Schwangerschaft, Geburt und Beckenboden

Zusammenfassung

Sowohl die Schwangerschaft wie auch die Vaginalgeburt sind für das Auftreten der Stressharninkontinenz und einer Beckenbodenschädigung verantwortlich zu machen. Allerdings im Lichte der heutigen Datenlage beruhen über 90 % der Angaben auf Auswertungen von Fragebögen. Nur ein geringer Anteil der heute vorliegenden Untersuchungen ist prospektiv. Weitere Untersuchungen sind notwendig, die Zusammenhänge zwischen Schwangerschaft, Geburt und Beckenbodenschädigung zu objektivieren. Longitudinalstudien sind erforderlich die Langzeitfolgen von Schwangerschaft und der Geburt auf den unteren Harntrakt und die Beckenbodenfunktion zu untersuchen.

Pregnancy, childbirth and the pelvic floor

Summary

Pregnancy and vaginal delivery are responsible for the onset of genuine stress urinary incontinence, and pelvic floor damage. A striking dearth of prospective studies exists regarding the relationship of pregnancy and delivery to these problems. The vast majority of published data is based on analysis retreived from questionnaires. Most damage of the pelvic floor obviously occurs during first delivery. Objective findings have demonstrated pudendal nerve damage mostly found after forceps delivery, increased duration of second stage of labour, third degree perineal tear and high birth weight. Episiotomy offers no protection against perineal tears and should be restricted to specified feto-maternal indications. Longitudinal studies are needed to assess long term consequences of pregnancy and child birth on both, lower urinary tract and pelvic floor function.

Schwangerschaft - Geburt - Beckenboden - Inkontinenz

Pregnancy - childbirth - pelvic floor - incontinence

Literatur

• 1 Al-Mufti R, McCarthy A, Fisk N M. Obstetricians personal choice and mode of delivery.  Lancet. 1996;  347 544
• 2 Morkved S, Bo K TI. Prevalence of urinary incontinence during pregnancy and postpartum.  Int Urogynecol J Pelvic Floor Dysfunct. 1999;  10 394-398
• 3 Mason L, Glenn S, Walton I, Appleton C. The experience of stress incontinence after childbirth.  Birth. 1999;  26 164-171
• 4 Beck R P, Hsu N. Pregnancy, childbirth an the menopause related to the development of stress incontinence.  Am J Obstet Gynecol. 1965;  91 820-823
• 5 Swash M, Snooks S J, Henry M M. Unifying concept of pelvic floor disorders and incontinence.  J Roy Soc Med. 1985;  78 906-933
• 6 Cutner A, Cardozo L D. The lower urinary tract in pregnancy and the puerperium.  Int Urogynecol J. 1992;  3 317-323
• 7 Francis W JA. Disturbances of bladder function in relation to pregnancy.  J Obstet Gynecol Br Emp. 1960;  67 353-366
• 8 Stanton S L, Kerr-Wilson R, Harris V G. The incidence of urological symptoms in normal pregnancy.  Br J Obstet Gynaecol. 1980;  87 897-900
• 9 Hong P L, Leong M, Seltzer V. Uroflowmetric observation in pregnancy.  Neurourol Urodynam. 1988;  7 61-70
• 10 Parboosingh J, Doig A. Studies in nocturia in normal pregnancy.  J Obstet Gynaecol Br Comw. 1873;  80 888-895
• 11 Nemir A, Middleton R P. Stress incontinence in young nulliparous women.  Am J Obstet Gynecol. 1954;  68 1166-1168
• 12 Wolin L H. Stress incontinence in young healthy nulliparous subjects.  J Urol. 1969;  101 545-549
• 13 Hojberg K E, Salvig J D, Winslow N A, Lose G, Secher N J. Urinary incontinence: prevalence and risk factors at 16 weeks of gestation.  Br J Obstet Gynaecol. 1999;  106 842-850
• 14 Francis W JA. The onset of stress incontinence.  J Obstet Gynecol Br Emp. 1960;  67 899-903
• 15 Iosif S. Stress incontinence during pregnancy and in puerperium.  Int J Gynaecol Obstet. 1989;  19 13-20
• 16 Iosif S, Henriksson L, Ulmsten U. Postpartum incontinence.  Urol Int. 1981;  36 53-58
• 17 Viktup L, Lose G, Rolff M, Barfoed K. The symptom of stress incontinence caused by pregnancy or delivery in primiparas.  Obstet Gynecol. 1992;  79 945-949
• 18 Groutz A, Gordon D, Keidar R, Lessing J B, Wolman I, David M P, Chen B. Stress urinary incontinence: prevalence among nulliparous compared with primiparous and grand multiparous premenopausal women.  Neurourol Urodyn. 1999;  18 419-425
• 19 Allen R E, Hosker G L, Smith A R, Warrell D WTI. Pelvic floor damage and childbirth: a neurophysiological study.  Br J Obstet Gynaecol. 1990;  97 770-779
• 20 Snooks S J, Swash M, Henry M M, Setchell M. Risk factors in childbirth causing damage to the pelvic floor innervation.  Int J Colorectal Dis. 1986;  1 20-24
• 21 Brown S, Lumley J. Maternal health after childbirth: results of an Australian population based survey.  Br J Obstet Gynaecol. 1998;  105 156-161
• 22 Handa V L, Harris T A, Ostergard D R. Protecting the pelvic floor: obstetric management to prevent incontinence and pelvic organ prolapse.  Obstet Gynecol. 1996;  88 470-478
• 23 Peschers U M, Schaer G N, DeLancey J O, Schuessler B. Levator ani function before and after childbirth.  Br J Obstet Gynaecol. 1997;  104 1004-1008
• 24 Tunn R, DeLancey J O, Howard D, Thorp J M, Ashton-Miller J A, Quint L E. MR imaging of levator ani muscle recovery following vaginal delivery.  Int Urogynecol J Pelvic Floor Dysfunct. 1999;  10 300-307
• 25 Persson J, Wolner-Hanssen P, Rydhstroem H. Obstetric risk factors for stress urinary incontinence: a population-based study.  Obstet Gynecol. 2000;  96 440-445
• 26 Karasick S, Spettell C M. The role of parity and hysterectomy on the development of pelvic floor abnormalities revealed by defecography.  AJR Am J Roentgenol. 1997;  169 1555-1558
• 27 Johanson R B, Heycock E, Carter J, Sultan A H, Walklate K, Jones P W. Maternal and child health after assisted vaginal delivery: five-year follow up of a randomised controlled study comparing forceps and ventouse.  Br J Obstet Gynaecol. 1999;  106 544-549
• 28 Meyer S, Schreyer A, DeGrandi P, Hohlfeld P. The effects of birth on urinary continence mechanisms and other pelvic-floor characteristics.  Obstet Gynecol. 1998;  92 613-618
• 29 Meyer S, Bachelard O, DeGrandi P. Do bladder neck mobility and urethral sphincter function differ during pregnancy compared with during the non-pregnant state.  Int Urogynecol J Pelvic Floor Dysfunct. 1998;  9 397-404
• 30 King J K, Freeman R M. Is antenatal bladder neck mobility a risk factor for postpartum stress incontinence? .  Br J Obstet Gynaecol. 1998;  105 1300-1307
• 31 Abitbol M M. Birth and human evolution: anatomical and obstetrical mechanics in primates. Bergin and Garvey, Westport, CT 1997
• 32 Moerman M L. Growth of the birth canal in adolescent girls.  Am J Obstet Gynecol. 1982;  143 528-532
• 33 Kolawole T M, Adamu S P, Evans K T. Comparative pelvimetric measurements in Nigerian and Welsh women.  Clin Radiol. 1978;  29 85-90
• 34 Signorello L B, Harlow B L, Chekos A K, Repke J T. Midline episiotomy and anal incontinence: retrospective cohort study.  BMJ. 2000;  320 86-90
• 35 WHO .Unicef. Revised 1990 estimates of maternal mortality: A new approach. World Health Organization, Geneva 1996
• 36 Fortney J A, Smith J B. The base of the iceberg: Prevalence and perceptions of maternal morbidity in four developing countries. Family Health International, Research Triangle Park, NC 1996
• 37 Carroli G, Belizan J. Episiotomy for vaginal birth. Cochrane Database Syst Rev 2000 (2): CD000081
• 38 Angioli R, Gomez-Marin O, Cantuaria G, O'Sullivan M J. Severe perineal lacerations during vaginal delivery: the University of Miami experience.  Am J Obstet Gynecol. 2000;  182 1083-1085
• 39 Klein M C, Gauthier R J, Robbins J M, Kaczorowski J, Jorgensen S H, Franco E D, Johnson B, Waghorn K, Gelfand M M, Guralnick M S. et al . Relationship of episiotomy to perineal trauma and morbidity, sexual dysfunction, and pelvic floor relaxation.  Am J Obstet Gynecol. 1994;  171 591-598
• 40 Eason E, Feldman P. Much ado about a little cut: is episiotomy worthwhile? .  Obstet Gynecol. 2000;  95 616-618
• 41 Olayinka-Oyelese K, Porter A, Wai C. Midline episiotomy and anal incontinence. Is episiotomy ethically acceptable? .  BMJ. 2000;  320 1602
• 42 Mills M S, Murphy D J. Midline episiotomy and anal incontinence. Results should be interpreted with caution in British context [letter].  BMJ. 2000;  320 1601-1602
• 43 Chaliha C, Sultan A H. Midline episiotomy and anal incontinence. Training is needed in the recognition and repair of perineal trauma [letter].  BMJ. 2000;  320 1601
• 44 Sampselle C M, Miller J M, Mims B L, Delancey J O, Ashton-Miller J A, Antonakos C L. Effect of pelvic muscle exercise on transient incontinence during pregnancy and after birth.  Obstet Gynecol. 1998;  91 406-412
• 45 Morkved S, Bo K. Effect of postpartum pelvic floor muscle training in prevention and treatment of urinary incontinence: a one-year follow up.  BJOG. 2000;  107 1022-1028
• 46 Miller K, Richardson D A, Siegel S W, Karram M M, Blackwood N B, Sand P K. Pelvic floor electrical stimulation for genuine stress incontinence: who will benefit and when? .  Int Urogynecol J Pelvic Floor Dysfunct. 1998;  9 265-270
• 47 Cockshott W P. Pubic changes associated with obstetric vesico-vaginal fistulae.  Clin Radiol. 1973;  23 241-247
• 48 Flynn P, Franiek J, Janssen P, Hannah W J, Klein M C. How can second-stage management prevent perineal trauma. Critical review.  Can Fam Physician. 1997;  43 73-84
• 49 Klein M C, Janssen P A, MacWilliam L, Kaczorowski J, Johnson B. Determinants of vaginal-perineal integrity and pelvic floor functioning in childbirth.  Am J Obstet Gynecol. 1997;  176 403-410
• 50 Eason E, Labrecque M, Wells G, Feldman P. Preventing perineal trauma during childbirth: a systematic review.  Obstet Gynecol. 2000;  95 464-471
• 51 Cooper Z R, Rose S. Fecal incontinence: a clinical approach.  Mt Sinai J Med. 2000;  67 96-105
• 52 Toglia M R, DeLancey J O. Anal incontinence and the obstetrician-gynecologist.  Obstet Gynecol. 1994;  84 731-740
• 53 Podnar S, Lukanovi Cbreve A, Vodusek D B. Anal sphincter electromyography after vaginal delivery: neuropathic insufficiency or normal wear and tear.  Neurourol Urodyn. 2000;  19 249-257