Prevention of Labour-Associated Pelvic Floor Injuries – What is Known for Sure

Abstract

In order to avoid pelvic floor injuries a caesarean section is on the one hand often requested by the pregnant women and, on the other hand, offered by obstetric staff. For both forms of delivery, comprehensive risk-benefit analyses should be carried out before deciding in favour of the surgical procedure. The present brief review summarizes the current evidence on the avoidance of pelvic floor injuries.

Zusammenfassung

Zur Vermeidung einer Beckenbodenschädigung wird die Sectio caesarea zum einen von Schwangeren eingefordert, zum anderen aber auch von Geburtshelfern angeboten. Für beide Entbindungsmodi sind die Risiken vs. die Vorteile abzuwägen, bevor die operative Entbindung favorisiert wird. Diese Kurzübersicht zeigt die derzeitige Evidenz auf, eine geburtsbedingte Beckenbodenschädigung zu vermeiden.

Key words

pelvic floor injuries - delivery method - incontinence - genital prolapse

Schlüsselwörter

Beckenbodenschädigung - Entbindungsmodus - Inkontinenz - Genitalprolaps

• References

• 1 Handa V, Blomquist J, Knoepp L et al. Pelvic floor disorders 5–10 years after vaginal or cesarean childbirth. Obstet Gynecol 2011; 118: 777-784
• 2 Beckmann MW, Bader W, Bechtold I et al. Finanzierung und finanzielle Probleme von Leistungen und Strukturen im Fachgebiet Gynäkologie und Geburtshilfe im Jahr 2011 – allgemeine Aspekte und geburtshilfliche Versorgung. Geburtsh Frauenheilk 2011; 71: 367-380
• 3 Beckmann MW, Bader W, Bechtold I. Finanzierung und finanzielle Probleme von Leistungen und Strukturen im Fachgebiet Gynäkologie und Geburtshilfe im Jahr 2011 – DRG-System und stationäre Versorgung inklusive Urogynäkologie und benigner wie auch maligner gynäkologischer Operationen. Geburtsh Frauenheilk 2011; 71: 497-510
• 4 Nygaard I. Vaginal birth: A relic of the past in bulldogs and women?. Obstet Gynecol 2011; 118: 774-776
• 5 Turner CE, Young JM, Solomon MJ et al. Incidence and etiology of pelvic floor dysfunction and mode of delivery: an overview. Dis Colon Rectum 2009; 52: 1186-1195
• 6 Hendrix SL, Clark A, Nygaard I et al. Pelvic organ prolapse in the Womenʼs Health Initiative: gravity and gravidity. Am J Obstet Gynecol 2002; 186: 1160-1166
• 7 Rortveit G, Hannestad YS, Daltveit AK et al. Age- and type-dependent effects of parity on urinary incontinence: the Norwegian EPINCONT study. Obstet Gynecol 2001; 98: 1004-1010
• 8 Abramov Y, Sand PK, Botros SM et al. Risk factors for female anal incontinence: new insight through the Evanston-Northwestern Twin Sisters Study. Am J Obstet Gynecol 2005; 106: 726-732
• 9 Handa V. Pelvic floor disorders associated with pregnancy and childbirth (2012). Im Internet:. http://www.uptodate.com Stand: 24.04.2012
• 10 Leijonhufvud A, Lundholm C, Cnattingius S et al. Risk of stress urinary incontinence and pelvic organ prolapse surgery in relation to mode of childbirth. Am J Obstet Gynecol 2011; 204: 70.e1-70.e6
• 11 Viktrup L, Rortveit G, Lose G. Risk of urinary incontinence twelve years after the first pregnancy and delivery. Obstet Gynecol 2006; 108: 248-254
• 12 MacArthur C, Glazener CM, Wilson PD et al. Persistent urinary incontinence and delivery mode history: a six-year longitudinal study. BJOG 2006; 113: 218-224
• 13 Sultan AH, Kamm MA, Hudson CN et al. Anal-sphincter disruption during vaginal delivery. N Engl J Med 1993; 329: 1905-1911
• 14 Eason E, Labreque M, Wells G et al. Preventing perineal trauma during childbirth: a systematic review. Obstet Gynecol 2000; 95: 464-471
• 15 Wheeler II T, Richter H. Delivery method, anal sphincter tears and fecal incontinence: new information on a persistent problem. Curr Opin Obstet Gynecol 2007; 19: 474-479
• 16 Schwertner-Tiepelmann N, Thakar R, Sultan AH et al. Obstetric levator ani muscle injuries: current status. Ultrasound Obstet Gynecol 2012; 39: 372-383
• 17 Dietz HP. Geburtsbedingtes Beckenbodentrauma. Geburtsh Frauenheilk 2010; 70: 969-978
• 18 Valsky DV, Messing B, Pomp R et al. Fetal head circumference and length of second stage of labor are risk factors for levator ani muscle injury, diagnosed by 3-dimensional transperineal ultrasound in primiparous women. Am J Obstet Gynecol 2009; 201: 91.e1-91.e7
• 19 Lavy Y, Sand P, Kaniel C et al. Can pelvic floor injury secondary to delivery be prevented?. Int Urogynecol J 2012; 23: 165-173
• 20 Hannah ME, Whyte H, Hannah WJ et al. 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 2004; 191: 917-927
• 21 Borello-France D, Bugio KL, Richter HE et al. Pelvic floor Disorders Network. Prevalence of fecal and urinary incontinence after childbirth: the Childbirth and Pelvic Symptoms (CAPS) Study. Obstet Gynecol 2006; 108: 863-872
• 22 Lal M, Mann CH, Callender R et al. Does cesarean delivery prevent anal incontinence?. Obstet Gynecol 2003; 101: 305-312
• 23 Nelson R, Westercamp M, Furner S. A systematic review of the efficacy of cesarean section in the preservation of anal continence. Dis Colon Rectum 2006; 49: 1587-1595
• 24 Weber AM. Elective cesarean delivery: the pelvic perspective. Clin Obstet Gynecol 2007; 50: 510-517
• 25 Faltin DL, Sangalli MR, Roche B et al. Does a second delivery increase the risk of anal incontinence. Br J Obstet Gynecol 2001; 108: 684-688
• 26 Mahony R, Behan M, OʼConnell PR et al. Effect of second vaginal delivery on anal function in patients at risk of occult anal sphincter injury after first forceps delivery. Dis Colon Rectum 2008; 51: 1361-1366
• 27 Sultan AH, Thakar R, Fenner D. Perineal and anal Sphincter Trauma. London: Springer; 2007
• 28 Hay-Smith J, Mørkved S, Fairbrother KA et al. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev 2008; (4) CD007471
• 29 Stafne S, Salvesen K, Romundstad P et al. Does regular exercise including pelvic floor muscle training prevent urinary and anal incontinence during pregnancy? A randomized controlled trial. BJOG 2012;
• 30 Mason L, Roe B, Wong H et al. The role of antenatal pelvic floor muscle exercises in prevention of postpartum stress incontinence: a randomized trial. J Clin Nurs 2010; 19: 2777-2786
• 31 Taran-Munteanu L, Taran FA, Hosang B et al. Abdominale Sakrokolpopexie versus vaginale sakrospinale Fixation: klinische Parameter und subjektive Patienteneinschätzungen. Geburtsh Frauenheilk 2011; 71: 760-766
• 32 Kemp B, Maass N, Najjari L et al. Magnetstimulation – eine zusätzliche Therapieoption beim OAB-Syndrom. Geburtsh Frauenheilk 2010; 70: 580-583
• 33 Naumann G, Kölbl H. Current developments and perspectives on the diagnosis and treatment of urinary incontinence and genital prolapse in women. Geburtsh Frauenheilk 2012; 72: 202-210
• 34 Gadonneix P, Campagna G, Villet R. Pregnancy after laparoscopic sacral colpopexy – a case report. Int Urogynecol J 2012; 23: 651-653
• 35 Kohorst F, Flock F, Kreienberg R et al. Pregnancy and delivery after tension-free vaginal tape (TVT) procedure: literature review and case report. Eur J Obstet Gynecol Reprod Biol 2010; 151: 10-13