关键词:

妊娠期糖尿病, 28～34周, 盆底超声, 压力性尿失禁, 诊断

Abstract:

Purpose Using pelvic floor ultrasound to quantitatively evaluate the effect of gestational diabetes mellitus（GDM）on pelvic floor structure and function during 28 ~ 34 weeks，and to establish the SUI ultrasonic diagnostic index and boundary value of patientswith GDM. Methods 106 pregnant women in the third trimester of pregnancy（28 ~ 34 weeks）with GDM were selected as GDM group（50 cases in SUI subgroup and 56 cases in on SUI subgroup）. 94 healthy late pregnant women（28 ~ 34 weeks）were also selected as non GDM group. Pelvic floor ultrasonography was performed and recorded to the accordinggroups. These data were：bladder neck movement （BND），urethral inclination angle（UIA），urethral rotation angle（URA），posterior bladder urethral angle（PVUA1， PVUA2），levator anihole area（LHA1，LHA2）. The differences of ultrasonic parameters and SUI detection rate between the GDM group and non GDM group were compared.Analyse the difference of balancing BMI1 and BMI2 factors between the two groups.The differences of ultrasonic parameters between SUI subgroup and non SUI sub⁃ group were also compared. Analyse the differences between the two groups of balancing pregnancy，delivery and gestational weeks. Using clinical diagnosis SUI value as the“gold standard”，establish the ROC curve of pelvicfloor ultrasound parameters according to the diagnosis of GDM.Then，analyse its diagnosticefficacy. Results These value of BND，UIA，LHA1，LHA2 and detection rates of SUI in GDM group were significantly higher than that in non GDM group，the difference have statistically significance（P < 0.05）. After balancing BMI1 and BMI2 factors， the BND，UIA，LHA1，LHA2 and detection rates of SUI in GDM group were still higher than that in non GDMgroup，the difference have statistically significance（P < 0.05）. The value of BND，URA，LHA1 and LHA2 in SUI subgroup were significantly higher than those in non SUI subgroup，the difference have statistically significance （P < 0.05）. After balancingthe pregnancy，parity and gestational weeks factors，the value of URA，LHA1 and LHA2 in SUI subgroup was still higher than that in non SUI subgroup，the difference have statistically significance （P < 0.05）. The ROC curves of SUI in patients with GDM were further constructed，and the areas under the curves were all > 0.7. Among them，the area under LHA1 curve was the largest，and when thediagnostic value was 12.93 cm2 ， the sensitivity and specificity were 80.0% and65.7% respectively. Conclusion The support of pelvic floor struc⁃ ture in patients with GDM during 28 ~ 34 weeks is significantly weakened，especially in patients with SUI，pelvic floor ultrasound can quantitatively evaluate the changes of pelvic floor structure and function in patients with GDM. LHA1 can be used as the preliminary diagnostic index of SUI in patients with GDM during late pregnancy，and the diagnostic boundary value is 12.93 _cm2 . 

Key words:

GDM, 28～34 _weeks, pelvic floor ultrasound, SUI, diagnose