Protecting the pelvic floor: Obstetric management to prevent incontinence and pelvic organ prolapse

被引:162
作者
Handa, VL
Harris, TA
Ostergard, DR
机构
[1] UNIV CALIF IRVINE, DEPT OBSTET & GYNECOL, IRVINE, CA 92717 USA
[2] LONG BEACH MEM MED CTR, IRVINE, CA USA
关键词
D O I
10.1016/0029-7844(96)00151-2
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
Objectives: To review the literature regarding the effects of childbirth on the muscles, nerves, and connective tissue of the pelvic floor; review the evidence to support an association between childbirth and anal incontinence, urinary incontinence, and pelvic organ prolapse; and present recommendations for the prevention of these sequelae. Data Sources: Sources were identified from a MEDLINE search of English-language articles published from 1984 to 1995. Additional sources were identified from references cited in relevant research articles. Methods of Study Selection: We studied articles on the following topics: anatomy of the pelvic floor; association of childbirth with neuromuscular injury, biomechanical and morphologic alterations in muscle function, and connective tissue structure and function; the long-term effects of childbirth on continence and pelvic organ support; and the effects of obstetric interventions on the pelvic floor. Tabulation, Integration, and Results: Articles were reviewed and summarized. An overview of the structure and function of the pelvic floor was developed to provide a context for subsequent data. Childbirth was found to be associated with a variety of muscular and neuromuscular injuries of the pelvic door that are linked to the development of anal incontinence, urinary incontinence, and pelvic organ prolapse. Risk factors for pelvic door injury include forceps delivery, episiotomy, prolonged second-stage of labor, and increased fetal size. Cesarean delivery appears to be protective, especially if the patient does not labor before delivery. Conclusion: The pelvic floor plays an important role in continence and pelvic organ support. Obstetricians may be able to reduce pelvic floor injuries by minimizing forceps deliveries and episiotomies, by allowing passive descent in the second stage, and by selectively recommending elective cesarean delivery.
引用
收藏
页码:470 / 478
页数:9
相关论文
共 46 条
[1]   PELVIC FLOOR DAMAGE AND CHILDBIRTH - A NEUROPHYSIOLOGICAL STUDY [J].
ALLEN, RE ;
HOSKER, GL ;
SMITH, ARB ;
WARRELL, DW .
BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY, 1990, 97 (09) :770-779
[2]   A COMPARISON OF BIOELECTRICAL AND MECHANICAL-ACTIVITY OF THE FEMALE URETHRA [J].
BARNICK, CGW ;
CARDOZO, LD .
BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY, 1993, 100 (08) :754-757
[3]   DENERVATION AND RE-INNERVATION OF THE URETHRAL SPHINCTER IN THE ETIOLOGY OF GENUINE STRESS-INCONTINENCE - AN ELECTROMYOGRAPHIC STUDY [J].
BARNICK, CGW ;
CARDOZO, LD .
BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY, 1993, 100 (08) :750-753
[4]   RISKS OF ANAL INCONTINENCE FROM SUBSEQUENT VAGINAL DELIVERY AFTER A COMPLETE OBSTETRIC ANAL-SPHINCTER TEAR [J].
BEK, KM ;
LAURBERG, S .
BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY, 1992, 99 (09) :724-726
[5]  
BERGLAS B, 1953, SURG GYNECOL OBSTET, V97, P677
[6]  
BERGMAN A, 1987, J REPROD MED, V32, P273
[7]   RISK-FACTORS FOR 3RD-DEGREE AND 4TH-DEGREE PERINEAL LACERATIONS IN FORCEPS AND VACUUM DELIVERIES [J].
COMBS, CA ;
ROBERTSON, PA ;
LAROS, RK .
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 1990, 163 (01) :100-104
[8]  
CRAWFORD LA, 1993, OBSTET GYNECOL, V82, P527
[9]   THE PREVALENCE OF ANAL-SPHINCTER DEFECTS IN FECAL INCONTINENCE - A PROSPECTIVE ENDOSONIC STUDY [J].
DEEN, KI ;
KUMAR, D ;
WILLIAMS, JG ;
OLLIFF, J ;
KEIGHLEY, MRB .
GUT, 1993, 34 (05) :685-688
[10]   ANATOMY AND BIOMECHANICS OF GENITAL PROLAPSE [J].
DELANCEY, JOL .
CLINICAL OBSTETRICS AND GYNECOLOGY, 1993, 36 (04) :897-909