Objective To investigate the value of pelvic floor ultrasound in primiparas in 6~8 weeks after delivery.Methods From May 2014 to August 2016,pelvic floor ultrasound was performed in 335 consecutive primiparas who visited the Outpatient Department of the Third Affiliated Hospital,Sun Yat-sen University in 6-8 weeks after delivery.The bladder neck position,and bladder neck mobility,retrovesical angle,urethral rotation angle,area of levator hiatus and cervical perigee were assessed at rest and maximum Valsalva maneuver,and the ultrasound findings were summarized.According to the criterion of bladder bulging, they were divided into normal group, type Ⅰ bladder bulging group, type Ⅱ bladder bulging group and type Ⅲ bladder bulging group.Results Twelve women were excluded from the study because they failed to exhale with maximum effort (Valsalva maneuver),the rest 323 were recruited.The bladdler neck position,retrovesical angle,area of levator hiatus,cervical perigee at rest was(27.8±3.7)mm,(109.5°±20.4°),(14.3±4.8)cm2,(33.6±6.1)mm,respectively,and those during maximum Valsalva maneuver was (5.5±9.3)mm,(133.4°±24.5°),(21.7±5.7)cm2,and (25.4±5.6)mm,respectively.The bladder neck mobility and urethral rotation angle during maximum Valsalva maneuver was (22.7±8.5)mm,and(47.2°±21.7°),respectively.A total of 227 participants had normal ultrasound findings,96 had cystocele.Among the 96 cases,21 had gradeⅠcystocele with the manifestations:the bladder neck was lower than inferoposterior margin of the symphysis pubis,cystocele with open retrovesical angle (≥140°) and urethral rotation <45° during maximum Valsalva maneuver;57 had grade Ⅱ cystocele with the following manifestations:the bladder neck was lower than inferoposterior margin of the symphysis pubis,cystocele with open retrovesical angle (≥140°) and urethral rotation ≥45° during maximum Valsalva maneuver;18 had grade Ⅲ cystocele with the manifestations:the bladder was lower than inferoposterior margin of the symphysis pubis,cystocele with intact retrovesical angle (<140°) and urethral rotation ≥45° during maximum Valsalva maneuver.There were 18 (5.6%)women with cystocele combined with uterine prolapse,with the presentation of cervical perigee were 15 mm lower than the inferoposterior margin of the symphysis pubis during maximum Valsalva maneuver.The area of levator hiatus in each type of bladder bulging group was larger than that in normal group(P<0.05).Conclusion The pelvic floor ultrasound can correctly evaluate the bladder neck position and mobility,retrovesical angle,the urethral rotation angle,area of levator hiatus and cervical perigee at rest and maximum Valsalva maneuver in primiparas in 6-8 weeks after delivery.It also can be used for grading cystocele in postpartum women,which may provide reliable reference for clinical diagnosis and prevention of organ prolapse.%目的 探讨盆底超声在首次分娩女性产后6~8周检查中的的应用价值.方法 选择2014年5月-2016年8月在中山大学附属第三医院产后门诊就诊的首次分娩产后6~8周女性335例,采用盆底超声进行检查,观察静息状态及最大Valsalva动作时膀胱颈位置、膀胱颈活动度、膀胱后角、尿道旋转角、肛提肌裂孔面积及宫颈外口位置,分析并总结其盆底超声检查特点.根据膀胱膨出判断标准将受检者分为正常组,Ⅰ型、Ⅱ型、Ⅲ型膀胱膨出组.结果 335例受检者中有12例无法配合完成最大Valsalva动作退出研究,余323例能配合完成最大Valsalva动作.在静息状态下及最大Valsalva动作时膀胱颈位置分别为(27.8±3.7)mm、(5.5±9.3)mm,膀胱后角分别为(109.5°±20.4°)、(133.4°±24.5°),肛提肌裂孔面积分别为(14.3±4.8)cm2、(21.7±5.7)cm2,宫颈外口位置分别为(33.6±6.1)mm、(25.4±5.6)mm;最大Valsalva动作时膀胱颈活动度为(22.7±8.5)mm,尿道旋转角为(47.2°±21.7°).323例受检者中盆底超声检查无异常者227例,膀胱膨出者96例,其中Ⅰ型膀胱膨出21例,最大Valsalva动作时膀胱颈位于耻骨联合水平线以下,膀胱后角开放≥140°,尿道旋转角度<45°;Ⅱ型膀胱膨出57例,最大Valsalva动作时膀胱颈位于耻骨联合水平线以下,膀胱后角开放≥140°,尿道旋转角度≥45°;Ⅲ型膀胱膨出18例,最大Valsalva动作时膀胱位于耻骨联合水平线以下,膀胱后角完整<140°,尿道旋转角度≥45°.膀胱膨出合并子宫脱垂18例(5.6%),表现为宫颈外口最低点在Valsalva动作后耻骨联合水平线上15 mm以下.各膀胱膨出组肛提肌裂孔面积大于正常组(P<0.05).结论 盆底超声可准确评估产后女性的静息状态及最大Valsalva 动作时膀胱颈位置、膀胱颈活动度、膀胱后角、尿道旋转角度、肛提肌裂孔面积及宫颈外口位置,同时对盆腔脏器脱垂进行合理分型,对临床诊断及预防盆腔脏器脱垂具有参考价值.
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