Fatton B, Jacquetin B
Unité d'urogynécologie Centre hospitalo-universitaire Maternité de l'Hôtel-Dieu, Clermont-Ferrand.
Rev Prat. 1999 Jan 15;49(2):160-6.
Vaginal delivery especially with dystocia, may result in relaxation or disruption of fascial and ligamentous supports of pelvic organs. The relationship between first childbirth and obstetric trauma is strong but additional pregnancies and deliveries are aggravating factors as well as ageing and hormonal effects of the menopause. These anatomic changes are contributing to the development of stress urinary incontinence, anal incontinence and genital prolapse. Preventing obstetric trauma needs changes in current obstetric practice: reduction in the episiotomy rate, use of vacuum extractor in preference to forceps. General practitioners can help at the time of postnatal control by making a full clinical evaluation of pelvic floor damage, referring women for further investigation and asking them about postnatal sexual difficulties. Postpartum perineal physiotherapy is indicated for women at risk: pelvic floor congenital weakness instrumental delivery, postpartum urinary and/or anal incontinence.
阴道分娩尤其是难产，可能导致盆腔器官的筋膜和韧带支持结构松弛或破坏。初产与产科创伤之间的关系密切，但额外的妊娠和分娩以及衰老和绝经的激素影响也是加重因素。这些解剖学变化会促使压力性尿失禁、肛门失禁和生殖器脱垂的发生。预防产科创伤需要改变当前的产科做法：降低会阴侧切率，优先使用真空吸引器而非产钳。全科医生可以在产后检查时提供帮助，对盆底损伤进行全面的临床评估，将女性转诊进行进一步检查，并询问她们产后的性方面问题。产后会阴物理治疗适用于有风险的女性：盆底先天性薄弱、器械助产、产后尿失禁和/或肛门失禁。
