Handa V L, Harris T A, Ostergard D R
Department of Obstetrics and Gynecology, University of California Davis Medical Center, Sacramento, USA.
Obstet Gynecol. 1996 Sep;88(3):470-8. doi: 10.1016/0029-7844(96)00151-2.
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.
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.
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 floor that are linked to the development of anal incontinence, urinary incontinence, and pelvic organ prolapse. Risk factors for pelvic floor 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.
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.
回顾有关分娩对盆底肌肉、神经和结缔组织影响的文献，审视支持分娩与肛门失禁、尿失禁及盆腔器官脱垂之间存在关联的证据；并提出预防这些后遗症的建议。
通过对1984年至1995年发表的英文文章进行医学文献数据库检索来确定来源。其他来源则从相关研究文章中引用的参考文献中确定。
我们研究了以下主题的文章：盆底解剖结构、分娩与神经肌肉损伤的关联、肌肉功能的生物力学和形态学改变以及结缔组织的结构和功能；分娩对控尿和盆腔器官支撑的长期影响；以及产科干预措施对盆底的影响。
制表、整合与结果：对文章进行了综述和总结。绘制了盆底结构和功能的概述，以便为后续数据提供背景。发现分娩与盆底的多种肌肉和神经肌肉损伤有关，这些损伤与肛门失禁、尿失禁和盆腔器官脱垂的发生有关。盆底损伤的危险因素包括产钳助产、会阴切开术、第二产程延长和胎儿体重增加。剖宫产似乎具有保护作用，尤其是在患者分娩前未经历产程的情况下。
盆底在控尿和盆腔器官支撑方面发挥着重要作用。产科医生或许能够通过尽量减少产钳助产和会阴切开术、允许第二产程被动下降以及选择性地推荐择期剖宫产来减少盆底损伤。
