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Abstract：
BACKGROUND: This study aimed to explore the association of the second birth delivery mode and interval with maternal pelvic floor changes.
METHODS: This prospective cohort study included women who had a first delivery and were in weeks 36-41 of a subsequent pregnancy at Panzhihua Central Hospital between July 2017 and June 2018. The primary outcomes of the study were the hiatus area at 6 months postpartum and bladder neck (mm) at rest and during a maximum Valsalva maneuver.
RESULTS: There were 112 women with vaginal delivery and 182 with Cesarean section. The hiatus area and hiatus circumference decreased at all time points (all P < 0.001). The women with Cesarean section had a smaller hiatus area and circumference (P < 0.001 and P < 0.001). The hiatus diameters decreased with time in both groups (all P < 0.001) and were smaller after Cesarean section (both P < 0.001). The bladder neck at maximum Valsalva increased with time (all P < 0.001) without significant differences between the two groups. Finally, the proportion of patients with POP-Q stage 0/I increased with time in both groups (all P < 0.001), with the proportions being higher in the Cesarean group (P = 0.002). The birth interval was negatively correlated with the hiatus area (B=-0.17, 95%CI: -0.25, -0.08, P < 0.001) and positively correlated with the bladder neck at rest (B = 0.22, 95%CI: 0.08, 0.35, P = 0.001) and at maximum Valsalva (B = 0.85, 95%CI: 0.65, 1.05, P < 0.001).
CONCLUSIONS: In conclusion, the mode of delivery at the second birth could influence the hiatus area and circumference and bladder neck size. The birth interval was negatively correlated with the hiatus area and positively correlated with the bladder neck at rest and at maximum Valsalva.
METHODS: This prospective cohort study included women who had a first delivery and were in weeks 36-41 of a subsequent pregnancy at Panzhihua Central Hospital between July 2017 and June 2018. The primary outcomes of the study were the hiatus area at 6 months postpartum and bladder neck (mm) at rest and during a maximum Valsalva maneuver.
RESULTS: There were 112 women with vaginal delivery and 182 with Cesarean section. The hiatus area and hiatus circumference decreased at all time points (all P < 0.001). The women with Cesarean section had a smaller hiatus area and circumference (P < 0.001 and P < 0.001). The hiatus diameters decreased with time in both groups (all P < 0.001) and were smaller after Cesarean section (both P < 0.001). The bladder neck at maximum Valsalva increased with time (all P < 0.001) without significant differences between the two groups. Finally, the proportion of patients with POP-Q stage 0/I increased with time in both groups (all P < 0.001), with the proportions being higher in the Cesarean group (P = 0.002). The birth interval was negatively correlated with the hiatus area (B=-0.17, 95%CI: -0.25, -0.08, P < 0.001) and positively correlated with the bladder neck at rest (B = 0.22, 95%CI: 0.08, 0.35, P = 0.001) and at maximum Valsalva (B = 0.85, 95%CI: 0.65, 1.05, P < 0.001).
CONCLUSIONS: In conclusion, the mode of delivery at the second birth could influence the hiatus area and circumference and bladder neck size. The birth interval was negatively correlated with the hiatus area and positively correlated with the bladder neck at rest and at maximum Valsalva.
摘要：
背景：本研究旨在探讨第二胎分娩方式和间隔与产妇盆底变化的关系。
方法：这项前瞻性队列研究包括2017年7月至2018年6月在攀枝花市中心医院首次分娩并在随后妊娠第36-41周的妇女。研究的主要结果是产后6个月的裂孔面积和休息时和最大Valsalva动作期间的膀胱颈（mm）。
结果：阴道分娩112例，剖宫产182例。在所有时间点，裂孔面积和裂孔周长均降低（均P<0.001）。剖宫产妇女的裂孔面积和周长较小（P<0.001和P<0.001）。两组的裂孔直径均随时间减小（均P<0.001），剖宫产后裂孔直径均较小（均P<0.001）。最大Valsalva时的膀胱颈随时间增加（所有P<0.001），两组之间没有显着差异。最后,两组POP-Q分期为0/I的患者比例均随时间增加(均P<0.001),剖宫产组的比例较高（P=0.002）。出生间隔与裂孔面积呈负相关（B=-0.17，95CI：-0.25，-0.08，P<0.001），与静息时膀胱颈呈正相关（B=0.22，95CI：0.08，0.35，P=0.001），最大Valsalva时呈正相关（B=0.85，95CI：0.65，1.05，P<0.001）。
结论：结论：第二胎的分娩方式可能会影响裂孔面积和周长以及膀胱颈的大小。出生间隔与裂孔面积呈负相关，与休息时和最大Valsalva时的膀胱颈呈正相关。
方法：这项前瞻性队列研究包括2017年7月至2018年6月在攀枝花市中心医院首次分娩并在随后妊娠第36-41周的妇女。研究的主要结果是产后6个月的裂孔面积和休息时和最大Valsalva动作期间的膀胱颈（mm）。
结果：阴道分娩112例，剖宫产182例。在所有时间点，裂孔面积和裂孔周长均降低（均P<0.001）。剖宫产妇女的裂孔面积和周长较小（P<0.001和P<0.001）。两组的裂孔直径均随时间减小（均P<0.001），剖宫产后裂孔直径均较小（均P<0.001）。最大Valsalva时的膀胱颈随时间增加（所有P<0.001），两组之间没有显着差异。最后,两组POP-Q分期为0/I的患者比例均随时间增加(均P<0.001),剖宫产组的比例较高（P=0.002）。出生间隔与裂孔面积呈负相关（B=-0.17，95CI：-0.25，-0.08，P<0.001），与静息时膀胱颈呈正相关（B=0.22，95CI：0.08，0.35，P=0.001），最大Valsalva时呈正相关（B=0.85，95CI：0.65，1.05，P<0.001）。
结论：结论：第二胎的分娩方式可能会影响裂孔面积和周长以及膀胱颈的大小。出生间隔与裂孔面积呈负相关，与休息时和最大Valsalva时的膀胱颈呈正相关。
