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Geburt und Beckenboden

verfasst von: MBA Prim. PD Dr. Oliver Preyer, BSc Dr. Philipp Fößleitner

Erschienen in: Journal für Urologie und Urogynäkologie/Österreich | Ausgabe 3/2022

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Zusammenfassung

Eine Spontangeburt steigert bekannterweise das Risiko für eine Harninkontinenz und/oder einen uterovaginalen Prolaps im späteren Leben jeder Frau. Die Suche nach effektiven Präventionsmaßnahmen und Optimierungen im Geburtsmanagement beschäftigt die Forschung daher seit vielen Jahrzehnten. Die Hauptursachen der Beckenbodendysfunktion nach einer Geburt sind dabei die Verletzung des Beckenbodens durch Kompression, Zerrungen, Ab- und Ausriss von Nerven, Muskeln und Bindegewebsfasern. Der Abriss des M. levator ani spielt dabei in der Entstehung von Inkontinenz und Prolaps eine wichtige Rolle. Vielfach wird die Entbindung per Sectio caesarea als effektive Prävention zur Verhinderung von Harninkontinenz und Prolaps angesehen, ein Blick auf die aktuelle Datenlage bestätigt diese These jedoch nicht. Die einzigen evidenzbasierten Methoden zur Prävention von Harninkontinenz und Prolaps sind derzeit das Beckenbodentraining während und nach der Schwangerschaft sowie Lebensstilmodifikationen.

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Nygaard I, Barber MD, Burgio KL et al. Pelvic Floor Disorders Network (2008) Prevalence of symptomatic pelvic floor disorders in US women. JAMA 300(11):1311–1316. https://doi.org/10.1001/jama.300.11.1311 CrossRefPubMedPubMedCentral

Rortveit G, Daltveit AK, Hannestad YS et al. (2003) Vaginal delivery parameters and urinary incontinence: the Norwegian EPINCONT study. Am J Obstet Gynecol 189(5):1268–1274. https://doi.org/10.1067/s0002-9378(03)00588-x CrossRefPubMed

Cattani L, Decoene J, Page AS et al. (2021) Pregnancy, labour and delivery as risk factors for pelvic organ prolapse: a systematic review. Int Urogynecol J 32(7):1623–1631. https://doi.org/10.1007/s00192-021-04724-y CrossRefPubMed

Snooks SJ, Setchell M, Swash M et al. (1984) Injury to innervation of pelvic floor sphincter musculature in childbirth. Lancet 2(8402):546–550. https://doi.org/10.1016/s0140-6736(84)90766-9 CrossRefPubMed

Ashton-Miller JA, Delancey JO (2009) On the biomechanics of vaginal birth and common sequelae. Annu Rev Biomed Eng 11:163–176. https://doi.org/10.1146/annurev-bioeng-061008-124823 CrossRefPubMedPubMedCentral

DeLancey JO, Miller JM, Kearney R et al (2007) Vaginal birth and de novo stress incontinence: relative contributions of urethral dysfunction and mobility. Obstet Gynecol 110(2 Pt 1):354–362. https://doi.org/10.1097/01.AOG.0000270120.60522.55 CrossRefPubMedPubMedCentral

Dietz HP, Simpson JM (2008) Levator trauma is associated with pelvic organ prolapse. BJOG 115(8):979–984. https://doi.org/10.1111/j.1471-0528.2008.01751.x CrossRefPubMed

DeLancey JO, Kearney R, Chou Q et al (2003) The appearance of levator ani muscle abnormalities in magnetic resonance images after vaginal delivery. Obstet Gynecol 101(1):46–53. https://doi.org/10.1016/s0029-7844(02)02465-1 CrossRefPubMedPubMedCentral

Albrich SB, Laterza RM, Skala C et al. (2012) Impact of mode of delivery on levator morphology: a prospective observational study with three-dimensional ultrasound early in the postpartum period. BJOG 119(1):51–60. https://doi.org/10.1111/j.1471-0528.2011.03152.x CrossRefPubMed

10.

Caudwell-Hall J, Kamisan Atan I, Martin A et al. (2017) Intrapartum predictors of maternal levator ani injury. Acta Obstet Gynecol Scand 96(4):426–431. https://doi.org/10.1111/aogs.13103 CrossRefPubMed

11.

Memon HU, Blomquist JL, Dietz HP et al. (2015) Comparison of levator ani muscle avulsion injury after forceps-assisted and vacuum-assisted vaginal childbirth. Obstet Gynecol 125(5):1080–1087. https://doi.org/10.1097/AOG.0000000000000825 CrossRefPubMedPubMedCentral

12.

Kearney R, Miller JM, Ashton-Miller JA et al. (2006) Obstetric factors associated with levator ani muscle injury after vaginal birth. Obstet Gynecol 107(1):144–149. https://doi.org/10.1097/01.AOG.0000194063.63206.1c CrossRefPubMedPubMedCentral

13.

Chen L, Ashton-Miller JA, Hsu Y et al. (2006) Interaction among apical support, levator ani impairment, and anterior vaginal wall prolapse. Obstet Gynecol 108(2):324–332. https://doi.org/10.1097/01.AOG.0000227786.69257.a8 CrossRefPubMedPubMedCentral

14.

Handa VL, Blomquist JL, Roem J et al. (2020) Levator morphology and strength after obstetric avulsion of the levator ani muscle. Female Pelvic Med Reconstr Surg 26(1):56–60. https://doi.org/10.1097/SPV.0000000000000641 CrossRefPubMedPubMedCentral

15.

Handa VL, Roem J, Blomquist JL et al. (2019) Pelvic organ prolapse as a function of levator ani avulsion, hiatus size, and strength. Am J Obstet Gynecol 221(1):41.e1–41.e7. https://doi.org/10.1016/j.ajog.2019.03.004 CrossRef

16.

Lien KC, Mooney B, DeLancey JO et al. (2004) Levator ani muscle stretch induced by simulated vaginal birth. Obstet Gynecol 103(1):31–40. https://doi.org/10.1097/01.AOG.0000109207.22354.65 CrossRefPubMedPubMedCentral

17.

Dietz HP, Simpson JM (2007) Does delayed child-bearing increase the risk of levator injury in labour? Aust N Z J Obstet Gynaecol 47(6):491–495. https://doi.org/10.1111/j.1479-828X.2007.00785.x CrossRefPubMed

18.

Dietz HP, Kirby A, Shek KL et al (2009) Does avulsion of the puborectalis muscle affect bladder function? Int Urogynecol J Pelvic Floor Dysfunct 20(8):967–972. https://doi.org/10.1007/s00192-009-0882-1 CrossRefPubMed

19.

Friedman S, Blomquist JL, Nugent JM et al. (2012) Pelvic muscle strength after childbirth. Obstet Gynecol 120(5):1021–1028. https://doi.org/10.1097/aog.0b013e318265de39 CrossRefPubMedPubMedCentral

20.

Hilde G, Stær-Jensen J, Siafarikas F et al. (2013) Postpartum pelvic floor muscle training and urinary incontinence: a randomized controlled trial. Obstet Gynecol 122(6):1231–1238. https://doi.org/10.1097/AOG.0000000000000012 (Erratum in: Obstet Gynecol. 2014 Sep;124(3):639) CrossRefPubMed

21.

Richardson AC, Lyon JB, Williams NL (1976) A new look at pelvic relaxation. Am J Obstet Gynecol 126(5):568–573. https://doi.org/10.1016/0002-9378(76)90751-1 CrossRef

22.

Delancey JO (2002) Fascial and muscular abnormalities in women with urethral hypermobility and anterior vaginal wall prolapse. Am J Obstet Gynecol 187(1):93–98. https://doi.org/10.1067/mob.2002.125733 CrossRefPubMed

23.

Connell KA (2011) Elastogenesis in the vaginal wall and pelvic-organ prolapse. N Engl J Med 364(24):2356–2358. https://doi.org/10.1056/NEJMcibr1104976 CrossRefPubMed

24.

Goepel C, Johanna Kantelhardt E, Karbe I et al (2011) Changes of glycoprotein and collagen immunolocalization in the uterine artery wall of postmenopausal women with and without pelvic organ prolapse. Acta Histochem 113(3):375–381. https://doi.org/10.1016/j.acthis.2010.02.001 CrossRefPubMed

25.

Chen B, Wen Y, Zhang Z et al (2006) Microarray analysis of differentially expressed genes in vaginal tissues from women with stress urinary incontinence compared with asymptomatic women. Hum Reprod 21(1):22–29. https://doi.org/10.1093/humrep/dei276 CrossRefPubMed

26.

Nygaard I (2006) Urinary incontinence: is cesarean delivery protective? Semin Perinatol 30(5):267–271. https://doi.org/10.1053/j.semperi.2006.07.007 CrossRefPubMed

27.

King VG, Boyles SH, Worstell TR et al (2010) Using the Brink score to predict postpartum anal incontinence. Am J Obstet Gynecol 203(5):486.e1–486.e5. https://doi.org/10.1016/j.ajog.2010.07.032 CrossRef

28.

Krofta L, Otcenásek M, Kasíková E et al (2009) Pubococcygeus-puborectalis trauma after forceps delivery: evaluation of the levator ani muscle with 3D/4D ultrasound. Int Urogynecol J Pelvic Floor Dysfunct 20(10):1175–1181. https://doi.org/10.1007/s00192-009-0837-6 CrossRefPubMed

29.

Snooks SJ, Swash M, Henry MM et al (1986) Risk factors in childbirth causing damage to the pelvic floor innervation. Int J Colorectal Dis 1(1):20–24. https://doi.org/10.1007/BF01648831 CrossRefPubMed

30.

Gyhagen M, Bullarbo M, Nielsen TF et al (2013) The prevalence of urinary incontinence 20 years after childbirth: a national cohort study in singleton primiparae after vaginal or caesarean delivery. BJOG 120(2):144–151. https://doi.org/10.1111/j.1471-0528.2012.03301.x CrossRefPubMed

31.

Casey BM, Schaffer JI, Bloom SL et al (2005) Obstetric antecedents for postpartum pelvic floor dysfunction. Am J Obstet Gynecol 192(5):1655–1662. https://doi.org/10.1016/j.ajog.2004.11.031 CrossRefPubMed

32.

Leijonhufvud A, Lundholm C, Cnattingius S et al (2011) Risks of stress urinary incontinence and pelvic organ prolapse surgery in relation to mode of childbirth. Am J Obstet Gynecol 204(1):70.e1–70.e7. https://doi.org/10.1016/j.ajog.2010.08.034 CrossRef

33.

Leijonhufvud Å, Lundholm C, Cnattingius S et al (2012) Risk of surgically managed pelvic floor dysfunction in relation to age at first delivery. Am J Obstet Gynecol 207(4):303.e1–303.e7. https://doi.org/10.1016/j.ajog.2012.08.019 CrossRef

34.

Thom DH, Brown JS, Schembri M et al (2011) Parturition events and risk of urinary incontinence in later life. Neurourol Urodyn 30(8):1456–1461. https://doi.org/10.1002/nau.21166 CrossRefPubMedPubMedCentral

35.

Pomeroy RH (1918) Shall we cut and reconstruct the perineum for every primipara. Trans Am Gynecol Assoc 43:201

36.

Hartmann K, Viswanathan M, Palmieri R et al (2005) Outcomes of routine episiotomy: a systematic review. JAMA 293(17):2141–2148. https://doi.org/10.1001/jama.293.17.2141 CrossRefPubMed

37.

Röckner G, Olund A (1991) The use of episiotomy in primiparas in Sweden. A descriptive study with particular focus on two hospitals. Acta Obstet Gynecol Scand 70(4):325–330. https://doi.org/10.3109/00016349109007881 CrossRefPubMed

38.

Sartore A, De Seta F, Maso G et al (2004) The effects of mediolateral episiotomy on pelvic floor function after vaginal delivery. Obstet Gynecol 103(4):669–673. https://doi.org/10.1097/01.AOG.0000119223.04441.c9 CrossRefPubMed

39.

Carroli G, Mignini L (2009) Episiotomy for vaginal birth. Cochrane Database Syst Rev 1:CD81. https://doi.org/10.1002/14651858.CD000081.pub2 CrossRef

40.

Joris F, Hoesli I, Kind A et al (2019) Obstetrical and epidemiological factors influence the severity of anal incontinence after obstetric anal sphincter injury. BMC Pregnancy Childbirth 19(1):94. https://doi.org/10.1186/s12884-019-2238-2 CrossRefPubMedPubMedCentral

41.

Nilsson IEK, Åkervall S, Molin M et al (2021) Symptoms of fecal incontinence two decades after no, one, or two obstetrical anal sphincter injuries. Am J Obstet Gynecol 224(3):276.e1–276.e23. https://doi.org/10.1016/j.ajog.2020.08.051 CrossRef

42.

Magoga G, Saccone G, Al-Kouatly HB et al (2019) Warm perineal compresses during the second stage of labor for reducing perineal trauma: a meta-analysis. Eur J Obstet Gynecol Reprod Biol 240:93–98. https://doi.org/10.1016/j.ejogrb.2019.06.011 CrossRefPubMed

43.

Beckmann MM, Garrett AJ (2006) Antenatal perineal massage for reducing perineal trauma. Cochrane Database Syst Rev 1:CD5123. https://doi.org/10.1002/14651858.CD005123.pub2 CrossRef

44.

Aquino CI, Guida M, Saccone G et al (2020) Perineal massage during labor: a systematic review and meta-analysis of randomized controlled trials. J Matern Fetal Neonatal Med 33(6):1051–1063. https://doi.org/10.1080/14767058.2018.1512574 CrossRefPubMed

45.

AWMF-Leitlinie Reg. Nr. 015-079 zum Management von Dammrissen III. und IV. Grades nach vaginaler Geburt (awmf.org), https://www.awmf.org/uploads/tx_szleitlinien/015-079l_S2k_Dammriss-III-IV-Grades_2020-12_1.pdf, gültig bis 31.01.2023

46.

Wesnes SL, Hunskaar S, Bo K et al (2009) The effect of urinary incontinence status during pregnancy and delivery mode on incontinence postpartum. A cohort study. BJOG 116(5):700–707. https://doi.org/10.1111/j.1471-0528.2008.02107.x CrossRefPubMedPubMedCentral

47.

Solans-Domènech M, Sánchez E, Espuña-Pons M, Pelvic Floor Research Group (Grup de Recerca del Sòl Pelvià; GRESP) (2010) Urinary and anal incontinence during pregnancy and postpartum: incidence, severity, and risk factors. Obstet Gynecol 115(3):618–628. https://doi.org/10.1097/AOG.0b013e3181d04dff CrossRefPubMed

48.

Boyle R, Hay-Smith EJ, Cody JD et al (2012) Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev 10:CD7471. https://doi.org/10.1002/14651858.CD007471.pub2 CrossRefPubMed

49.

Mørkved S, Bø K (2014) Effect of pelvic floor muscle training during pregnancy and after childbirth on prevention and treatment of urinary incontinence: a systematic review. Br J Sports Med 48(4):299–310. https://doi.org/10.1136/bjsports-2012-091758 CrossRefPubMed

50.

ACOG Committee Opinion No. 761: Cesarean Delivery on Maternal Request. Obstet Gynecol 133(1):e73–e77. https://doi.org/10.1097/AOG.0000000000003006 CrossRef

51.

Borello-France D, Burgio KL, Richter HE et al, Pelvic Floor Disorders Network (2006) Fecal and urinary incontinence in primiparous women. Obstet Gynecol 108(4):863–872. https://doi.org/10.1097/01.AOG.0000232504.32589.3b CrossRefPubMed

52.

Hannah ME, Whyte H, Hannah WJ et al, Term Breech Trial Collaborative Group (2004) Maternal outcomes at 2 years after planned cesarean section versus planned vaginal birth for breech presentation at term: the international randomized term breech trial. Am J Obstet Gynecol 191(3):917–927. https://doi.org/10.1016/j.ajog.2004.08.004 CrossRefPubMed

53.

Goldberg RP, Abramov Y, Botros S et al (2005) Delivery mode is a major environmental determinant of stress urinary incontinence: results of the Evanston-Northwestern Twin Sisters Study. Am J Obstet Gynecol 193(6):2149–2153. https://doi.org/10.1016/j.ajog.2005.08.055 CrossRefPubMed

54.

Hannestad YS, Rortveit G, Daltveit AK, Hunskaar S (2003) Are smoking and other lifestyle factors associated with female urinary incontinence? The Norwegian EPINCONT Study. BJOG 110(3):247–254 CrossRef

Titel: Geburt und Beckenboden
verfasst von: MBA Prim. PD Dr. Oliver Preyer
BSc Dr. Philipp Fößleitner
Publikationsdatum: 04.07.2022
Verlag: Springer Vienna
Erschienen in: Journal für Urologie und Urogynäkologie/Österreich / Ausgabe 3/2022
Print ISSN: 1023-6090
Elektronische ISSN: 1680-9424
DOI: https://doi.org/10.1007/s41972-022-00168-8

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Geburt und Beckenboden

Zusammenfassung

Springer Medizin Österreich

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