand and machine to detect pelvic floor muscle strength, fatigue and vaginal pressure to assess postpartum pelvic floor function; general questionnaire and pelvic organ prolapse Quantitative (POP-Q) staging method to understand the incidence of postpartum PFD and influencing factors. Results The normal rates of muscle strength of type Ⅰ and type Ⅱ myofibers in postpartum pelvic floor were 29.40% and 33.10% respectively. The normal rates of fatigue were 52.82% and 89.08% respectively. The maximum normal pressure of vagina was 72.54%. There was no statistical difference between different modes of delivery (P> 0.05). The incidence of stress urinary incontinence (SUI) in pregnancy was 27.82%, there was no significant difference between different modes of delivery (P> 0.05) The incidences of wall and uterine prolapse were 9.86%, 79.40%, 21.13% and 12.50%, respectively. There was significant difference between the cesarean section and vaginal delivery group (P <0.05). Logistic regression showed that vaginal delivery, Pelvic episiotomy and newborn birth mass (≥ 4000 g) are common risk factors for postpartum SUI and POP, whereas gestational SUI is an important risk factor for postpartum SUI. Conclusion Pregnancy and childbirth related factors will reduce pelvic floor function, postpartum SUI and POP, should be given priority in the early.