Objectives: Pelvic floor dysfunction (PFD) seriously affects women's physical and mental health. Pregnancy and childbirth are recognized as high-risk factors for PFD, and studies have shown that vaginal microenvironmental disorders can promote the development of pelvic organ prolapse. In this study, we intend to investigate whether the changes in vaginal microecology during pregnancy affect the pelvic floor function and participate in the development of postpartum PFD, and provide a basis for the prevention and treatment of PFD.
Methods: A total of 358 full-term mothers who delivered in Third Xiangya Hospital, Central South University from November 2019 to April 2020 were selected and underwent review 6 to 8 weeks after delivery. The pelvic floor structures were examined using pelvic floor ultrasound, and ultrasound values were measured at rest and at maximum Valsalva maneuver. One hundred and seventy women with PFD were assigned in a PFD group, and 188 women without PFD were assigned in a control group. The clinical data of all mothers were collected, and the clinical data and the results of microecological testing for vaginal secretions after 36 weeks of gestation and before delivery were compared between the 2 groups. The correlation of PFD with leucorrhoea cleanliness, lactobacillus level, bacterial vaginosis (BV), and vulvovaginal candidiasis (VVC) was analyzed, and logistic regression analysis was used to screen for independent risk factors for PFD.
Results: The incidences of VVC, BV, Lactobacillus vaginalis deficiency, and leucorrhoea cleanliness ≥III° were all higher in the PFD group than those in the control group (P<0.05). Among them, leukocyte cleanliness ≥III°and lack of Lactobacilli in the vagina were independent risk factors for the development of PFD, while VVC and BV were not independent risk factors for the development of PFD.
Conclusions: Postpartum PFD is related to vaginal microecological imbalance in late pregnancy, among which Lactobacillus vaginalis deficiency and leucorrhoea cleanliness ≥III° are independent risk factors for the occurrence of PFD. Therefore, pregnant women with Lactobacillus vaginalis deficiency and leucorrhoea cleanliness ≥III° in late pregnancy should pay attention to the occurrence of postpartum PFD, and early diagnosis and effective intervention of postpartum PFD should be enhanced.
目的: 盆底功能障碍(pelvic floor dysfunction，PFD)严重影响女性的身心健康，妊娠和分娩是公认的PFD的高危因素，阴道微环境紊乱可以促进盆腔脏器脱垂的发展。妊娠期女性各器官、系统及阴道微生态系统均会发生一系列改变，本研究拟探讨妊娠期阴道微生态的改变是否影响盆底功能和产后PFD的发生，为PFD的预防及治疗提供依据。方法: 选取2019年11月至2020年4月在中南大学湘雅三医院分娩的足月产妇358例，产后6~8周使用盆底超声检查盆底结构，测量静息及最大Valsalva动作下的超声数值，存在PFD的170例产妇为PFD组，无PFD的188例为对照组。收集所有产妇的临床资料，比较2组产妇的临床资料及妊娠36周至产前的阴道分泌物微生态检测结果，分析PFD与白带清洁度、乳酸杆菌含量、细菌性阴道病(bacterial vaginosis，BV)、外阴阴道假丝酵母菌病(vulvovaginal candidiasis，VVC)等的相关性，并采用logistic回归分析法筛查PFD的独立危险因素。结果: PFD组VVC及BV发生率、阴道内乳酸杆菌缺乏率、白带清洁度≥III°发生率均高于对照组(均P<0.05)；其中白带清洁度≥III°和阴道内乳酸杆菌缺乏是PFD发生的独立危险因素，而VVC和BV不是PFD发生的独立危险因素。结论: 产后PFD与妊娠晚期阴道微生态失衡有关，其中阴道内乳酸杆菌缺乏、白带清洁度≥III°是PFD发生的独立危险因素，因此应警惕妊娠晚期白带清洁度≥III°、阴道内乳酸杆菌缺乏的孕妇产后PFD的发生，应加强产后PFD的早期诊断和有效干预。.
目的: 盆底功能障碍(pelvic floor dysfunction，PFD)严重影响女性的身心健康，妊娠和分娩是公认的PFD的高危因素，阴道微环境紊乱可以促进盆腔脏器脱垂的发展。妊娠期女性各器官、系统及阴道微生态系统均会发生一系列改变，本研究拟探讨妊娠期阴道微生态的改变是否影响盆底功能和产后PFD的发生，为PFD的预防及治疗提供依据。
方法: 选取2019年11月至2020年4月在中南大学湘雅三医院分娩的足月产妇358例，产后6~8周使用盆底超声检查盆底结构，测量静息及最大Valsalva动作下的超声数值，存在PFD的170例产妇为PFD组，无PFD的188例为对照组。收集所有产妇的临床资料，比较2组产妇的临床资料及妊娠36周至产前的阴道分泌物微生态检测结果，分析PFD与白带清洁度、乳酸杆菌含量、细菌性阴道病(bacterial vaginosis，BV)、外阴阴道假丝酵母菌病(vulvovaginal candidiasis，VVC)等的相关性，并采用logistic回归分析法筛查PFD的独立危险因素。
结果: PFD组VVC及BV发生率、阴道内乳酸杆菌缺乏率、白带清洁度≥III°发生率均高于对照组(均P<0.05)；其中白带清洁度≥III°和阴道内乳酸杆菌缺乏是PFD发生的独立危险因素，而VVC和BV不是PFD发生的独立危险因素。
结论: 产后PFD与妊娠晚期阴道微生态失衡有关，其中阴道内乳酸杆菌缺乏、白带清洁度≥III°是PFD发生的独立危险因素，因此应警惕妊娠晚期白带清洁度≥III°、阴道内乳酸杆菌缺乏的孕妇产后PFD的发生，应加强产后PFD的早期诊断和有效干预。
Keywords: Lactobacillus vaginalis deficiency; leucorrhoea cleanliness; pelvic floor dysfunctional disorders; risk factors.