三维超声评估妊娠期糖尿病对初产妇产后早期盆底功能的影响

Three Dimensional Ultrasound Evaluation of the Effect of Diabetes in Pregnancy on the Pelvic Floor Function of Primipara in the Early Postnatal Period

摘要: 目的：探究三维超声评估妊娠期糖尿病(GDM)对初产妇产后早期盆底功能的影响。方法：选取2022年6月至2023年12月于产后6~13周于青岛大学附属医院产检的317例初产妇临床资料开展回顾性分析，根据GDM发生情况分为GDM组(75例)、非GDM组(242例)。所有研究对象产后均接受盆底超声评估，比较两组一般资料、盆底功能与并发症的差异。结果：两组在产后时间、妊娠32周胎儿双顶径、头围、腹围、孕周、产妇身高、体重、产时出血量、新生儿体重、产后漏尿、便秘、巨大儿方面比较差异无统计学意义(P > 0.05)，而GDM组的年龄、孕前及产前BMI均大于非GDM组(P < 0.05)，孕期体重增长显著小于非GDM组(P < 0.01)。GDM组接受剖宫产的机率更高。两组在静息状态尿道倾斜角、膀胱最低点至参考线距离、Vasalva状态尿道倾斜角、膀胱尿道后角、尿道旋转角、膀胱最低点至参考线距离、膀胱颈移动度、肛提肌裂孔面积比较差异无统计学意义(P > 0.05)，但GDM组静息状态膀胱后角低于非GDM组(P < 0.05)。两组在尿道内口漏斗形成、膀胱颈移动度增大、膀胱膨出、膀胱后角开放、会阴体过度运动、肛提肌裂孔面积增大、子宫脱垂、直肠膨出、肛体肌损伤方面的发生率比较差异无统计学意义(P > 0.05)，但两组膀胱膨出、膀胱颈移动度增大、肛提肌裂孔面积增大的发生率均较高(≥60%)。结论：GDM不会对初产妇产后早期盆底功能产生显著负面影响，三维超声评估可充分反映盆底功能与结构改变。

Abstract: Objective: To explore the effect of diabetes mellitus (GDM) in pregnancy on the pelvic floor function of primiparas in the early postnatal period. Methods: The clinical data of 317 primigravid women who underwent obstetric examination in Affiliated Hospital of Qingdao University from June 2022 to December 2023 at 6~13 weeks postpartum were selected for retrospective analysis, and were divided into GDM group (75 cases) and non-GDM group (242 cases) according to the occurrence of GDM. All study subjects received pelvic floor ultrasound evaluation after delivery, and the differences in general information, pelvic floor function and complications between the two groups were compared. Results: There was no significant difference between the two groups in postpartum time, fetal biparietal diameter, head circumference, abdominal circumference, gestational age, maternal height, weight, intrapartum hemorrhage, neonatal weight, postpartum urine leakage, constipation and macrosomia (P > 0.05). In GDM Group, the age, pre-pregnancy and prenatal BMI were higher than those in non-GDM group (P < 0.05), and the weight gain during pregnancy was significantly lower than that in non-GDM group (P < 0.01). The GDM group had a higher rate of cesarean section. There was no significant difference between the two groups in terms of resting urethral tilt angle, bladder nadir to reference line distance, Vasalva urethral tilt angle, posterior bladder urethral angle, urethra rotation angle, bladder nadir to reference line distance, bladder neck mobility and levator ani muscle hiatus area (P > 0.05), but the bladder posterior angle in GDM group was lower than that in non-GDM group (P < 0.05). There was no significant difference between the two groups in the incidence of infundibulum formation, bladder neck mobility, bladder bulge, bladder posterior angle opening, perineal overmovement, levator ani muscle hiatus area enlargement, uterine prolapse, rectocele and anal muscle injury (P > 0.05). However, the incidences of bladder bulge, bladder neck mobility and the area of levator ani muscle fissure were higher in both groups (≥60%). Conclusion: GDM does not have a significant negative effect on pelvic floor function in the early postpartum period in primiparas women, and three-dimensional ultrasound assessment can adequately reflect the functional and structural changes of the pelvic floor.