Clinical effect of electrical stimulation combined with biofeedback pelvic floor muscle training on postpartum pelvic floor dysfunction / 中国医师进修杂志

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.