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Disease research background female pelvic floor dysfunction (pelvic floor dysfunction, PFD), including stress urinary incontinence (stress urinary incontinence, SUI), pelvic organ prolapse (pelvic organ prolapse, POP), and at the same time associated with the disorder (sexual dysfunction , SD), chronic pelvic pain (chronic pelvic pain, CPP) and urination and defecation abnormalities common in middle-aged women, the occurrence of an aging population and the improvement of people's quality of life, PFD growing concern by the people, and its incidence also increased year by year, older women seriously affect the quality of life and physical and mental health, and bring a heavy economic burden for society, society has become worldwide health problem. PFD pathogenic diseases with multiple etiologies, anything that can affect the structure and function of the pelvic support system factors are likely to lead to the PFD. Pelvic support system including the pelvic floor muscles and pelvic connective tissue. Levator ani muscle is the most powerful part of the pelvic floor muscles, pelvic organs play a major role of the bracket, domestic and foreign research found that the occurrence of the levator ani muscle injury with PFD closely related to the levator ani muscle structure and function become the hotspot of the PFD. Pregnancy and childbirth directly change the structure of the levator ani muscle, caused by changes in its function, is considered to be one of the causative factors of the PFD. Mode of delivery on the levator ani muscle structure and function is still controversial, some studies show that natural childbirth compared with vaginal, elective cesarean section to reduce the damage of the levator ani muscle, has a protective effect on the pelvic floor. However, some scholars believe that the impact of elective cesarean section and spontaneous vaginal delivery on the pelvic floor no difference elective cesarean section on pelvic floor function is not absolute protection. With the development of diagnostic and treatment medical technology, more and more imaging technology is used in the PFD study, ultrasound because of its non-invasive, inexpensive, easy to operate, and the use of real-time imaging technology, has now become one of the means of diagnosis of the PFD. Abroad more research on female pelvic ultrasound, but has yet to see about perineal ultrasound evaluation of the mode of delivery of the levator ani muscle structure and function of impact and postnatal levator ani muscle structure and function to restore the dynamic observation reports. Research purposes using Yin Sanwei ultrasound to observe the different mode of delivery on the of postpartum reproductive hiatus morphology and anal levator function and provide experimental data for the etiology and prevention of the PFD. 2, will Yinsan Wei ultrasound dynamic observation of the different periods postpartum reproductive hiatus morphological changes in levator ani muscle function and provide clinical evidence for the early detection of postpartum PFD and postpartum pelvic floor rehabilitation. Materials and Methods Subjects: select from August 2009 to December 2009 in the First Affiliated Hospital of Guangzhou Medical College obstetric primipara childbirth, a total of 32 cases were randomly selected in a 2:1 ratio elective cesarean section group and vaginal natural childbirth group, including 21 cases of elective cesarean section, natural vaginal delivery 11 cases of the same period, to choose the age, height, BMI homogeneous matching health has not given birth women (volunteers) 13 cases in the control group. Test items: (1) Yin Sanwei ultrasound: choose three different states (including static, the Valsalva maneuver and the levator ani muscle maximum contraction at 6 weeks postpartum and 12 weeks postpartum), using Yin Sanwei the ultrasonic detection reproductive hiatus diameter (Levator hiatal dimeter, LHD), anteroposterior diameter (Levator hiatal anteroposterior diameter, LHAP), transverse diameter (Levator hiatal lateral diameter, LHLR), perimeter (Levator hiatal circle, LHC) and the urethra midpoint to the levator ani muscle distance (Levator urethra gap, LUG). (2) vaginal refers to the clinic detection contraction of the levator ani muscle strength, the modified Oxford scoring system (modified Oxford grading system, MOS) of the levator ani muscle score. (3) the levator ani muscle elasticity of the maximum contraction calculated according εcont = CcCornets-tC-lrbe st formula. (Εcont levator ani the elastic muscle contraction, Ccont, Crest denote the levator ani muscle maximum contraction in resting reproductive hiatus perimeter, lb said the suprapubic arc length). Levator ani muscle εcont significance: levator ani muscle εcont the the smaller the greater the elasticity. Research methods: (1) relatively natural vaginal delivery group, elective cesarean section group and the control group at 12 weeks postpartum Yin Sanwei ultrasound indicators, the levator ani muscle strength and flexibility. (2) dynamic observation of the natural vaginal delivery group and selective cesarean section group 6 weeks postpartum and 12 weeks postpartum Yin Sanwei ultrasound indicators levator ani muscle strength and flexibility changes. Statistical methods for data analysis using SPSS 17.0 software to check the results are expressed as mean and standard deviation (X ± S). Normal distribution of the multi-group comparison between single-factor analysis of variance between the two groups using independent samples T-test (Independent the Samples Test), non-normal distribution, non-parametric test (K-Independent Samples) linear correlation analysis , P lt; 0.05 was considered statistically significant. The results of the three groups of the general situation, including: age, height, body mass index compared the difference was not statistically significant. A different mode of delivery of reproductive hiatus morphology, the levator ani muscle structure and function (1) elective cesarean section group and the natural vaginal delivery group: selective cesarean section group resting, Valsalva maneuver, the levator ani muscle the maximum contraction reproductive hole LHD (5.01 ± 0.61 cm, 5.71 ± 0.86 cm, 4.32 ± 0.57 cm), LHAP (5.11 ± 0.77 cm, 5.58 ± 0.84 cm, 4.45 ± 0.50 cm), LHLR (3.81 ± 0.22 cm, 4.18 ± 0.28 cm, 3.54 ± 0.30 cm), LHC (14.19 ± 1.10 cm, 15.43 ± 1.71 cm, 13.24 ± 1.48 cm), LUG (1.92 ± 0.26 cm, 2.05 ± 0.30 cm, 1.90 ± 0.26 cm) and vaginal natural childbirth the the group LHD (5.24 ± 0.60 cm, 5.98 ± 0.68 cm, 4.32 ± 0.47 cm), LHAP (5.38 ± 0.51 cm, 5.67 ± 0.80 cm, 4.56 ± 0.51 cm), LHLR (3.86 ± 0.40 cm, 4.21 ± 0.49 cm, 3.68 ± 0.50 cm), LHC (15.45 ± 1.07 cm, 16.81 ± 2.07 cm, 15.07 ± 1.15 cm), LUG (1.90 ± 0.22 cm, 2.12 ± 0.32 cm, 1.95 ± 0.30 cm) compared with no statistically significant difference, P gt; 0.05; selective cesarean section group anal mention muscle strength mainly in three (47.6%, 10/21), while the natural vaginal delivery group levator ani muscle strength 2, 3, 4 are (27.3% , 3/11), the two groups were statistically significant, P lt; 0.05; levator ani muscle εcont (-0.06 ± 0.07VS-0.08 ± 0.07) between the two groups, there was no statistically significant difference, P gt; 0.05. (2) selective cesarean section group compared with the control group: selective cesarean section group resting, Valsalva maneuver, the levator ani muscle the maximum contraction reproductive hole LHD the LHAP, ??LHLR, the LHC, LUG compared with the control group LHD (4.50 ± 0.61 cm, 4.98 ± 0.84 cm, 3.80 ± 0.67 cm), LHAP (4.60 ± 0.66 cm, 4.98 ± 0.81 cm, 3.99 ± 0.68 cm), LHLR (3.53 ± 0.40cm, 3.67 ± 0.27 cm, 3.41 ± 0.45 cm), LHC (13.29 ± 1.25 cm, 14.00 ± 1.54 cm, 12.09 ± 1.13 cm), LUG (1.63 ± 0.27 cm, 1.71 ± 0.27 cm, 1.67 ± 0.43 cm) significant increases were statistical differences between groups significance, P lt; 0.05; levator ani muscle strength compared with the control group decreased muscle strength of the control group 4 (58.3%, 7/13) the main difference was statistically significant, P lt; 0.05; levator ani muscle εcont (-0.21 ± 0.06) compared with the control group εcont large elastic than the control is small, the difference was statistically significant, P lt; 0.05. (3) vaginal natural childbirth group compared with the control group: natural vaginal delivery group resting, Valsalva maneuver, the levator ani muscle significantly increased the maximum contraction the reproductive hiatus LHD, LHAP LHLR, the LHC, the LUG compared with the control group, The difference was statistically significant, P lt; 0.05. Levator ani muscle strength compared with the control group decreased, and the difference was statistically significant, P lt; 0.05; levator ani muscle εcont compared with the control group, the small elastic than the control, the difference was statistically significant, P lt; 0.05. Second, the dynamic observation of the natural vaginal delivery group and selective cesarean section group reproductive hiatus morphological changes in the levator ani muscle strength and flexibility, natural vaginal delivery group postpartum comparison of six weeks and 12 weeks postpartum reproductive hiatus will Yinsan Wei ultrasound measure : vaginal natural childbirth group postpartum 6 weeks resting, Valsalva action, anal mention muscle maximum contraction state reproductive hiatus of LHD (5.90 ± 0.86 cm, 6.71 ± 0.82 cm, 5.07 ± 0.60 cm), LHAP (5.85 ± 0.49 cm, 6.46 ± 0.60 cm, 5.33 ± 0.55 cm), LHLR (4.45 ± 0.60 cm, 4.82 ± 0.53 cm, 4.12 ± 0.37 cm), LHC (17.30 ± 1.07 cm, 18.30 ± 1.03 cm, 16.14 ± 0.94 cm), LUG (2.19 ± 0.30 cm, 2.43 ± 0.34 cm, 2.31 ± 0.43 cm) compared with postpartum 12 weeks increases, the difference was statistically significant, P lt; 0.05; levator ani muscle strength, the main one (45.5%, 5/11) than 12 weeks postpartum weakened, the difference was statistically significant, P lt; 0.05; levator ani muscle εcont (-0.02 ± 0.06) compared with postpartum 12 weeks, the levator ani muscle elasticity than 12 weeks postpartum small difference was statistically significant, P lt; 0.05. 2, compare elective cesarean section group 6 weeks postpartum and 12 weeks postpartum Yin Sanwei ultrasound measure: selective the cesarean group of postpartum 6 weeks resting, Valsava action levator ani muscle contraction reproductive hiatus (5.32 ± 0.66 cm, 6.11 ± 0.71 cm and 4.61 ± 0.54 cm), LHAP (5.29 ± 0.61 cm, 5.86 ± 0.72 cm, 4.76 ± 0.80 cm), LHLR (3.86 ± 0.38 cm and 4.06 ± 0.41 cm, 3.51 ± 0.32 cm), LHC (14.14 ± 1.10 cm, 15.43 ± 1.71 cm, 13.24 ± 1.48 cm), LUG (1.87 ± 0.25 cm, 2.01 ± 0.36 cm, 1.93 ± 0.28 cm), the levator ani muscle εcont (-0.06 ± 0.05 ) compared with 12 weeks postpartum, were not statistically different, P gt; 0.05. Levator ani muscle strength at 6 weeks postpartum 2 (61.9%, 13/21) dominated, representing 12 weeks postpartum weakened, the difference was statistically significant, P lt; 0.05. Analysis of the levator ani muscle εcont levator ani muscle strength grade: 6 weeks postpartum levator ani the muscle εcont was negatively correlated with the muscle level, P lt; 0.05. 12 weeks postpartum levator ani muscle εcont was negatively correlated with the muscle level, but not statistically significant, P gt; 0.05. Conclusion 1. Elective cesarean section and vaginal natural childbirth reproductive hiatus form differences cause reproductive hiatus morphological changes of pregnancy-related elective cesarean section. Elective cesarean section than vaginal natural childbirth small impact of the levator ani muscle strength, the elective caesarean change of the levator ani muscle strength may be related to injury of the levator ani muscle nerve. 3 the postpartum reproductive breaks morphology, the levator ani muscle strength and flexibility are the natural recovery trend, the selective cesarean reproductive hiatus form of rehabilitation at 6 weeks postpartum has been basically completed, but failed to return to pre-pregnancy levels, and the levator ani muscle strength damage persists at 12 weeks postpartum, may be associated with nerve injury failed to recover related. The natural vaginal childbirth reproductive hiatus morphology, the levator ani muscle strength and flexibility change to 12 weeks postpartum failed to return to pre-pregnancy levels, suggesting that postpartum pelvic floor rehabilitation treatment and prevention of pelvic floor dysfunction should be performed.
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