精准医学杂志 (Feb 2024)
Value of perineal 3D ultrasound in assessing the morphological changes of pelvic diaphragm hiatus after vaginal delivery in primipara
Abstract
Objective To investigate the morphological changes of pelvic diaphragm hiatus after vaginal delivery in primipara by perineal 3D ultrasound and its value in predicting pelvic organ prolapse. Methods A total of 112 primipara who were admitted to our hospital and had vaginal delivery from October 2016 to February 2020 were enrolled as study group, and 84 healthy women without pregnancy and history of childbirth who underwent physical examination in our hospital during the same period of time were enrolled as control group. The two groups were compared in terms of the proportion of patients with pelvic organ prolapse, parameters of pelvic diaphragm hiatus (anteroposterior diameter, left-right diameter, and area of pelvic diaphragm hiatus), thickness of levator ani muscle, and Young’s modulus after one year follow-up. The receiver operating characteristic (ROC) curve was plotted to analyze the efficacy of various parameters in predicting pelvic organ prolapse. Results There were significant differences in each parameter of pelvic diaphragm hiatus, the thickness of levator ani muscle, and Young’s modulus of the left and right sides under the resting state, the anal contraction state, and the Valsalva state between the study group and the control group and between the prolapse subgroup and the non-prolapse subgroup (t=4.645-37.691,P<0.05). The ROC curve analysis showed that for the subjects in the study group at 6 weeks postpartum, perineal 3D ultrasound at the resting state obtained a cut-off value of 5.15 cm for the anteroposterior diameter of pelvic diaphragm hiatus, 3.45 cm for the left-right diameter of pelvic diaphragm hiatus, 14.99 cm2 for the area of pelvic diaphragm hiatus, 0.47 cm for the thickness of levator ani muscle, 22.15 kPa for Young’s modulus of the left side, and 20.05 kPa for Young’s modulus of the right side in predicting pelvic organ prolapse (P<0.05); at the anal constriction state, the cut-off values of these indices were 4.31 cm, 3.39 cm, 13.83 cm2, 0.68 cm, 31.17 kPa, and 28.34 kPa, respectively, in predicting pelvic organ prolapse (P<0.05); at the Valsalva state, the cut-off values of these indices were 5.47 cm, 4.08 cm, 16.82 cm2, 0.57 cm, 26.88 kPa, and 25.02 kPa, respectively, in predicting pelvic organ prolapse (P<0.05). Conclusion Perineal 3D ultrasound for primipara after vaginal delivery can accurately reflect the morphological changes of pelvic diaphragm hiatus and provide a reference for predicting postpartum pelvic organ prolapse in women and developing individualized rehabilitation training regimens.
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