To quantitatively assess pelvic floor structure and function changes and SUI, and to determine the ultrasonic diagnostic indices and threshold values for SUI in the early postpartum period in parturients of advanced maternal age using 2D and 3D ultrasound and real-time shear wave elastography (SWE) of the pelvic floor.

Participants were 194 puerperants who received ambulatory services in the early postpartum period (within the first 6-8 weeks after childbirth) from North China University of Science and Technology Affiliated Hospital from August 2016 to February 2021, including 105 of advanced maternal age (≥35 years old) and 89 of proper maternal age (<35 years old). SUI was determined by medical history, physical examination, urination diary and urodynamic test results and clinical diagnosis. Intergroup comparisons were conducted in terms of the detection rate of SUI, and parameters of 2D and 3D ultrasound and real-time SWE of the pelvic floor〔bladder neck position at rest (h_1BL) and tension (h_2BL), degree of mobility of bladder neck (Δh_BL), urethral inclination angle at rest (UIA₁) and tension (UIA₂), and urethral rotation angle (URA), posterior vesicourethral angle at rest (PVUA₁) and tension (PVUA₂), levator ani hiatus area at rest (LHA₁) and tension (LHA₂), elastic modulus of puborectal muscle in resting (E₁) and anal constriction state (E₂), and the difference between E₁ and E₂ (ΔE) 〕. The above-mentioned multimodal ultrasound parameters were also compared between those with SUI (n=51) and without (n=54) in the advanced maternal age group. The performance of multimodal ultrasound parameters in predicting early postpartum SUI was analyzed using the analysis of the area under the receiver operating characteristic curve (AUC), and was estimated with the accuracy of clinical diagnosis as the gold standard.

Compared to parturients of proper maternal age, those of advanced maternal age had higher h_1BL, h_2BL, Δh_BL, PVUA₁, and LHA₂, and lower bilateral E₁, E₂, and ΔE (P<0.05). Moreover, they had higher detection rate of SUI〔48.6% (51/105) vs 32.6% (29/89) 〕 (χ²=5.081, P=0.028). Parturients of advanced maternal age with SUI had greater h_1BL, h_2BL, Δh_BL, UIA₂, URA, PVUA₁, PVUA₂, LHA₁, LHA₂, and less bilateral E₁, E₂, and ΔE than those without (P<0.05). For parturients of advanced maternal age, the analysis of the receiver operating characteristic curve of multimodal ultrasound parameters predicting early postpartum SUI revealed that the AUC for h_1BL, h_2BL, Δh_BL, PVUA₁, PVUA₂, LHA₁, LHA₂, bilateral E₂, or bilateral ΔE was greater than 0.700. In particular, the AUC was greater than 0.850 for h_1BL (-2.28 cm optimal cutoff, 82.4% sensitivity, 90.2% specificity), h_2BL (-0.50 cm optimal cutoff, 83.3% sensitivity, 85.2% specificity), LHA₁ (16.79 cm² optimal cutoff, 94.1% sensitivity, 90.2% specificity), or bilateral ΔE (16.85 kPa optimal cutoff, 88.9% sensitivity, 87.0% specificity). Binary Logistic regression analysis of PRESUI=-3.691×h_2BL-0.952×LHA₁+0.675×bilateral ΔE, an algorithm with three ultrasound parameters incorporated for predicting SUI in parturients of advanced maternal age, indicated that the AUC of h_2BL in combination with LHA₁ and bilateral ΔE was 0.992〔95%CI (0.982, 0.999) 〕, with 0.571 optimal cutoff, 96.1% sensitivity and 96.3% specificity.

The early postpartum pelvic floor structure of parturients of advanced maternal age, especially those with SUI, was more relaxed than that of those of proper maternal age. Multimodal ultrasound can quantitatively evaluate the changes of early postpartum pelvic floor structure and function in parturients of advanced maternal age. h_1BL, h_2BL, LHA₁, bilateral ΔE or the combination of h_2BL, LHA₁ and bilateral ΔE could be used as an ultrasonic predictor of early postpartum SUI in this group, and the latter has higher diagnostic value.

应用盆底二维、三维超声及实时剪切波弹性成像（SWE）定量评估高龄产妇产后早期盆底结构及功能的变化，确立高龄产妇产后早期SUI的超声诊断指标及界值。

选取2016年8月至2021年2月于华北理工大学附属医院门诊就诊的产后早期（6~8周）高龄产妇（年龄≥35岁）105例为高龄组，并依据病史、体格检查结果、排尿日记、尿动力学检查结果等临床综合指标及临床诊断分为SUI亚组（51例）与非SUI亚组（54例）；选取同期来本院门诊就诊的产后早期适龄产妇（<35岁）89例为适龄组。产妇均接受多模态超声检查并记录检查结果：静息及张力状态下膀胱颈的位置及移动度（h_1BL、h_2BL、Δh_BL）、尿道倾斜角及尿道旋转角度（UIA₁、UIA₂、URA）、膀胱尿道后角（PVUA₁、PVUA₂）、肛提肌裂孔面积（LHA₁、LHA₂）、静息及缩肛状态下耻骨直肠肌弹性模量值及变化量（E₁、E₂、ΔE）。比较高龄组与适龄组多模态超声参数、SUI检出率；比较SUI亚组与非SUI亚组多模态超声参数；以临床诊断SUI为金标准，绘制多模态超声参数诊断高龄产妇产后早期SUI的受试者工作特征（ROC）曲线，计算ROC曲线下面积（AUC）。

高龄组产妇h_1BL、h_2BL、Δh_BL、PVUA₁、LHA₂均大于适龄组，E_1双侧、E_2双侧、ΔE_双侧均小于适龄组（P<0.05）。高龄组产妇中SUI检出率〔48.6%（51/105）〕高于适龄组〔32.6%（29/89）〕（χ²=5.081，P=0.028）。SUI亚组产妇h_1BL、h_2BL、Δh_BL、UIA₂、URA、PVUA₁、PVUA₂、LHA₁、LHA₂均大于非SUI亚组，E_1双侧、E_2双侧、ΔE_双侧均小于非SUI亚组（P<0.05）。绘制多模态超声参数诊断高龄产妇产后早期SUI的ROC曲线，结果显示，h_1BL、h_2BL、Δh_BL、PVUA₁、PVUA₂、LHA₁、LHA₂、E_2双侧、ΔE_双侧诊断高龄产妇产后早期SUI的AUC均>0.700，其中h_1BL、h_2BL、LHA₁、ΔE_双侧诊断高龄产妇产后早期SUI的AUC均>0.850，当最佳截断值分别为-2.28 cm、-0.50 cm、16.79 cm²、16.85 kPa时，灵敏度分别为82.4%、83.3%、94.1%、88.9%，特异度分别为90.2%、85.2%、90.2%、87.0%。采用二元Logistic回归分析构建的联合指标诊断SUI的函数为PRESUI=-3.691×h_2BL-0.952×LHA₁+0.675×ΔE，联合指标诊断高龄产妇产后早期SUI的AUC为0.992〔95%CI（0.982，0.999）〕，最佳截断值为0.571时，灵敏度及特异度分别为96.1%、96.3%。

高龄产妇产后早期盆底结构较适龄产妇松弛明显，尤其是SUI患者，多模态超声可以定量评估高龄产妇产后早期盆底结构及功能的变化，h_1BL、h_2BL、LHA₁、ΔE_双侧及联合指标均可作为高龄产妇产后早期SUI的超声诊断指标，其中联合指标的诊断价值较高。