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Zentralbl Gynakol 2001; 123(12): 666-671
DOI: 10.1055/s-2001-20016
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© Georg Thieme Verlag Stuttgart · New York

Schwangerschaft, Geburt und Beckenboden

Pregnancy, childbirth and the pelvic floorH. Kölbl
  • Klinik und Poliklinik für Gynäkologie des Klinikums der Medizinischen Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle/Saale
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Publication History

Publication Date:
11 February 2002 (online)

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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.

Schlüsselwörter

Schwangerschaft - Geburt - Beckenboden - Inkontinenz

Key words

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
    PubMedGoogle Scholar
  • 2 Morkved S, Bo K TI. Prevalence of urinary incontinence during pregnancy and postpartum.  Int Urogynecol J Pelvic Floor Dysfunct. 1999;  10 394-398
    CrossrefPubMedGoogle Scholar
  • 3 Mason L, Glenn S, Walton I, Appleton C. The experience of stress incontinence after childbirth.  Birth. 1999;  26 164-171
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 6 Cutner A, Cardozo L D. The lower urinary tract in pregnancy and the puerperium.  Int Urogynecol J. 1992;  3 317-323
    PubMedGoogle Scholar
  • 7 Francis W JA. Disturbances of bladder function in relation to pregnancy.  J Obstet Gynecol Br Emp. 1960;  67 353-366
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 9 Hong P L, Leong M, Seltzer V. Uroflowmetric observation in pregnancy.  Neurourol Urodynam. 1988;  7 61-70
    PubMedGoogle Scholar
  • 10 Parboosingh J, Doig A. Studies in nocturia in normal pregnancy.  J Obstet Gynaecol Br Comw. 1873;  80 888-895
    PubMedGoogle Scholar
  • 11 Nemir A, Middleton R P. Stress incontinence in young nulliparous women.  Am J Obstet Gynecol. 1954;  68 1166-1168
    PubMedGoogle Scholar
  • 12 Wolin L H. Stress incontinence in young healthy nulliparous subjects.  J Urol. 1969;  101 545-549
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 14 Francis W JA. The onset of stress incontinence.  J Obstet Gynecol Br Emp. 1960;  67 899-903
    PubMedGoogle Scholar
  • 15 Iosif S. Stress incontinence during pregnancy and in puerperium.  Int J Gynaecol Obstet. 1989;  19 13-20
    PubMedGoogle Scholar
  • 16 Iosif S, Henriksson L, Ulmsten U. Postpartum incontinence.  Urol Int. 1981;  36 53-58
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 21 Brown S, Lumley J. Maternal health after childbirth: results of an Australian population based survey.  Br J Obstet Gynaecol. 1998;  105 156-161
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 31 Abitbol M M. Birth and human evolution: anatomical and obstetrical mechanics in primates. Bergin and Garvey, Westport, CT 1997
    Google Scholar
  • 32 Moerman M L. Growth of the birth canal in adolescent girls.  Am J Obstet Gynecol. 1982;  143 528-532
    PubMedGoogle Scholar
  • 33 Kolawole T M, Adamu S P, Evans K T. Comparative pelvimetric measurements in Nigerian and Welsh women.  Clin Radiol. 1978;  29 85-90
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 35 WHO .Unicef. Revised 1990 estimates of maternal mortality: A new approach. World Health Organization, Geneva 1996
    Google Scholar
  • 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
    Google Scholar
  • 37 Carroli G, Belizan J. Episiotomy for vaginal birth. Cochrane Database Syst Rev 2000 (2): CD000081
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 40 Eason E, Feldman P. Much ado about a little cut: is episiotomy worthwhile? .  Obstet Gynecol. 2000;  95 616-618
    CrossrefPubMedGoogle Scholar
  • 41 Olayinka-Oyelese K, Porter A, Wai C. Midline episiotomy and anal incontinence. Is episiotomy ethically acceptable? .  BMJ. 2000;  320 1602
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 47 Cockshott W P. Pubic changes associated with obstetric vesico-vaginal fistulae.  Clin Radiol. 1973;  23 241-247
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 50 Eason E, Labrecque M, Wells G, Feldman P. Preventing perineal trauma during childbirth: a systematic review.  Obstet Gynecol. 2000;  95 464-471
    CrossrefPubMedGoogle Scholar
  • 51 Cooper Z R, Rose S. Fecal incontinence: a clinical approach.  Mt Sinai J Med. 2000;  67 96-105
    PubMedGoogle Scholar
  • 52 Toglia M R, DeLancey J O. Anal incontinence and the obstetrician-gynecologist.  Obstet Gynecol. 1994;  84 731-740
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar

Univ. Prof. Dr. Heinz Kölbl

Klinik und Poliklinik für Gynäkologie

Martin-Luther-Universität Halle-Wittenberg

Magdeburger Straße 24

D-06097 Halle/Saale

Phone: +49-3 45-5 57-18 47

Fax: +49-3 45-5 57-15 01

Email: heinz.koelbl@medizin.uni-halle.de