Zusammenfassung
Bei der Mehrheit aller Frauen kommt es während der Geburt zu einem Trauma am Beckenboden.
Wir sind alle vertraut mit Damm- und Scheidenrissen und die Identifikation und Behandlung
von dritt- und viertgradigen Dammrissen ist ein Schwerpunkt der geburtshilflichen
Ausbildung. Innerhalb der letzten 10 Jahre ist allerdings klar geworden, dass der
Begriff Beckenbodentrauma eine weitere Kategorie von Verletzungen umfasst, die meist
okkult bleiben und nur selten unter der Geburt diagnostiziert werden. Fortschritte
in der bildgebenden Diagnostik, insbesondere in der Kernspin- und 3-D-/4-D-Ultraschalldiagnostik,
haben es uns ermöglicht, den M. levator ani, vor allem den M. puborectalis, routinemäßig
darzustellen. Es ist inzwischen klar, dass das Puborectalis-Trauma („Avulsion“) recht
häufig ist (15–40 % aller vaginalen Geburten) und dass es womöglich der numerisch
wichtigste Faktor in der Pathogenese von Prolapsbeschwerden sein könnte. In der vorliegenden
Übersichtsarbeit werde ich versuchen, den jetzigen Stand der klinischen Forschung
auf diesem Gebiet zu umreißen. Ich werde mich auf Schäden am Levator ani beschränken,
da zum Sphinktertrauma bereits ausreichend Literatur vorliegt. Ich werde auch versuchen,
Perspektiven aufzuzeigen – nicht nur für die klinische oder bildgebende Diagnose von
Levator-Rissen, sondern auch für die Prävention und chirurgische Behandlung dieser
bisher vollständig vernachlässigten Form von Geburtstraumata.
Abstract
A majority of women delivering via the vaginal route suffer some form of trauma to
the pelvic floor and perineum. Perineal and anal sphincter tears have been recognised
as a major issue, requiring dedicated training of obstetric staff to ensure proper
diagnosis and treatment. Over the last ten years, however, it has become evident that
pelvic floor trauma comprises yet another category of trauma that usually remains
occult and is virtually always overlooked in Labour Ward. Progress in the field of
multiplanar and 3D/4D imaging, both in magnetic resonance and in ultrasound, has enabled
us to assess the levator ani, in particular the puborectalis muscle, as a matter of
routine. It has become clear that major damage in the form of an avulsion of the puborectalis
muscle is common (15–40 % of vaginal deliveries), and that it may well be the most
important aetiological factor in the development of female pelvic organ prolapse.
In this review I'll try and summarize the current state of clinical research in this
field. I'll limit myself to the levator ani, since anal sphincter trauma has been
suffficiently covered in the literature. II'll also try to show up perspectives, not
just for the diagnosis of such trauma by clinical examination and imaging, but also
for prevention and surgical treatment of this hitherto ignored form of birth trauma.
Schlüsselwörter
3‐D - Beckenboden - Geburtstrauma - M. levator ani - Prolaps - Ultraschall
Key words
3D - birth trauma - female pelvic organ prolapse - levator ani - pelvic floor - ultrasound
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Hans Peter Dietz, MD PhD FRANZCOG DDU CU, Professor in Obstetrics and Gynaecology
Sydney Medical School Nepean
Nepean Hospital
Darby Street
Penrith NSW 2750
Australia
eMail: hpdietz@bigpond.com
