Division of Urogynecology, Department of Obstetrics and Gynecology, Kafkas University Medical School, Kars, Turkey.
Division of Urogynecology, Department of Obstetrics and Gynecology, Taksim Education and Research Hospital, İstanbul, Turkey.
Taiwan J Obstet Gynecol. 2014 Dec;53(4):452-8. doi: 10.1016/j.tjog.2014.08.001.
Pelvic floor dysfunction (PFD), although seems to be simple, is a complex process that develops secondary to multifactorial factors. The incidence of PFD is increasing with increasing life expectancy. PFD is a term that refers to a broad range of clinical scenarios, including lower urinary tract excretory and defecation disorders, such as urinary and anal incontinence, overactive bladder, and pelvic organ prolapse, as well as sexual disorders. It is a financial burden on the health care system and disrupts women's quality of life. Strategies applied to decrease PFD are focused on the course of pregnancy, mode and management of delivery, and pelvic exercise methods. Many studies in the literature define traumatic birth, usage of forceps, length of the second stage of delivery, and sphincter damage as modifiable risk factors for PFD. Maternal age, fetal position, and fetal head circumference are nonmodifiable risk factors. Although numerous studies show that vaginal delivery affects pelvic floor structures and their functions in a negative way, there is not enough scientific evidence to recommend elective cesarean delivery in order to prevent development of PFD. PFD is a heterogeneous pathological condition, and the effects of pregnancy, vaginal delivery, cesarean delivery, and possible risk factors of PFD may be different from each other. Observational studies have identified certain obstetrical exposures as risk factors for pelvic floor disorders. These factors often coexist; therefore, the isolated effects of these variables on the pelvic floor are difficult to study. The routine use of episiotomy for many years in order to prevent PFD is not recommended anymore; episiotomy should be used in selected cases, and the mediolateral procedures should be used if needed.
盆底功能障碍（PFD）虽然看似简单，但却是一个复杂的过程，是多种因素继发引起的。随着预期寿命的延长，PFD 的发病率不断增加。PFD 是一个术语，指的是广泛的临床情况，包括下尿路排泄和排便障碍，如尿失禁和肛门失禁、膀胱过度活动症和盆腔器官脱垂，以及性功能障碍。它给医疗保健系统带来了经济负担，并扰乱了女性的生活质量。用于减少 PFD 的策略集中在妊娠过程、分娩方式和管理以及骨盆运动方法上。文献中的许多研究将创伤性分娩、使用产钳、第二产程的长度和括约肌损伤定义为 PFD 的可改变危险因素。产妇年龄、胎儿位置和胎头直径是不可改变的危险因素。尽管许多研究表明阴道分娩以负面方式影响盆底结构及其功能，但没有足够的科学证据推荐选择性剖宫产以预防 PFD 的发生。PFD 是一种异质性病理状况，妊娠、阴道分娩、剖宫产以及 PFD 的可能危险因素的影响可能彼此不同。观察性研究已经确定了某些产科暴露是盆底疾病的危险因素。这些因素通常同时存在；因此，这些变量对盆底的孤立影响难以研究。多年来为了预防 PFD 而常规使用会阴切开术的做法不再被推荐；会阴切开术应在选定的情况下使用，如果需要，应使用侧方切开术。
