ABSTRACT
Objective:To explore the effect of different intensity electrical stimulation combined with biofeedback pelvic floor muscle training on postpartum pelvic floor dysfunction (PFD) in vaginal delivery patients.Methods:Seven hundred and twenty patients with PFD after vaginal delivery from January 2017 to April 2019 in Jinshan Branch of Shanghai Sixth People′s Hospital were selected. The patients were divided into control group (358 cases) and observation group (362 cases) by random digits table method. The control group was treated with conventional electric stimulation combined with biofeedback pelvic floor muscle training, and the observation group was treated with enhanced electric stimulation combined with biofeedback pelvic floor muscle training. The electrophysiological indexes of pelvic floor, incidence of stress urinary incontinence (SUI), pelvic organ prolapse/urinary incontinence function questionnaire (PISQ-12) score and the 6 measurement points of quantitative stage of pelvic organ prolapse (POP-Q) staging method after treatment were compared between 2 groups. The 6 measuring points were 3 cm from central line of anterior wall of vagina to edge of the hymen (Aa point), furthest point in the upper part of anterior wall of vagina between top of vagina or anterior vault to Aa point (Ba point), 3 cm point from central line of vaginal posterior wall to hymen (Ap point), farthest point of posterior vaginal vault or upper part of posterior vaginal wall from top of vagina to Ap point (Bp point), farthest point of the top of vagina after cervix or hysterectomy (C point) and position of posterior fornix in presence of cervix (D point).Results:The fatigue degree of class Ⅰ muscle fibers, fatigue degree of class Ⅱ muscle fibers, average electromyography value of pre rest, average electromyography value of slow muscle, average electromyography value of post rest, maximum electromyography value of fast muscle and dynamic vaginal pressure in observation group were significantly better than those in control group: (- 2.51 ± 0.22)% vs. (- 3.29 ± 0.37)%, (- 2.89 ± 0.27)% vs. (- 3.18 ± 0.32)%, (3.41 ± 0.39) μV vs. (2.91 ± 0.28) μV, (30.12 ± 0.22) μV vs. (28.29 ± 0.37) μV, (3.14 ± 0.55) μV vs. (2.51 ± 0.30) μV, (39.89 ± 0.27) μV vs. (38.18 ± 0.32) μV and (76.92 ± 28.18) cmH 2O(1 cmH 2O=0.098 kPa) vs. (69.10 ± 30.66) cmH 2O, and there were statistical differences ( P<0.01). The incidence of SUI and PISQ-12 score in observation group were significantly lower than those in control group: 14.36% (52/362) vs. 27.09% (97/358) and (28.49 ± 3.61) scores vs. (37.62 ± 3.83) scores, and there were statistical differences ( P<0.01). The Aa, Ba, Ap and C points in observation group were significantly improved than those in control group: (- 2.69 ± 0.21) cm vs. (- 2.38 ± 0.13) cm, (- 2.30 ± 0.52) cm vs. (- 2.21 ± 0.33) cm, (- 2.91 ± 0.35) cm vs. (- 2.85 ± 0.24) cm and (- 5.33 ± 065) cm vs. (- 5.20 ± 056) cm, and there were statistical differences ( t=2.365, 2.469, 2.691 and 2.889; P<0.05); there were no statistical differences in Bp and D points between 2 groups ( P>0.05). Conclusions:After vaginal delivery, the patients with PFD who use strong electric stimulation combined with biofeedback pelvic floor muscle training can significantly improve the pelvic floor electrophysiological index and POP-Q staging, reduce the incidence of SUI, and improve the quality of sexual life.
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Objective To explore the value of cervical lesions screened with white acetate solution. Methods Four hundred and eighty-five patients who were suspected with cervical lesion during Janurary to March 2016 were enrolled in this study. The patients were asked about the medical history, filled the registration form, and performed routine gynecological examinations with white acetate solution, thinprep cytology test (TCT) and vaginal endoscopic biopsy. The value of white acetate solution in clinic was assessed. Results In 485 patients, 450 patients (92.78%) were pathologically diagnosed of inflammation (92.78%), 24 patients (4.95%) were diagnosed of low-grade squamous intraepithelial lesion (LSIL), 10 patients (2.06%)were diagnosed of high-grade squamous intraepithelial lesion (HSIL), and one patient (0.21%) was diagnosed of cervical cancer. The detection rate of white acetate solution and TCT were gradually increased with the increase of the degree of cervical lesions. The detection rate of white acetate solution in the inflammation was 1.33%, in LSIL was 91.67%, in HSIL was 9/10, and in cervical cancer was 1/1. The detection rate of TCT in the inflammation was 8.44%, in LSIL was 66.67%, in HSIL was 6/10, and in cervical cancer was 1/1. The sensitivity, specificity and coincidence rate of the diagnostic results with white acetate solution were 84.21%, 99.33%, 98.14%, and with TCT were 62.30%, 93.63%, 89.69%. There were significant differences (P<0.05). Conclusions Cervical lesions screened with white acetate solution is good in sensitivity and specificity, which is an effective way for screening cervical cancer.
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Objective To analyze the effect on reproductive potential of salpingectomy in child-bearing period women.Methods Two hundred and forty-six tubal pregnancy patients were chosen,among whom 164 patients performed salpingectomy were classified as research group,and 82 patients retained ipsilateral tubal through conservative treatment were classified as control group.The levels of sex hormone,ovarian volume,sinus number of follicle,ovulation rate,reproductive outcome and reproductive status were compared between 2 groups.Seven patients were lost in research group,and 3 patients were lost in control group.Results One,three and six months after β-human chorionic gonadotrophin (β-hCG) put back,the serum levels of follicle stimulating hormone (FSH),luteinizing hormone (LH) in research group were significantly higher than those in control group,FSH:(10.00 ±4.82) U/L vs.(6.69 ± 2.71) U/L,(9.11 ± 3.77)U/L vs.(6.81 ± 2.80) U/L,(8.30 ± 3.49) U/L vs.(6.41 ± 2.41) U/L;LH:(8.74 ± 3.56) U/L vs.(6.10 ± 2.59)U/L,(9.42 ± 3.09) U/L vs.(5.79 ± 2.10) U/L,(7.96 ± 2.53) U/L vs.(6.50 ± 2.71) U/L,and there were statistical differences (P ＜ 0.05).One and three months after β-hCG put back,the serum levels of estradiol (E2) and anti-Mullerian hormone (AMH) in research group were significantly lower than those in control group,E2:(111.44 ± 22.24) pmol/L vs.(128.22 ± 24.01) pmol/L,(108.74 ± 21.67) pmol/L vs.(126.30 ± 23.78) pmol/L;AMH:(3.22 ± 0.85) μ g/L vs.(3.64 ± 0.87) μ g/L,(3.67 ± 0.94) μ g/L vs.(3.83 ± 1.12) μ g/L,and there were statistical differences (P ＜ 0.05).Six months after β-hCG put back,there was no statistical difference in the serum levels of E2 and AMH:(127.85 ± 24.42) pmol/L vs.(131.28 ± 25.54) pmol/L and (4.35 ± 1.34) μ g/L vs.(4.47 ± 1.76) μ g/L,P ＞ 0.05.In salpingectomy patients,the ovarian volume and the sinus number of follicle at lesion side (salpingectomy side) after treatment of 6 months were significantly lower than those in no lesion side:(8.86 ± 2.36) cm3 vs.(9.74 ± 2.31) cm3 and (5.10 ± 1.14) pieces vs.(7.26 ± 2.52) pieces,and there were statistical differences (P ＜ 0.05).After treatment of 2 years,the rate of ectopic pregnancy in control group was significantly higher than that in research group:12.66％ (10/79) vs.5.10％(8/157),and there was statistical difference (P ＜ 0.05).Especially,the patients who retained ipsilateral tubal conservative treatment had higher ectopic pregnancy rate:8.86％ (7/79) vs.0,and there was statistical difference (P ＜ 0.05).Conclusions Salpingectomy can affect the reproductive potential,but it can decrease the probability of ectopic pregnancy.Whether patients with tubal pregnancy need to be treated by salpingectomy,depends on the extent of tubal lesions and fertility desire of the patients.