To explore therapeutic effects of early postpartum (4-6 weeks postpartum) static contraction training (SCT) combined with neuromuscular electrical stimulation (NES) in the treatment of parturients with postpartum diastasis recti abdominis (DRA).

A total of 90 cases of postpartum DRA parturients who were admitted to Huai′an Maternal and Child Health Care Hospital from January 2018 to October 2021 were selected into this study. They were randomly divided into study group (n=45) and control group (n=45) by random number table method. At 4-6 weeks of early postpartum, parturients in study group were treated with SCT combined with NES, while parturients in control group were only treated with NES. Abdominal circumference, bilateral inter-recti distance (IRD), voltage values of type Ⅰ and Ⅱ muscle fiber of pelvic floor and visual analogue scale (VAS) scores of waist and back pain in two groups at the 2nd, 4th and 6th week of treatment were compared by variance of repeated measurement data method. Least significant difference (LSD)-t test was used for pairwise comparison of the above indicators at different time points. This study was approved by the ethics committee of Huai′an Maternal and Child Health Care Hospital (Approval No.201806), and informed consent for clinical research was signed with all subjects.

① There were no significant differences between two groups in general clinical data, such as gestational age of delivery, proportion of cesarean section, weight gain during pregnancy, duration of the first and second stage of labor, proportion of neonatal birth weight ≥ 4 000 g, parity, proportion of cesarean section more than twice, and proportion of body mass index (BMI) ≥ 24 kg/m², abdominal circumference and bilateral IRD before treatment (P>0.05). ② Analysis of variance of repeated measurement data of abdominal circumference and bilateral IRD of two groups at the 4th and 6th weeks of treatment showed that there were no statistical difference in interaction effects between different treatment measures and time factors (F_{treatment×time}=4.214, 2.193, P_{treatment×time}=0.062, 0.241). Further analysis of main effect of DRA treatment measures showed that main effects of different DRA treatment measures on abdominal circumference and bilateral IRD at different treatment time points of postpartum DRA parturients were statistically significant (F_treatment=6.874, 8.291; P_treatment=0.032, 0.012). Abdominal circumference and bilateral IRD in study group were 4.1 cm (95%CI: 1.2-5.3 cm, P<0.05) and 0.17 cm (95%CI: 0.06-0.31 cm, P<0.05) smaller and shorter than those in control group, respectively. Main effect analysis results of time factors showed that main effects of time factors on abdominal circumference and bilateral IRD of postpartum DRA parturients at different treatment time points were statistically significant (F_time=14.286, 9.574; P<0.001, =0.004). Further pairwise analysis showed that abdominal circumference and bilateral IRD at the 4th and 6th week of treatment were significantly smaller and shorter than those at the 2nd week of treatment, and abdominal circumference and bilateral IRD at the 6th week of treatment were also significantly smaller and shorter than those at the 4th week of treatment, all differences were statistically significant (P<0.05). ③ Analysis of variance of repeated measurement data of voltage values of type Ⅰ and Ⅱ muscle fiber of pelvic floor and VAS scores of waist and back pain in two groups at the 2nd, 4th and 6th weeks of treatment showed that there were statistical difference in interactive effects between different treatment measures and time factors (F_{treatment×time}=6.721, 7.284, 8.277; P_{treatment×time}=0.024, 0.017, 0.012). Further analysis of individual effects of treatment measures showed that voltage values of type Ⅰ muscle fiber of pelvic floor at the 4th and 6th weeks of treatment in study group were higher than those in control group, and voltage value of type Ⅱ muscle fiber of pelvic floor in study group was significantly higher than that in control group, and all differences were statistically significant (t=2.075, 4.336, 7.798; P=0.008, <0.001, <0.001). Further analysis of individual effects of time factors in study group and control group respectively showed that there were statistical differences in voltage values of type Ⅰ muscle fiber of pelvic floor at the 2nd, 4th and 6th week of treatment both of study group and control group (study group: F=155.488, 229.732, 598.316, all P<0.001; control group: F=83.498, 92.179, 765.398, all P<0.001). Further pairwise comparison within study group and control group showed that voltage values of type Ⅰ muscle fiber of pelvic floor at the 4th and 6th week of treatment of two groups were statistically higher than those at the 2nd week of treatment within group, VAS scores of waist and back pain were statistically lower than those at the 2nd week of treatment within group, and voltage values of type Ⅰ muscle fiber of pelvic floor at the 6th week of treatment of two groups were statistically higher than those at the 4th week of treatment within group, VAS scores of waist and back pain were statistically lower than those at the 4th week of treatment within group, and all differences were statistically significant (P<0.001).

Early postpartum SCT combined with NES in the treatment of postpartum DRA parturients can promote recovery of abdominal circumference and bilateral IRD, improve pelvic floor muscle strength and relieve lumbar and back pain.