ABSTRACT
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 χ2test 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) cm2vs (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.
ABSTRACT
Objectives To develop Z-scores reference ranges for kidney in normal fetuses from the measurements of gestational age (GA),biparietal diameter (BPD) or femur length (FL) using two-dimension ultrasound.Methods A retrospective cross-sectional study of 403 singleton normal fetuses was performed.The gestation age range was from 18 to 40 weeks.Fetal biologic parameters included GA and BPD and FL based on menstrual age.Left kidney length and left kidney width of normal fetus were measured.Normal Z-score ranges were developed for leftkidney length or left kidney width using GA,BPD and FL as independent variables.Results Linear regression model was the best description of the data in each case and correlation between left kidney length or left kidney width and independent variables were excellent (r=0.8761,0.8818,0.8797,0.8604,0.8723,0.8643).All P values were less than 0.01.The equations were as follows,Y=0.094 22 + 0.1088X,Y=0.132 57 + 0.4349X,Y=0.6664 + 0.491 05X,Y=0.060 58X-0.051 98,Y=0.262 19X-0.197 55,Y=0.294 02X + 0.136 19.Heteroscedasticity of standard deviation (s) with increasing independent variables also could be modeled with a simple linear (r=0.925,0.934,0.915,0.908,0.914,0.922),All P values were less than 0.01.The equations were as follows,Y=0.025 + 0.005 58X,Y=0.097 09 + 0.010 45X,Y=0.046 17 + 0.025 65X,Y=0.001 13 + 0.002 24X,Y=0.003 67 + 0.011 55X,Y=0.005 07 + 0.015 89X.Then we got Z-scores based on the equation,Z-score=(actual measurement data of left kidney length or left kidney width-predictive data of left kidney length or left kidney width) predictive s.Conclusions Normal reference ranges and Z-scores for fetal left kidney length and left kidney width had been provided.These normative data may be useful tools for assessment of fetal kidney length and kidney width,especially had potential applications in malformations of fetal kidney.