Abstract: Background　The effects of pelvic floor muscle training（PFMT） during pregnancy have been explored mainly in rigorous randomized controlled trials（RCTs），which may be difficult to be derived from real-world clinical practice.Real-world studies can reveal the treatment status and effect in clinical practice，which further test，expand or supplement the results of RCTs，providing real-world evidence for clinical practice.Objective　To investigate the status of PFMT during pregnancy，and its effect on the morphology of levator ani muscle in real-world clinical settings.Methods　From July 2016 to February 2017，a total of 521 pregnant women in their first or second trimester were enrolled from two hospitals in Shenzhen by convenience sampling.The participants' general information and performance of PFMT were collected by a self-administered questionnaire developed by us.The morphology of levator ani muscle 〔hiatal area at rest （HAR），and at Valsalva maneuver （HAV），difference between HAR and HAV （HAD） 〕were examined by three-dimensional transperineal ultrasound.Results　The proportions of women never，occasionally and regularly performing PFMT during pregnancy were 81.38% （424/521），12.28% （64/521） and 6.34%（33/521），respectively.The performance of PFMT showed significant differences in pregnant women by age and abortion history（P<0.05）.A larger HAR，HAV or HAD was found in those with urinary incontinence instead of those without （P<0.05）.Those with abortion history had a larger HAV than those without （P<0.05）.Multiple linear regression analysis showed that there was no significant association between HAR and PFMT during pregnancy 〔occasionally performed （t=-1.565，P=0.118），regularly performed （t=1.022，P=0.307）〕.And HAV had no association with PFMT during pregnancy〔occasionally performed （t=-1.558，P=0.120），regularly performed （t=-0.259，P=0.795）〕.HAD also showed no association with PFMT during pregnancy〔occasionally performed （t=-0.734，P=0.463），regularly performed （t=-1.436，P=0.152）〕.After propensity scoring adjustment，HAR still showed no significant association with PFMT during pregnancy，either performed occasionally（t=-1.514，P=0.131） or regularly（t=1.100，P=0.272）.HAV also still had no significant association with PFMT during pregnancy，either performed occasionally（t=-1.495，P=0.136） or regularly（t=-0.168，P=0.866）.Likewise，HAD demonstrated no significant association with PFMT during pregnancy，either performed occasionally（t=-0.735，P=0.463） or regularly（t=-1.358，P=0.175）.Conclusion　In our study，only 18.61%（97/521）of women performed PFMT during pregnancy，indicating that the implementation of PFMT in this group was not optimistic.Due to low rate of performing PFMT and lack of guarantee of the accuracy of PFMT，no significant effect of PFMT on the morphology of levator ani muscle was found.

Key words: Pelvic floor muscle training, Pregnancy, Levator ani muscle, Hiatal area, Real world research

摘要： 背景　目前探究妊娠期盆底肌训练（PFMT）的效果研究大多基于严格的随机对照试验（RCT），其结果外推到临床实际存在一定的局限性。真实世界研究（RWR）能够反映临床真实情况和效果，是对RCT的进一步验证和拓展补充，可为临床实践提供更为真实的证据。目的　了解临床真实环境中孕妇妊娠期PFMT的实施情况，探讨自发性PFMT对孕妇肛提肌形态的影响。方法　利用便利抽样的方法选取2016年7月—2017年2月于深圳地区某两家医院进行盆底三维超声检查的521例孕早、中期妇女为研究对象。采用自编调查问卷收集孕妇的一般资料和妊娠期PFMT实施情况。采用经会阴盆底三维超声测量孕妇肛提肌形态指标〔静息状态下肛提肌裂孔面积（HAR）、Vasalva状态下肛提肌裂孔面积（HAV）与两种状态下肛提肌裂孔面积的差值（HAD）〕。结果　521例孕妇中没有实施过妊娠期PFMT 424例（81.38%），偶尔实施妊娠期PFMT 64例（12.28%），经常实施妊娠期PFMT 33例（6.34%）。不同年龄、流产史孕妇妊娠期PFMT实施情况比较，差异有统计学意义（P<0.05）。有妊娠期尿失禁孕妇HAR、HAV、HAD大于无妊娠期尿失禁孕妇（P<0.05）；有流产史孕妇HAV大于无流产史孕妇（P<0.05）。多元线性回归分析结果显示，妊娠期PFMT实施情况与孕妇HAR〔偶尔实施妊娠期PFMT（t=-1.565，P=0.118），经常实施妊娠期PFMT（t=1.022，P=0.307）〕、HAV〔偶尔实施妊娠期PFMT（t=-1.558，P=0.120），经常实施妊娠期PFMT（t=-0.259，P=0.795）〕、HAD〔偶尔实施妊娠期PFMT（t=-0.734，P=0.463），经常实施妊娠期PFMT（t=-1.436，P=0.152）〕无关。经倾向性评分法校正后多元线性回归分析结果显示，妊娠期PFMT实施情况与孕妇HAR〔偶尔实施妊娠期PFMT（t=-1.514，P=0.131），经常实施妊娠期PFMT（t=1.100，P=0.272）〕、HAV〔偶尔实施妊娠期PFMT（t=-1.495，P=0.136），经常实施妊娠期PFMT（t=-0.168，P=0.866）〕、HAD〔偶尔实施妊娠期PFMT（t=-0.735，P=0.463），经常实施妊娠期PFMT（t=-1.358，P=0.175）〕无关。结论　在真实临床环境中，仅有18.61%（97/521）的孕妇在妊娠期实施过PFMT，孕妇妊娠期PFMT实施情况不容乐观。孕妇自发进行的妊娠期PFMT剂量低且无法保证正确性，尚未显现出对肛提肌形态的影响。

关键词: 盆底肌训练, 妊娠期, 肛提肌, 裂孔面积, 真实世界研究