To explore the effect of pelvic floor muscle training (PFMT) timing on pelvic floor muscle tension and sexual function in elderly (delivery age≥35 years old) primiparous women after delivery.

A total of 233 elderly, primiparous, and single pregnancy pregnant women with a confirmed due date of delivery from January to December 2022 due to prenatal examination in Shanghai First Maternity and Infant Hospital were selected as the research subjects. Using a prospective research method, participants were randomly divided into prenatal training group (n=78, starting PFMT at 25 weeks of pregnancy until delivery, duration>3 months), postpartum training group (n=79, starting PFMT at 7 days postpartum, duration>3 months), and control group (n=76, receiving routine perinatal health education but not receiving PFMT). Chi-square test, one-way ANOVA (overall comparison) and LSD-t test (pairwise comparison) were used to compare the pelvic floor muscle fiber strength for type Ⅰ and Ⅱ, incidence of pelvic organ prolapse (POP) and stress urinary incontinence (SUI), female sexual function index (FSFI) score, length of hospital stay, and maternal satisfaction rate among three groups of pregnant and puerperant at 42 days postpartum, 3 months postpartum, and 6 months postpartum. This study has been reviewed and approved by the Ethics Committee of our hospital (Approval No. 20200308). All pregnant and puerperant and their families have informed consent and signed the clinical study informed consent forms.

① At 42 d, 3 months and 6 months after delivery, the modified Oxford scores (MOS) of pelvic floor muscle fiber strength for type Ⅰ and Ⅱ were all showed that the prenatal and postpartum training groups were higher than control group, respectively, also the prenatal training group was higher than the postpartum training group, and the differences were statistically significant (P<0.05). Comparison of pelvic floor muscle fiber strength MOS scores of type Ⅰ and type Ⅱ among three groups of pregnant and puerperant at five time points (gestational age of 25 weeks, 7 days before delivery, 42 days after delivery, 3 months after delivery, and 6 months after delivery) showed intergroup effects, time effects, and interaction effects (type Ⅰ: F_intergroup=21.34, F_time=110.15, F_{intergroup×time}=4.45, all with P<0.001; type Ⅱ: F_intergroup=15.49, P<0.001; F_time=54.92, P<0.001; F_{intergroup×time}=2.58, P=0.007). ②There were no significant differences in the incidence of POP at 42 days, 3 months, and 6 months after delivery and SUI at 6 months after delivery among three groups of pregnant and puerperant (P>0.05). There were significant differences in the incidence of SUI at 42 days and 3 months after delivery among three groups of pregnant and puerperant (P<0.05), and the incidence of SUI at 42 days after delivery in postpartum training group was higher than that in prenatal training group, and the difference was statistically significant (P<0.01). ③There were significant differences in each dimension scores and total scores of FSFI among three groups of pregnant and puerperant (P<0.05). Among them, each dimension scores and total scores of FSFI in prenatal training group were higher than those in postpartum training group, and these indicators in prenatal and postpartum training groups were higher than those in control group, respectively, and the differences were statistically significant (P<0.05). ④The hospitalization time of prenatal training group and postpartum training group were shorter than those of control group, respectively, while the patient satisfaction rate were higher than those of control group, respectively, and the differences were statistically significant (P<0.05).

Prenatal PFMT is more effective in preventing postpartum pelvic floor dysfunction (PFD) compared to postpartum PFMT, and has a higher patient satisfaction rate. Prenatal PFMT is worthy of clinical promotion.