Evaluation on pelvic floor functions of primiparae in early postpartum period with different delivery modes by pelvic floor function of pelvic organ prolapse quantification

Abstract

Objective To investigate affects on the pelvic floor functions of primiparae in early postpartum period with different delivery modes by pelvic floor function of pelvic organ prolapse quantification (POP-Q) scoring system. Methods From January 1 to December 31, 2016, a total of 200 primiparae who were with single birth, full-term pregnancy and cephalic presentations in Chengdu Women and Children′s Central Hospital were chosen as study subjects by retrospective analysis method and random digits table method. According to different delivery modes, they were divided into observation group (n=100, with elective cesarean section delivery mode) and control group (n=100, with transvaginal delivery mode). All the primiparae received epidural anesthesia during labor and were managed in accordance with the Standard of New Production Process and Expert Consensus (2014). Primiparae with genital malformation, stress urinary incontinence (SUI), pelvic floor dysfunction (PFD) before pregnancy, and with internal and external severe complications were excluded from this study. At about 42 d after delivery, the incidences of SUI, 9 indicators in POP-Q scoring system, grades of vaginae anterior prolapse, vaginae posterior prolapse and uterine prolapse, muscle strength classification in Ⅰ and Ⅱ types of pelvic floor muscle fiber in two groups were detected. Independent sample t test was used to compare the results of 9 indicatons in POP-Q scoring system of two groups. Chi-square test was used to compare the incidences of SUI in early postpartum period and grade Ⅰ-Ⅲ vaginae anterior prolapse, vaginae posterior prolapse and uterine prolapse of two groups. Wilcoxon rank sum test was used to compare constituent ratios of muscle strength classification in Ⅰ and Ⅱ types of pelvic floor muscle fibers in two groups. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Chengdu Women and Children′s Central Hospital. Results ①There were no significant differences between two groups among the incidences of obstetrical complications, such as premature rupture of membranes, gestational diabetes mellitus and subclinical hypothyroidism, as well as age, body mass index (BMI) before pregnancy, weight gain during pregnancy, and birth weight of newborns, respectively (P>0.05). ②The results of POP-Q scoring system of primiparae in two groups showed as follows. The lengths of gh (genital hiatus) in observation group and control group were (2.8±0.4) cm and (3.0±0.6) cm, respectively; lengths of pb (perineal body) were (3.6±0.3) cm and (3.5±0.3) cm, respectively; tvl (total vaginal length) were (8.4±0.6) cm and (7.4±3.9) cm, respectively; point Aa (point in the anterior vaginal wall, 3 cm from hymen) were located at (-2.0±0.8) cm and (-1.3±0.8) cm, respectively; point Ba (point in the anterior vaginal prolapse, farthest from hymen) were located at (-2.1±0.8) cm and (-1.4±0.7) cm, respectively; point Bp (point in the posterior vaginal prolapse, farthest from hymen) were located at (-2.9±0.4) cm and (-2.7±0.5) cm, respectively; and all the differences between two groups in the measurement results were statistically significant (t=-2.774, P=0.006; t=2.537, P=0.019; t=-2.534, P=0.012; t=-6.187, P 0.05). ③The incidence of grade Ⅰ-Ⅲ vaginae anterior prolapse in observation group was 21.0% (21/100), which was significantly lower than that in control group 98.0% (98/100); and the incidence of grade Ⅰ-Ⅲ vaginae posterior prolapse was 13.0% (13/100), which was significantly lower than that in control group 26.0% (26/100), and both the differences were statistically significant (χ2=119.846, P 0.05). ④ There were no significant differences between two groups in the incidence of SUI in early postpartum period and constituent ratio of muscle strength classification inⅠ and Ⅱ types of pelvic floor muscle fibers (P>0.05). Conclusions As to primiparae in early postpartum period with elective cesarean section and transvaginal delivery, there are no differences in the incidences of SUI, muscle strength classification in pelvic floor muscle fibers and uterus prolapse. But the evaluation results of POP-Q scoring system show that transvaginal delivery may be the high risk factor of PFD. Key words: Pelvic organ prolapse quantification; Pelvic floor dysfunction; Stress urinary incontinence; Vaginal delivery; Elective cesarean section; Postpartum period; Primipara