Article

The risk of stress incontinence 5 years after first delivery

Department of Obstetrics and Gynecology, Glostrup County Hospital, University of Copenhagen, Ndr. Ringvej 2600, Copenhagen, Denmark.
American Journal of Obstetrics and Gynecology (Impact Factor: 3.97). 08/2001; 185(1):82-7. DOI: 10.1067/mob.2001.114501
Source: PubMed

ABSTRACT We aimed to evaluate the impact of a first pregnancy and delivery on the prevalence of stress incontinence 5 years afterward.
This longitudinal cohort study included 278 women who were questioned after their first delivery and again 5 years later.
The prevalence of stress incontinence 5 years after a first delivery was 30%, and the 5-year incidence was 19%. The risk of stress incontinence 5 years after a first delivery was related to the onset and duration of symptoms after the first pregnancy and delivery in a "dose-response-like" manner. The use of vacuum extraction or episiotomy during the first delivery increased the risk.
First pregnancy and delivery may result in stress incontinence 5 years later. Women with incontinence 3 months after a first delivery have a particularly high risk of long-lasting symptoms. Obstetric risk factors are vacuum extraction and episiotomy.

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    • "progressive et chronique des systè mes de soutè nement assurant la continence en cas de grossesse gé mellaire semble inté ressante. Les six facteurs associé s a ` l'IUE du post-partum dans notre e ´ tude sont des facteurs de risque reconnus dans la litté rature : obé sité [2] [3] [6], expression uté rine [2], duré e du travail supé rieure ou e ´ gale a ` huit heures [14], IUE du post-partum immé diat [3] [5], IUE pré natale [5] et poids de naissance [2]. Aucune e ´ tude n'a, a ` notre connaissance, e ´ valué l'impact de la gé mellité sur le risque de survenue d'une IUE en post-partum. "
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    ABSTRACT: Objective To study twin pregnancy and delivery as a risk factor for developing postpartum stress urinary incontinence (SUI).Patients and methodsRetrospective single centre study comparing 117 patients who have delivered twins to 117 patients who have given birth to singletons, between January 2003 and December 2005 in a tertiary maternal-foetal medicine unit. The risk factors associated with the onset of postpartum SUI, its severity, and its impact on the quality of life were studied.ResultsSixty patients in the twin pregnancy group and 59 in the singleton pregnancy group have answered an auto-questionnaire and were included in the study. The medium-term follow-up of the patient was 20.2 months ± 10.1. The prevalence of SUI in the total population was 30%. The rate was significantly higher in the “twin” group (40%) than in the “singleton” group (20%) (p = 0.03). Twin gestation was significantly associated with postpartum SUI for more than 20 months after delivery (OR = 2.6 [1.1–5.9]). The univariate analysis found six other risk factors: prenatal urinary incontinence (OR = 4.2 [1.7–10.4]), BMI greater than 30 (OR = 6.3 [1.2–34.1]), labour duration greater than 8 h (OR = 4.8 [1.6–14.5]), fundal uterine pressure (OR = 4.5 [1.1–18.3]), total intrauterine foetal weight (p = 0.003), and immediate postpartum urinary incontinence (OR = 12.9 [5–33.5]).Discussion and conclusionThe vaginal delivery of two successive foetuses does not seem more purveyor of SUI than caesarean. In twin pregnancies, the high rate of postpartum SUI appears to be related to total intrauterine weight.
    Gynécologie Obstétrique & Fertilité 04/2010; 38(4):238–243. DOI:10.1016/j.gyobfe.2010.02.004 · 0.58 Impact Factor
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    • "progressive et chronique des systè mes de soutè nement assurant la continence en cas de grossesse gé mellaire semble inté ressante. Les six facteurs associé s a ` l'IUE du post-partum dans notre e ´ tude sont des facteurs de risque reconnus dans la litté rature : obé sité [2] [3] [6], expression uté rine [2], duré e du travail supé rieure ou e ´ gale a ` huit heures [14], IUE du post-partum immé diat [3] [5], IUE pré natale [5] et poids de naissance [2]. Aucune e ´ tude n'a, a ` notre connaissance, e ´ valué l'impact de la gé mellité sur le risque de survenue d'une IUE en post-partum. "
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    ABSTRACT: To study twin pregnancy and delivery as a risk factor for developing postpartum stress urinary incontinence (SUI). Retrospective single centre study comparing 117 patients who have delivered twins to 117 patients who have given birth to singletons, between January 2003 and December 2005 in a tertiary maternal-foetal medicine unit. The risk factors associated with the onset of postpartum SUI, its severity, and its impact on the quality of life were studied. Sixty patients in the twin pregnancy group and 59 in the singleton pregnancy group have answered an auto-questionnaire and were included in the study. The medium-term follow-up of the patient was 20.2 months+/-10.1. The prevalence of SUI in the total population was 30%. The rate was significantly higher in the "twin" group (40%) than in the "singleton" group (20%) (p=0.03). Twin gestation was significantly associated with postpartum SUI for more than 20 months after delivery (OR=2.6 [1.1-5.9]). The univariate analysis found six other risk factors: prenatal urinary incontinence (OR=4.2 [1.7-10.4]), BMI greater than 30 (OR=6.3 [1.2-34.1]), labour duration greater than 8h (OR=4.8 [1.6-14.5]), fundal uterine pressure (OR=4.5 [1.1-18.3]), total intrauterine foetal weight (p=0.003), and immediate postpartum urinary incontinence (OR=12.9 [5-33.5]). The vaginal delivery of two successive foetuses does not seem more purveyor of SUI than caesarean. In twin pregnancies, the high rate of postpartum SUI appears to be related to total intrauterine weight.
    Gynécologie Obstétrique & Fertilité 03/2010; 38(4):238-43. · 0.58 Impact Factor
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    • "If the initial onset of SUI or urge urinary incontinence (UUI) was during or after the first pregnancy, long-term risks of SUI or UUI are greater (Altman et al., 2006; Viktrup, Rorkveit, & Lose, 2006). Subsequent deliveries, however, have not been found to be as influential on frequency of SUI or UUI long-term (Heit et al., 2001; Viktrup & Lose, 2001). With possible mechanisms of injury, including excessive stretching of perineal muscles and compression or excessive stretching of the pudendal nerve, primary prevention strategies might include antepartum pelvic floor exercises (PFEs) (see Figure 1) or elective primary cesarean section (CS) (DeLancey et al., 2007; Heit et al., 2001). "
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    ABSTRACT: The costs of urinary incontinence (UI) are financially and socially substantial to those who are living with its effects. When looking at the dramatic costs associated with UI and associated pelvic floor disorders, prevention of these disorders or management at the earliest possible level is indicated. Determining which modifiable factors cause UI and pelvic floor disorders is complicated. Listening to patients in an effort to improve their quality of life may be a reasonable starting point. Educating future health care providers to approach these topics with sensitivity will positively impact the care patients receive.
    Urologic nursing: official journal of the American Urological Association Allied 07/2008; 28(3):200-6; quiz 207.
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