经会阴三维超声评估产钳助产分娩对盆底功能的早期影响  

Early effects of forceps-assisted labor and delivery on pelvic floor function assessed by transperineal three-dimensional ultrasonography

作　　者：刘芮 朱晨 任芸芸 梁嬛 LIU Rui;ZHU Chen;REN Yun-yun;LIANG Huan(Department of Ultrasound,Obstetrics and Gynecology Hospital,Fudan University,Shanghai 200011,China;Department of Obstetrics,Obstetrics and Gynecology Hospital,Fudan University,Shanghai 200011,China)

机构地区：[1]复旦大学附属妇产科医院超声科,上海200011 [2]复旦大学附属妇产科医院产科,上海200011

出　　处：《复旦学报（医学版）》2024年第6期957-960,969,共5页Fudan University Journal of Medical Sciences

摘　　要：目的比较顺产、剖宫产、产钳助产3种生产方式对盆底器官功能的早期影响。方法收集2019年1月至2020年1月在复旦大学妇产科医院分娩后6周行经会阴三维盆底超声检查的58例产妇,分为顺产组(n=22)、剖宫产组(n=9)、产钳组(n=27),收集年龄、孕产次、新生儿体重等资料和盆底超声检查等数据。结果3组的年龄、分娩孕周、新生儿体重和孕次上的差异均无统计学意义。在盆底超声检查中发现,静息状态下,与顺产组相比,产钳组宫颈距耻骨联合下缘的垂直距离较小,膀胱尿道后角更小;与顺产组、剖宫产组相比,产钳组尿道倾斜角更大,肛提肌裂孔面积更小。在Valsalva状态下,产钳组膀胱颈和宫颈距耻骨联合下缘的垂直距离均小于顺产组和剖宫产组。在从静息状态向Valsalva状态转变的过程中,顺产组、产钳组的尿道旋转角大于剖宫产组;产钳组的宫颈移动度、直肠壶腹部移动度大于顺产组和剖宫产组,差异均有统计学意义(P<0.05)。结论分娩后早期产钳助产对盆底脏器的位移影响大于顺产和剖宫产。Objective To compare the early effects on pelvic floor function of three modes of labor:natural delivery,cesarean section and forceps-assisted delivery.Methods Fifty-eight cases of women who underwent transperineal three-dimensional pelvic floor ultrasonography at 6 weeks postpartum at Obstetrics and Gynecology Hospital,Fudan University from Jan 2019 to Jan 2020 were collected and divided into three groups:the natural birth group(n=22),cesarean section group(n=9),and forceps group(n=27).General data such as age,parity,birth order,neonatal weight,and pelvic floor ultrasonography findings were collected.Results The differences in age,gestational week at delivery,newborn weight and number of pregnancies among the three groups were not statistically significant.In pelvic floor ultrasonography,it was found that in the resting state,the cervix had a smaller vertical distance from the inferior border of the pubic symphysis and a smaller posterior vesicourethral angle in the forceps group compared with the cesarean section group.In the forceps group,the angle of urethral inclination was greater,and the area of the anorectal hiatus was smaller in the resting state compared with the natural birth group and cesarean section group.In the Valsalva state,the vertical distance of the bladder neck and the cervix from the lower edge of the pubic symphysis were smaller in the forceps group compared with the natural birth group and cesarean section group.In the transition from resting to Valsalva state,the angle of rotation of the urethra was greater in the natural birth group and the forceps group than in the cesarean section group.Cervical mobility and recto-pubic abdominal mobility were greater in the forceps group compared to the natural birth group and the cesarean section group.All these differences were statistically significant(P<0.05).Conclusion In the early stage of labor,forceps-assisted delivery had a greater effect on the displacement of pelvic floor organs than natural labour and cesarean section.

关 键 词：三维超声 产钳 盆底功能 顺产 剖宫产 

分 类 号：R714.4[医药卫生—妇产科学]