A feasibility study of the automatic cystocele severity grading software for quantitative evaluation of prolapse of bladder posterior wall by transperineal ultrasound

Objective To evaluate the diagnostic value of pelvic ultrasonography in female patients with postpartum bladder prolapse. Methods A total of 94 cases of postpartum females with cystocele were enrolled in the study group. And 35 postpartum asymptomatic subjects excluding cystocele by clinical and ultrasound examination were selected as the control group. Transperineal two-dimensional and real-time three-dimensional ultrasound was performed in two groups, and the bladder neck descent (BND) and the area of levator hiatus in Valsalva maneuver were measured, respectively. The BND and the area of levator hiatus were compared between the two groups, and ROC curve were used to assess the value of ultrasound in diagnosis of cystocele. Results The BND and the area of levator hiatus in Valsalva maneuver were (26.2±6.5) mm and (25.2±6.7) cm2 respectively in the study group, which were significantly higher than those in the control group (9.9±4.7) mm and (15.6±3.9) cm2. There were significant differences in BND and area of levator hiatus between the two groups (t=13.56, 7.92, both P<0.05). The cut-off value of the BND and the area of levator hiatus in diagnosis of cystocele were 16 mm and 17.9 cm2 in Valsalva maneuver, respectively. The area under the curve were 0.982 and 0.905, while the sensitivity and specificity were 98.9%, 88.6%, 88.3%, 80.0%, respectively. Conclusion The BND and the area of levator hiatus can be used as the imaging index to diagnose female postpartum cystocele in Valsalva maneuver with high diagnostic value. Key words: Pelvic floor; Ultrasonography; Neck of bladder; Levator ani muscles; Cystocele; Postpartum

Objective To investigate the pelvic floor in cystocele patients using translabial ultrasound, and discuss the ultrasound appearance. Methods Translabial 2D ultrasound was performed on 136 patients who were diagnosed or suspected as anterior vaginal wall prolapse or cystocele using pelvic organ prolapse quantitation system, the position of bladder, the retrovesical angle and urethral rotation were measured during maximum Valsalva maneuver. Cystocele subtypes were diagnosed according to the ultrasound findings. Results Translabial 2D ultrasound diagnosed 88 cases cystocele based on the position of bladder, retrovesical angle and urethral rotation, including ten cases cystocele type Ⅰ, 32 cases type Ⅱ and the remaining 46 classified as type Ⅲ. Conclusions Translabial 2D ultrasound successfully acquired the ultrasonic characteristics of cystocele subtypes, which could provide imaging evidence for clinic diagnosis of this disease. Key words: Ultrasonography; Pelvic floor; Cystocele

Objective To explore the value of transperineal ultrasonography in diagnosis of female anterior pelvic cavity dysfunction. Methods From April to November 2014, a total of 68 cases of outpatients with frequent urination, urgency, dysuria and rotor of vagina who were primary diagnosed or suspected as anterior vaginal wall prolapse or uterine prolapse by pelvic organ prolapse quantitation (POP-Q) in the Department of Obstetrics and Gynecology of the First Affiliated Hospital of Guangzhou Medical University were enrolled as research objects. They were classified into two groups by transperineal ultrasound diagnosed results, anterior pelvic cavity dysfunction group (n=58) and normal anterior pelvic cavity function group (n=10). At the same time, according to whether patients in anterior pelvic cavity dysfunction group were combined with cystocele or not, they were classified into cystocele subgroup (n=28) and without cystocele subgroup (n=30). The parameters of resting and max Valsalva conditions were observed and measured, respectively by transperineal ultrasound, including bladder position, funneling of the internal urethral orifice, bladder neck-symphyseal distance (BSD), vesicourethral angle, the bladder neck descent (BND), rotation angle of urethra and bladder neck. And the cystocele subtypes of patients were classified. The BND, rotation angle of urethra and bladder neck, retrovesical angle of resting and max Valsalva conditions were compared between anterior pelvic cavity dysfunction group and normal anterior pelvic cavity function group, and with cystocele subgroup, and without cystocele subgroup, respectively by statistical methods. There were no statistical differences among the age, body weight, gravidity, parity and POP-Q degree between anterior pelvic cavity dysfunction group and normal anterior pelvic cavity function group, and with cystocele subgroup and without cystocele subgroup (P>0.05). The research followed the ethical standards of the human trials of the First Affiliated Hospital of Guangzhou Medical University, approved by the committee, and clinical research informed consent was signed by each patient. Results ①Among 68 cases of patients in this research, 58 cases of anterior pelvic cavity dysfunction diseases were diagnosed by transperineal ultrasound based on the position of bladder, BND, vesicourethral angle, rotation angle of urethra and bladder neck. All the 58 cases were stress urinary incontinence (SUI), and there were 10 cases with funneling of bladder neck, 28 cases with cystocele (7 cases with typeⅠ, 10 cases with type Ⅱ, 11 cases with type Ⅲ). The anterior pelvic cavity function of rest 10 cases all were normal. ②The average of vesicourethral angles of resting and max Valsalva conditions of 58 cases of patients in anterior pelvic cavity dysfunction group were 122.2° (113.3°-136.3°) and 137.7° (119.4°-159.2°), respectively, and both were larger than those of 10 cases in normal anterior pelvic cavity function group which was 91.2° (81.3°-99.0°) and 111.0° (88.3°-117.7°), respectively, and both the differences were statistically significant (Z=-3.775, P=0.000; Z=-3.152, P=0.002). But as to the BND, angle rotation of urethra and bladder neck between two groups, there were no statistical differences (P>0.05). ③The BND, rotation angle of urethra and bladder neck in the patients with cystocele subgroup were (26.4±7.3) mm, 64.0° (43.2°-78.9°), 67.7° (42.7°-84.5°), respectively, all were larger than those of patients without cystocele subgroups, which were (14.2±3.6) mm, 15.5° (10.1°-24.9°), 29.6° (26.4°-38.7°), respectively, and all the differences were statistically significant (t=9.090, P=0.000; Z=5.275, P=0.000; Z=5.322, P=0.000). But as to the retrovesical angles of resting and max Valsalva conditions in two subgroups, there were no statistical differences (P>0.05). Conclusions Transperineal ultrasound is a noninvasive, shortcut and more accurate method to observe the anatomical position and function of anterior pelvic cavity. It is useful for the diagnosis of female anterior pelvic cavity dysfunction, and has a great application value. Key words: Ultrasonography; Anterior pelvic cavity dysfunction; Urinary incontinence, stress

Objective To investigate the value of evaluation of pelvic floor ultrasound in the transvaginal modified patch repair and sacrospinous ligament fixation in uterine prolapse patients. Methods Thirty-two patients with uterine prolapse were included in the retrospective study from March 2016 to January 2017 in Hangzhou maternity and child health care hospital. All patients were detected by pelvic floor ultrasound before operation and cured by vaginal patch bilateral sacral spine ligament fixation treatment after. Of them, 8 cases were complicated with cystocele and 3 cases with anorectal prolapse, and all the complications were treated at the same time. The observations of the change of position, shape and activity of the implant by transvaginal at rest, on maxium Valsalva and contraction, and the transperineal pelvic ultrasound were performed to evaluate the change of pelvic floor function and compare the distance from the lowest point of the bladder, uterus and the rectal ampulla to reference line (the horizontal line at the lower margin of the pubic bone), area of levator hiatus and the thickness of the puborectalis muscle before and after operation. Results The patches were observed 2D and 3D postoperatively by pelvic ultrasound. The U-shaped hyperecho could be clearly shown around the cervix and activity of patches were clearly shown. The observation of 32 cases of patients with pelvic viscera situation by the transperineal 2D and 4D pelvic ultrasound: the distance from the lowest point of the bladder, uterus and the rectal ampulla to reference line and the thickness of the puborectalis muscle enlarged after operation (0.65±1.85 vs 0.15±1.85, 2.80±1.10 vs -1.00±1.50, 0.60±1.90 vs -0.55±1.55, 0.51±0.24 vs 0.37±0.19) onmaxium valsalva, the area of levator hiatus decreased after operation (20.15±7.20 vs 29.00±9.50). The differences were both statistically significant (all P<0.05). Uterine prolapse were not found after operation. In the 8 cases with cystocele, 5 cases were cured and 3 cases were improved. And all the 3 cases of patients with anorectal prolapse were all cured. Conclusion Combined application of transvaginal and transperineal pelvic ultrasound can clearly show the suspension of the patch after the treatment of modified patch repair and Sacrospinous ligament fixation, which provide valuable imaging information in the evaluation of preoperative pelvic functionand postoperative therapeutic effect. Key words: Pelvic floor ultrasound; Uterine prolapse; Modified patch repair; Sacrospinous ligament fixation; Levator hiatus

Objective To evaluate any changes in overall pelvic floor function among women with stress urinary incontinence (SUI). Methods Twenty-five female SUI patients were recruited as the SUI group and twenty-three healthy female counterparts were selected as the control group. Pelvic organ prolapse quantification (POP-Q) was performed with both groups. Ultrasonography was used to measure the position of the bladder neck, the posterior angle of the urethra, the urethra′s inclination angle and the size of the diaphragmatic hiatus for both groups at rest, during the Valsalva maneuver, as well as during the transition from resting to the Valsalva maneuver. The strength and fatigue of type I and type II fibers in the pelvic muscles were evaluated electrophysiologically, and anorectal manometry was also performed with both groups. The significance of any relationship between these measurements and SUI was determined using multivariate logistic regression analysis. Results Eleven members of the SUI group showed phase I pelvic organ prolapse. Twelve were in phase II and 2 were in phase III. All of those incidences were significantly different from the control group. There were significant differences between the two groups in the average bladder neck position, urethral inclination angle, posterior urethra angle, descending distance of the bladder neck, and urethral rotation angle during the Valsalva maneuver. In the transition from resting to the Valsalva maneuver, significant differences were found only in the distance of the bladder neck′s descent and the rotation angle of the urethra. The severity of pelvic organ prolapse, the descending distance of the bladder neck and the urethral rotation angle, as well as the bladder neck position and urethral angle during the Valsalva maneuver were the major risk factors associated with female SUI, and the correlation was statistically significant. Conclusion The greater the mobility of the bladder neck and urethra in female SUI patients, the more serious the prolapse. Prolapse, bladder neck mobility and urethral support all affect the overall functionality of the pelvic floor. Key words: Stress; Urinary incontinence; Pelvic floor; Ultrasonography; Anorectal manometry

To explore the feasibility of dynamic three-dimensional ultrasound measurement in the diagnosis of pelvic floor dyssynergia(PFD). Thirty female patients with PFD received dynamic three-dimensional ultrasound. The differences in angle α measured by transperineal three-dimensional ultrasound, and angle β, angle γ, and H line as measured by transanorectal three-dimensional ultrasound were compared between resting state and Valsalva maneuver. In addition, the detective rate of PFD by different parameters was analyzed. In 30 patients, rectocele was found in 13 cases(43.3%), rectal internal mucous intussusception in 14 cases(46.7%), uterine prolapse in 11 cases(36.7%), and bladder prolapse in 1 case(3.3%). Compared with the resting state, α, β and H decreased obviously, but γ increased apparently in Valsalva maneuver, and differences of these parameters were statistically significant(all P<0.01). Detective rates of PFD for parameters of α, β, γ and H were 93.3%(28/30), 96.7%(29/30), 96.7%(29/30) and 86.7%(26/30), respectively. Measurements of α, β, γ and H can provide feasible indicators for clinical diagnosis of PFD.

Objective To evaluate the changes of pelvic floor structure and function quantitatively in different periods after taking total hysterectomy by transperineal pelvic ultrasound. Methods A total of 105 female patients who underwent ultrasound examination after hysterectomy at the Second Hospital of Lanzhou University from March 2016 to July 2017 were enrolled. Among them, 37 cases were 40-49 years old, 49 cases were 50-59 years old, 19 cases were over 60 years old; 29 cases were less than 1 years after hysterectomy, 33 cases were>1,≤5 years after hysterectomy, 28 cases were>5,≤10 years after hysterectomy, and 15 cases were over 10 years after hysterectomy. A total of 120 female volunteers from the Second Hospital of Lanzhou University who had not been diagnosed with pelvic floor dysfunction (PFD) were selected as the healthy control group without total hysterectomy or other pelvic floor surgery. All subjects were examined by pelvic floor ultrasound. The distance from the bladder neck to the lower edge of pubic symphysis (X), urethral angle (α), retrovesical angle (β), the distance from the lowest point from the rectal ampulla to the lower edge of pubic symphysis (D) and detrusor thickness under resting state and maximal Valsalva state were measured. And the urethral rotation angle (Rα) and bladder neck descent value (BND) were calculated. T test was used to compare the ultrasonic quantitative parameters between the total hysterectomy group and the healthy control group, and the detection rate of PFD was compared by Chi-square test between the patients of different age groups at different time after hysterectomy. Results The thickness of bladder detrusor in total hysterectomy group was significantly higher than that in healthy control group. The age of patients in the total hysterectomy group was older than that in the healthy control group, and the difference was statistically significant. At rest, compared with the subjects in the healthy control group, the βincreased, the X and D decreased in patients with total hysterectomy. The differences were significant. The α increased after hysterectomy, but the difference was not statistically significant. At maximum Valsalva state, compared with the subjects in the healthy control group, the α, β, Rα and BND all increased in the group of total hysterectomy, and the X and D decreased. The difference was statistically significant. The detection rate of PFD in 105 cases of total hysterectomy group was 60% (63/105), the detection rate of stress incontinence (SUI) was 33.3% (35/105), and the detection rate of pelvic organ prolapse (POP) was 36.2% (38/105). In POP, the detection rate of bladder prolapse, rectal prolapse and intestinal hernia was 18.1% (19/105), 10.5% (11/105) and 6.7% (7/105). SUI was the main occurrence of PFD within 1 year after total hysterectomy, and the detection rate was 48.3% (14/29). 10 years after operation, POP was the predominant occurrence of PFD, and the detection rate was 80.0% (12/15). There was no significant difference in the detection rate of PFD between different age groups after hysterectomy, indicating that the detection rate of PFD at different times after hysterectomy may not be closely related to the age of patients. Conclusion Transperineal pelvic floor ultrasonography can dynamically observe the changes of pelvic floor structure after total hysterectomy, and can evaluate PFD quantitatively after operation. Key words: Ultrasonography; Pelvic floor; Stress incontinence; Pelvic organ prolapse; Hysterectomy

Objective To determine the consistency of urogenital hiatus (UH) data between the semi-automatic measurement and manual measurement using transperineal pelvic floor ultrasonography. Methods Total of 286 three-dimensional images of minimal UH dimension were obtained. And they were divided into study group (100 images) and test group (186 images) randomly. Three experts traced and created the whole profile of the UH of those images in the study group by MATLAB. Then the semi-automatic software was obtained through machine learning algorithms. In the test group, 6 parameters of UH (including anterioposterior diameter, transverse diameter, circumference, area, left and right levator urethral gap distance) were measured by two experts (D1 and D2) both manually and semi-automatically. The time experts spent on measuring was also recorded and compared. Results The time used for semi-automatic measurement was significantly shorter than that for manual measurement[ (7.49±1.51)s vs (42.42±11.08)s, (7.52±1.37)s vs (43.45±9.09)s for D1 and D2, t=-12.09, -13.64, all P=0.00]. The Pearson correlation coefficients between semi-automatic and manual measurements of 6 parameters were 0.857-0.985 (P<0.01), 0.853-0.979 (P<0.01) in D1 and D2, respectively. The interclass correlation coefficients (ICC) of six parameters were ranged from 0.846-0.985 for D1 and 0.843~0.979 for D2(all P<0.01). The Bland Altman plot also showed good agreement between two methods. Conclusions Intellectual recognition and semi-automatic measurement has simplified the process for UH measurement, and it is proved to be a reliable and timesaving method that is practical for clinical use. Key words: Ultrasonography, transperineal; Urogenital hiatus; Intelligent identification; Semi-automatic measurement; artificial intelligence

Objective To observe the near-term impact of the second natural delivery on the structure of a female pelvic floor by ultrasonography. Methods Selected fifty second-natural-delivery women and fifty first-natural-delivery women from Tongde Hospital of Zhejiang Province between October, 2016 and October, 2017 undertook pelvic ultrasonnography (42 days postpartum). Pelvic ultrasonography was used to determine all mothers′ bladder neck descent, bladder posterior angle, bladder neck tilt angle, bladder neck rotation angle, and the area of pelvic diaphragm hiatus when performing the Valsalva maneuver. Besides, pelvic ultrasonography was used to determine the extent of mothers′ internal-urethral-of-orifice funneling, perineal hyperactivity, uterine prolapse and rectal bulge. The paired t test was applied between groups to compare the bladder neck descent, bladder posterior angle, bladder neck tilt angle, bladder neck rotation angle and the area of pelvic diaphragm hiatus of the second-natural-delivery mothers with those of the first-natural-delivery mothers. The χ2 test was also applied to examine the degree of mothers′ uterine prolapse, rectal bulge and internal-urethral-of-orifice funneling, as well as their perineal hyperactivity rate. Results The bladder neck descent, bladder posterior angle, bladder neck tilt angle, bladder neck rotation angle and the area of pelvic diaphragm hiatus of the second-natural-delivery mothers were all wider than those of the first-natural-delivery mothers [(29.37±5.32) mm vs (22.63±6.35) mm, (148.8±14.97)° vs (141.2±15.20)°, (73.69±16.03)° vs (69.8±15.25)°, (44.41±19.27)° vs (40.0±17.52)°, (21.47±5.19) cm2 vs (19.15±4.10) cm2], and differences were statistically significant (t=5.761, P<0.001; t=2.519, P=0.001; t=2.476, P=0.001; t=3.123, P=0.001; t=2.481, P<0.001). The degree of the second-natural-delivery mothers′ uterine prolapse and internal-urethral-of-orifice funneling as well as their perineal hyperactivity rate were all higher than those of the first-natural-delivery mothers [46.0% (23/50) vs 20.0% (10/50), 12.0% (6/50) vs 6.0% (3/50), 20.0% (10/50) vs 6.0% (3/50)], and differences were statistically significant (χ2=7.644, P=0.006; χ2=3.342, P=0.043; χ2=4.332, P=0.037). The differences in the incidence rate of rectal bulge between the two groups were of no statistical significance [4.0% (2/50) vs 2.0% (1/50), χ2=1.197, P=1.000]. Conclusions The pelvic ultrasonogram showed that the near-term impacts of the second natural-delivery on women′s pelvic floor were more obvious than those of the first natural delivery. What′s more, pelvic floor ultrasound has been proved to be a reliable basis for the diagnosis and screening of dysfunctional diseases of pelvic floor. Key words: Ultrasonography; Pelvic floor; Parturition

Objective To dynamically observe and evaluate the position and movement of anterior pelvic floor organs in vaginal delivery and selective caesarean section primipara with translabial two-dimensional(2D) ultrasound, and discuss the short-term effect of delivery mode on the anterior compartment of pelvic floor. Methods Translabial 2D ultrasound was performed on selective caesarean section and vaginal delivery primipara in 6-8 weeks. The position of bladder, the existence of bladder neck funneling were observed, and the mobility of bladder neck and the urethral rotation angle were measured during maximum Valsalva maneuver. Results The mobility of bladder neck was larger in vaginal delivery group than selective caesarean section group during maximum Valsalva maneuver. The rates of bladder neck funneling, cystocele and stress urinary incontinence were higher in vaginal delivery group. Conclusions Translabial 2D ultrasound could dynamically observe and evaluate the position and movement of anterior pelvic floor organ, which could be used to assess the effect of delivery mode on anterior compartment of pelvic floor. The short-term effect of vaginal delivery on anterior compartment of pelvic floor is greater than that of selective cesarean delivery. Key words: Translabial ultrasonography; Pelvic floor; Delivery mode; Anterior compartment of pelvic floor

Objective To evaluate the pelvic floor function in post-hysterectomy patients. Methods Transperineal pelvic ultrasound was used to observe the pelvic organs in post- hysterectomy patients, and parameters of pelvic floor were measured. Taking the inferior margin of public symphysis as the reference plane, the shape and motion of the proximal urethra and bladder neck were observed at rest and on maximum Valsalva maneuver. Bladder neck-symphyseal distance(BSD) and retrovesical angle were measured. And the bladder neck descent(BND), urethral rotation angle and the rotation angle of the bladder neck were also calculated. Interclass correlation coefficients were calculated to evaluate the consistency of data. Results At rest, the BSD and retrovesical angle were (-2.73±0.37)cm and (119.00±22.40)°, while on maximum Valsalva maneuver was (-0.25±0.67)cm and (114.74±21.50)°, respectively. BND was (2.46±0.59)cm, the urethral rotation angle and the rotation angle of the bladder neck was (70.68±19.91)° and (60.81±17.34)°, respectively. Combined with pelvic ultrasound and clinical manifestations, 29 cases of pelvic floor dysfunction after hysterectomy were diagnosed (58.00%, 5 cases of stress urinary incontinence, 8 cases of proctoptoma and 16 cases of bladder prolapse). The consistency was very high in measuring BNS, retrovesical angle at rest and on maximum Valsalva maneuver and BND by different observers. The interclass coefficient was 0.90, 0.89, 0.91, 0.88, 0.92, respectively. And the interclass coefficient of urethral rotation angle and the rotation angle of the bladder neck was 0.79, 0.88, respectively. These results showed a good interobserver agreement. Conclusion Transperineal pelvic ultrasound is a simple, reproducible and noninvasive imaging method, which can reveal the position and function of female pelvic organ dynamically and evaluate postoperative pelvic floor function. Key words: Ultrasonography; Pelvi floor function; Hysterectomy

Objective To investigate the influence of different modes of delivery on primiparae's pelvic floor structure and function change.Methods 250 cases delivering through caesarean section (C-section group) and 250 cases delivering vaginally (natural labor group) were chosen,then their pelvic floors were checked by three-dimensional uhrasonography 6-8 weeks after the delivery.The signs of anterior,middle,and posterior pelvic prolapse were observed and the bladder neck down distance and the urethral transfer angle were measured during Valsalva maneuver.The changes were observed and the areas of levator hiatal were measured when the patients was in rest,Shrinkage anal maneuver,and Valsalva maneuver.Results More cases occurred more severe pelvic organ prolapse in the natural labor group than in the C-section group (P ＜ 0.05).During Valsalva maneuver,the bladder neck down distance was longer and the urethral teansfer angle was larger in the natural labor group than in the C-section group (P ＜ 0.05).When the patients were in rest,Shrinkage anal maneuver,and Valsalva maneuver,the areas of levator hiatal were larger in the natural labor group than in the C-section group (P ＜ 0.05).Conclusions Natural labor is more harmful to primiparae's pelvic floor structure and function than C-section.Three-dimensional ultrasonography is a simple and objective method for postpartum pelvic floor dysfunction screening and worth being generalized. Key words: Three-dimensional ultrasonography; Delivery mode; Primipara; Pelvic organ prolapse; Levator hiatal

Objective To investigate the application value of transperineal ultrasound in female patients with cystocele.Methods Transperineal ultrasound were performed in 36 female patients with cystocele and the bladder neck movement degrees (BND),retrovesical angle and the degree of urethral rotation were observed at maximum Valsalva.The ultrasonic manifestation of 36 female patients with cystocele were summarized.Results On maximal Valsalva bladder neck mobility all increased in 36 patients,32 patients with open retrovesical angle (≥140°) and 30 female patients with urethral rotation ≥ 45°.There were 6 cases with type Ⅰ,bladder neck was lower than inferoposterior margin of the symphysis pubis,cystocele with open retrovesical angle (≥140°) and urethral rotation ＜45°.There were 26 cases with type Ⅱ,bladder neck was lower than inferoposterior margin of the symphysis pubis,cystocele with open retrovesical angle (≥140°) and urethral rotation ≥45°.There were 4 cases with type Ⅲ,bladder was lower than inferoposterior margin of the symphysis pubis,cystocele with intact retrovesical angle (＜ 140°) and urethral rotation ≥45°.Conclusions The transperineal ultrasound can be used for classification of cystocele in female patients and which may provide more reliable information for clinical diagnosis. Key words: Ultrasonography ; Cystocele

Objective To investigate effects of macrosomia on the incidence of early pelvic floor dysfunction (PFD) in puerperae. Methods A total of 301 primiparae who had full-term pregnancy and vaginal delivery, and evaluated the pelvic floor function after 6-8 weeks postpartum from March to December 2014 in Affliated Hospital of Hubei University of Medicine, Xiangyang No.1 People′s Hospital, were chosen as research subjects. According to birth weight of newborns, they were divided into study group (n=145, macrosomia delivery, birth weight ≥4 000 g) and control group (n=156, normal weight fetus delivery, 3 000 g≤ birth weight<4 000 g). The general clinical data, the proportion of normal pelvic floor muscle strength, fatigue degree and vaginal dynamic pressure, incidence rates of postpartum stress urinary incontinence (SUI) and pelvic organ prolapse (POP), and the results of maternal perineal ultrasonography were all statistically compared between two groups of puerperae by independent-samples t test or chi-square test. The study protocol was approved by the Ethics Committee of Affliated Hospital of Hubei University of Medicine, Xiangyang No.1 People′s Hospital, and informed consents were obtained and signed by participants. Results ① There were no significant differences between two groups of puerperae in general clinical data such as maternal age, body mass index before pregnancy, incidence rates of prolonged labor and perineal episiotomy, family monthly income, etc. (P>0.05). ②The proportions of normal pelvic floor typeⅠ and Ⅱ muscle fibers strength of puerperae were 9.7% and 11.0% in study group, and 19.2% and 21.2% in control group, respectively; The proportions of normal pelvic floor type Ⅰ and Ⅱ muscle fibers fatigue degrees of puerperae were 15.9% and 11.7% in study group, and 30.8% and 26.3% in control group, respectively; The proportions of normal vaginal dynamic pressure of puerperae were 31.0% in study group and 81.4% in control group, respectively. The above mentioned proportions of indexes of puerperae in study group were all lower than those in control group, and all the differences were statistically significant (χ2=5.521, P=0.019; χ2=5.646, P=0.017; χ2=9.265, P=0.002; χ2=10.238, P=0.001; χ2=77.873, P<0.001). ③The incidence rates of SUI, anterior and posterior vaginal walls prolapse of puerperae in study group (9.0%, 27.6%, 25.5%) were all higher than those in control group (2.6%, 11.5%, 10.3%), and the differences were statistically significant (χ2=5.779, P=0.016; χ2=12.441, P<0.001; χ2=12.064, P=0.001). ④The results of perineal ultrasonography in 38 cases of puerperae in study group and 40 cases of puerperae in control group showed that incidence rates of POP, the distance of downward dislocation of bladder neck and urethral metastatic angle during Valsalva movement, and the levator ani muscle hole area during calm state, anal contraction and Valsalva movements in study group [68.4%, (28.4±5.8) mm, (46.2±16.3)°, (15.1±3.5) mm2, (13.6±1.6) mm2, (22.9±5.2) mm2] were all higher, wider or larger than those in control group [40.0%, (6.4±4.4) mm, (19.3±13.2)°, (12.9±3.4) mm2, (11.1±2.3) mm2, (14.3±2.8) mm2], and the differences were statistically significant (χ2=6.334, P=0.012; t=18.930, P<0.001; t=8.029, P<0.001; t=2.816, P=0.006; t=5.545, P<0.001; t=9.157, P<0.001). Conclusions Macrosomia can reduce pelvic floor muscle strength and vaginal dynamic pressure of puerperae, increase muscle fatigue degree, which resulting in SUI and POP in postpartum. Mild PFD and injuries of levator ani muscle should be detected by postpartum three dimensional ultrasonography. Key words: Fetal macrosomia; Pregnancy; Parturition; Urinary incontinence, stress; Pelvic organ prolapse; Muscle fatigue; Puerpera

Objective: To probe the effect of multiple pregnancy on pelvic floor function of pregnant women, Pelvic floor ultrasonography was performed on the 42 day postpartum women.And the bladder neck mobility, bladder and urethral posterior angle and pelvic diaphragmatic hiatus area were measured. Methods: Collect 200 cases 42 day postpartum women who visited the second hospital of Jilin University from July 2015 to June 2017, of which 100 cases of primipara belong to group A, 100 cases of multiple pregnancy belong to group B, and 100 cases without maternal at the same age belong to the control group, ultrasound measurement of the bladder neck mobility, bladder and urethral posterior angle and pelvic diaphragmatic hiatus area were measured.t test were proformed respectively between the three groups, P<0.05 was considered statistically significant difference. Results: In the control group, the bladder neck mobility is (2.59±0.51) cm , the bladder neck mobility in A group is (2.99±0.69) cm, the bladder neck mobility in B group is (3.36±0.71) cm; the bladder and urethral posterior angle in the control group is (112.56±13.61)°, the bladder and urethral posterior angle in the control group after Valsalva action angle is(135.37±12.17)°, the bladder and urethral posterior angle in A group is(119.26±15.80)°, the bladder and urethral posterior angle in group A after Valsalva action is(141.79±12.08)°, the bladder and urethral posterior angle in B group is(123.62±16.20)°, the bladder and urethral posterior angle in group B after Valsalva action is (148.92±13.60)°; the pelvic diaphragmatic hiatus area in the control group is (13.35±2.86) cm(2,) the pelvic diaphragmatic hiatus area in the control group after Valsalva action is(15.28±3.15) cm(2,) the pelvic diaphragmatic hiatus area in A group is(17.52±3.19) cm(2,) the pelvic diaphragmatic hiatus area in A group ater Valsalva action is (18.06±5.13_the pelvic diaphragmatic hiatus area) cm(2,) the pelvic diaphragmatic hiatus area in B group is (18.26±4.18) cm(2,) the pelvic diaphragmatic hiatus area in B group after Valsalva action is (20.3±3.53) cm(2).In group A, group B and the control group, the measured value of the bladder neck mobility, bladder and urethral posterior angle and pelvic diaphragmatic hiatus area were examined by t test, and P<0.05, which means the difference was statistically significant. Conclusion: Pregnancy can affect the function of female pelvic floor, and the effect of parturient is more significant than that of the primipara.