Hösli Irene
Frauenklinik, Universitätsspital Basel.
Ther Umsch. 2010 Jan;67(1):11-8. doi: 10.1024/0040-5930/a000003.
One third of women will suffer from urinary incontinence 3 to 6 months after birth, one in ten from anal incontinence and one percent from prolapse. The risk for uterine prolapse increases with future vaginal pregnancies, an indication for an elective cesarean section however must be balanced based on the multifactorial nature and the low prevalence of prolapse against the risks of a cesarean section especially of placental pathology in future pregnancies. The correlation between mode of delivery and urinary incontinence decreases with increasing number of pregnancies and with follow up after 65 years. Anal incontinence depends mostly from the mode of delivery and occurs often in combination with a high sphincter laceration or damage of the pudendus nerve. Due to different definitions and populations and lack of randomised studies the prevalence and risk calculations are divergent. In the absence of evidence and the presence of established placental risks in future pregnancies a general recommendation for an elective caesarean section is not justified. Decisions on the mode of delivery can be complex which is why established risk factors, life style factors and preventive evidence based methods are important informations for the antenatal care consultation. To identify women with a high risk for pelvic floor disorders is part of ongoing research.
三分之一的女性在产后3至6个月会出现尿失禁，十分之一的女性会出现肛门失禁，百分之一的女性会出现脏器脱垂。子宫脱垂的风险会随着未来的阴道分娩而增加，然而，鉴于其多因素性质以及脱垂的低发生率，在决定是否选择剖宫产时，必须综合权衡剖宫产的风险，尤其是未来妊娠时胎盘病变的风险。随着妊娠次数的增加以及65岁之后的随访，分娩方式与尿失禁之间的相关性会降低。肛门失禁主要取决于分娩方式，且常与高位括约肌撕裂或阴部神经损伤同时出现。由于定义和研究人群不同，且缺乏随机研究，患病率和风险计算结果存在差异。在缺乏证据且未来妊娠存在既定胎盘风险的情况下，一般建议进行选择性剖宫产是不合理的。分娩方式的决策可能很复杂，这就是为什么既定的风险因素、生活方式因素和基于证据的预防方法对于产前护理咨询很重要。识别盆底功能障碍高危女性是正在进行的研究内容之一。
