Prophylaxe von Inkontinenz und Prolaps: Ein Merkmal zukünftiger mütterlicher geburtshilflicher Qualität?

Purpose: To review the literature with respect to pelvic floor damage due to childbirth and obstetric intervention; to present recommendations for the prevention of possible sequelae. Data sources and methods: MEDLINE research of all English language articles published from 1983 to 1997.Topics: vaginal delivery, instrumental delivery, pelvic floor damage, episiotomy, perineal tear, anal sphincter rupture, prolapse, urinary and fecal incontinence. Selection and review of results in these articles were in accordance with the recommendations for systematic review articles. Results: Vaginal delivery but not elective caesarean section bears the risk of varying degrees of muscular, neuromuscular and connective tissue damage of the pelvic floor, which may result in urinary and/or fecal incontinence. Routine and selective median episiotomies have an increased risk of third-degree and fourth-degree lacerations in comparison to mediolateral episiotomies. In primiparae routine mediolateral episiotomy, compared to restricted episiotomy rates as low as 40% does not prevent urinary incontinence and third-degree and fourth-degree perineal tears. Forceps delivery compared to ventouse is associated with an increased risk of such lacerations. Conclusions: Obstetric management has a major influence on the prevention of damage to the pelvic floor and its sphincters. Routine episiotomy in general and midline episiotomy in particular and the use of forceps have an increased risk of pelvic floor and sphincter damage.