Factors involved in the persistence of stress urinary incontinence from pregnancy to 2 years post partum
To identify factors involved in the persistence of stress urinary incontinence (SUI) from pregnancy to 2 years post partum.
In a longitudinal study at Donostia Hospital, San Sebastián, Spain, 458 primigravid women were recruited from April to October 2007. SUI was diagnosed via the 2002 International Continence Society definition. Severity was assessed via the Incontinence Severity Index, and impact on quality of life via the International Consultation on Incontinence Questionnaire. Means (Student t test and analysis of variance) and percentages (χ(2) and Fisher exact tests) were compared, and multiple logistic regression analysis was performed with variables that were significant or close to significant in a univariate analysis (P<0.2).
Among 272 eligible women attending follow-up at 2 years post partum, 26 (9.5%) women reported persistent SUI since pregnancy. Incontinence severity was slight or moderate in most cases and the impact on quality of life was low. A higher body mass index (BMI) in pregnant women at term was the only factor found to be associated with persistent SUI (odds ratio 1.19; 95% confidence interval 1.08-1.32).
Higher BMI in pregnant women at term was an independent risk factor for the persistence of SUI from pregnancy to 2 years post partum.
Available from: Encarnación Rubio
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ABSTRACT: Background and objective:
Urinary incontinence initiated before and right after delivery and persisting 3 months after delivery tends to become chronic. We intended to estimate the persistence of urinary incontinence 6 months postpartum and to analyse the different factors associated with it.
Patients and methods:
Follow-up study 6 months after delivery of women presenting urinary incontinence symptoms in gestation or in the first 2 months of postpartum. The dependent variable was the persistence and the independent variables were grouped in obstetric and non-obstetric. Odds ratio (OR) were calculated with their confidence interval at 95% (IC 95%) in the bivariate analysis. The variables that showed an important risk of persistence of incontinence were used to perform a multivariate model of logistic regression.
The persistence of incontinence 6 months after delivery was 21.4% (CI 95% 16-26.7). The risk of persistence increased with the Kristeller maneuver (OR 7.89, CI 95% 3.04-20.49), not weight recovery (OR 3.64, CI 95% 1.10-12.02), not practising pelvic floor muscle exercises in postpartum (OR 9.36, CI 95% 2.71-32.33), appearance of incontinence after delivery (OR 6.66, CI 95% 2.37-18.68) and the weight of the newborn>3.5 kg (OR 6.76, CI 95% 2.54-18.03), all of them explaining 58% of the variability of persistence.
21.4% of women with urinary incontinence caused by pregnancy/delivery will continue to have it 6 months postpartum. An important part of this persistence is associated with some factors easy to modify.
Medicina Clínica 07/2012; 141(4). DOI:10.1016/j.medcli.2012.05.020 · 1.42 Impact Factor
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Human childbirth simulated by vaginal distention is known to increase the expression of chemokines and receptors involved in stem cell homing and tissue repair. We hypothesized that pregnancy and parturition in rats contributes to the expression of chemokines and receptors after vaginal distention.
Materials and methods:
We used 72 age matched female Lewis rats, including virgin rats with and without vaginal distention, and delivered rats with and without vaginal distention. Each rat was sacrificed immediately, or 3 or 7 days after vaginal distention and/or parturition, and the urethra was harvested. Relative expression of chemokines and receptors was determined by real-time polymerase chain reaction. Mixed models were used with the Bonferroni correction for multiple comparisons.
Vaginal distention up-regulated urethral expression of CCL7 immediately after injury in virgin and postpartum rats. Hypoxia inducible factor-1α and vascular endothelial growth factor were up-regulated only in virgin rats immediately after vaginal distention. CD191 expression was immediately up-regulated in postpartum rats without vaginal distention compared to virgin rats without vaginal distention. CD195 was up-regulated in virgin rats 3 days after vaginal distention compared to virgin rats without vaginal distention. CD193 and CXCR4 showed delayed up-regulation in virgin rats 7 days after vaginal distention. CXCL12 was up-regulated in virgin rats 3 days after vaginal distention compared to immediately after vaginal distention. Interleukin-8 and CD192 showed no differential expression.
Vaginal distention results in up-regulation of the chemokines and receptors expressed during tissue injury, which may facilitate the spontaneous functional recovery previously noted. Pregnancy and delivery up-regulated CD191 and attenuated the expression of hypoxia inducible factor-1α and vascular endothelial growth factor in the setting of vaginal distention, likely by decreasing hypoxia.
The Journal of urology 09/2012; 189(4). DOI:10.1016/j.juro.2012.09.096 · 4.47 Impact Factor
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ABSTRACT: To examine the association between vaginal or cesarean delivery and urinary incontinence (UI) and identify the trend in the change in UI within the first 12 months postpartum.
This was a prospective longitudinal study of 330 of 749 women who completed a UI questionnaire and a personal characteristics questionnaire over five visits in a medical center.
The vaginal delivery group had a significant higher prevalence of any UI at 4-6 weeks and at 3, 6, and 12 months (29.1-40.2% vaginal compared with 14.2-25.5% cesarean); stress urinary incontinence (SUI) at 4-6 weeks and 3 and 12 months (15.9-25.4% vaginal compared with 6.4-15.6% cesarean); and moderate or severe UI at 3-5 days, 4-6 weeks, and 6 months (7.9-18.5% vaginal compared with 4.3-11.3% cesarean); and a significant higher score for interference in daily life at 3-5 days and 4-6 weeks (1.0, 0.7 vaginal compared with 0.7, 0.4 cesarean) compared with those in the cesarean delivery group. Prevalence increased for any UI, SUI, and slight UI (all P<.02) and daily life interference score decreased (P=.02) for women who had a vaginal delivery through 1 year postpartum.
Vaginal delivery was associated with higher UI prevalence that persisted for 1 year postpartum, but there was no association with interference in daily life after 6 weeks postpartum. Variation was observed in UI changes within the first year in the vaginal delivery and cesarean delivery groups. LEVEL OF EVIDENCE:: II.
Obstetrics and Gynecology 02/2014; 123(3). DOI:10.1097/AOG.0000000000000141 · 5.18 Impact Factor
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