Geburtshilfe Frauenheilkd 2023; 83(02): 165-183
DOI: 10.1055/a-1933-2647
GebFra Science
Guideline/Leitlinie

Management von Dammrissen dritten und vierten Grades nach vaginaler Geburt. Leitlinie der DGGG, OEGGG und SGGG (S2k-Level, AWMF-Register Nr. 015/079, Dezember 2020)

Article in several languages: English | deutsch
Stephan Kropshofer
1   Frauenheilkunde und Geburtshilfe, Tirol Kliniken GmbH, Innsbruck, Austria
,
Thomas Aigmüller
2   Leoben Regional Hospital, Leoben, Austria
,
Kathrin Beilecke
3   Klinik für Urogynäkologie, Alexianer Sankt Hedwig Kliniken Berlin GmbH, Berlin, Germany
,
Andrea Frudinger
4   Department of Gynecology, Medical University of Graz, Graz, Austria
,
Ksenia Krögler-Halpern
5   Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
,
Engelbert Hanzal
5   Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
,
Hanns Helmer
6   Department of Obstetrics and Maternal-fetal Medicine, Medical University of Vienna, Vienna, Austria
,
Susanne Hölbfer
7   Wiener Gesundheitsverbund, Vienna, Austria
,
Hansjoerg Huemer
8   Frauenklinik, Bethesda Spital Basel, Basel, Switzerland
,
MoenieDer Kleyn Van
9   Midwivery, University of applied sciences, Graz, Austria
,
Irmgard Kronberger
10   Visceral- und Thoraxchirurgie, Tirol Kliniken GmbH, Innsbruck, Austria
,
Annette Kuhn
11   Urogynaecology, Inselspital Universitatsspital Bern, Bern, Switzerland
,
Johann Pfeifer
12   Department of Surgery, Medical University of Graz, Graz, Austria
,
Christl Reisenauer
13   Frauenklinik, Universitätsklinikum Tübingen, Tübingen, Germany
,
Karl Tamussino
4   Department of Gynecology, Medical University of Graz, Graz, Austria
,
Wolfgang Umek
5   Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
,
Dieter Kölle
14   Abteilung Gynäkologie, Sanatorium Hera, Vienna, Austria
,
Michael Abou-Dakn
15   Klinik für Gynäkologie, St Joseph Krankenhaus Berlin-Tempelhof, Berlin, Germany
,
Boris Gabriel
16   Klinik für Gynäkologie und Geburtshilfe, Josefs Hospital Wiesbaden, Wiesbaden, Germany
,
Oliver Schwandner
17   Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany
,
Gunda Pristauz-Telsnigg
18   Abteilung Frauenheilkunde und Geburtshilfe, Landeskrankenhaus Feldbach Fürstenfeld, Feldbach, Austria
,
Petra Welskop
19   Österreichisches Hebammengremium, Innsbruck, Austria
,
Werner Bader
20   Gynäkologie und Geburtshilfe, Klinikum Bielefeld, Bielefeld, Germany
› Author Affiliations

Zusammenfassung

Ziel Die Leitlinie soll insbesondere durch Empfehlungen zu Diagnostik, Therapie und Nachsorge nach höhergradigen Dammrissen im Rahmen vaginaler Geburten das Management dieser Situationen verbessern und mitwirken, unmittelbare sowie langzeitige Folgeschäden zu reduzieren. Die Leitlinie richtet sich an Hebammen, an geburtshilflich tätige Ärztinnen und Ärzte sowie an Ärztinnen und Ärzte, die in die Versorgung von höhergradigen Dammrissen involviert sind.

Methoden Es erfolgte eine selektive Literaturrecherche. Die strukturierte Konsensfindung der Empfehlungen und Statements erfolgte bei der Konferenz unter neutraler Moderation.

Empfehlungen Nach jeder vaginalen Geburt soll ein Dammriss III°/IV° zunächst durch sorgfältige Inspektion und/oder Palpation durch den Geburtshelfer und/oder die Hebamme ausgeschlossen werden. Die vaginale sowie anorektale Palpation zur Evaluierung von Geburtsverletzungen sind dabei unabdingbar. Im Operationsteam soll ein Facharzt mit ausreichender Erfahrung (vorrangig Facharzt für Frauenheilkunde und Geburtshilfe oder Facharzt mit koloproktologischer Expertise) zur Verfügung stehen. In Ausnahmefällen kann die Versorgung auch bis zu 12 Stunden postpartal durchgeführt werden, um eine fachgerechte Versorgung in den einzelnen, durch das Trauma einbezogenen Schichten, zu gewährleisten. Da weder die Stoß-auf-Stoß-Technik noch die überlappende Technik in der Versorgung des Risses des M. sphincter ani externus eine Überlegenheit gezeigt hat, soll der Operateur die Methode, bei der die größere Routine besteht, zur Anwendung bringen. Hierbei soll die Anlage eines Anus praeters im Rahmen der primären Versorgung nicht vorgenommen werden. Eine tägliche Reinigung mit fließendem Wasser, insbesondere nach dem Stuhlgang, wird empfohlen. Diese kann z. B. als Spülung oder Wechseldusche durchgeführt werden. Die postoperative Gabe von Laxanzien sollte über eine Therapiedauer von zumindest 2 Wochen erfolgen. Eine Aufklärung über das Vorgehen bei Folgegeburten wie auch einer potenziellen analen Inkontinenz soll erfolgen.



Publication History

Received: 17 August 2022

Accepted after revision: 23 August 2022

Article published online:
07 December 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
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