Postpartum urinary and fecal incontinence in gemelar pregnancy according to route and mode of delivery
The incidence of multiple pregnancies increased in the last two decades. Several studies seeking the incidence of pelvic floor pathology, particularly urinary incontinence and its risk factors, conclude that a previous cesarean and vaginal delivery even more, carry an increased risk for developing urinary and fecal incontinence, compared with patients nulligravida.
To determine the different risk factors for urinary incontinence after a twin pregnancy.
331 women from 20 to 50 years of age without symptoms prior to pregnancy were interviewed, attending antenatal care of twin pregnancy in the Hospital La Paz, Madrid. The interview included the ICIQ-SF (International Consultation on Incontinence Questionnaire-Short Form). We recorded maternal age, gestational age, parity, episiotomy, weights of both newborns, the need for urinary protectors and fecal or gas incontinence.
The prevalence of urinary incontinence postpartum according ICIQ-SF >0 was 23%; 20.4% in the caesarean group, 25.3% in the eutocic delivery group and 35.5% in the instrumental delivery group (p = 0.033). The prevalence of moderate to severe incontinence (ICIQ-SF >6) was 14.8%; 12.3% in caesarean group, 14.5% in the eutocic delivery group and 32.3% in the instrumental delivery group (p = 0.005). The prevalence of fecal incontinence was 3.4%; 4.8% in eutocic delivery group, 1.9% in the caesarean group and 9.7% in the instrumental delivery group (p = 0.058).
The risk of urinary incontinence after a twin pregnancy was higher among patients who had an instrumental delivery when compared with patients with eutocic delivery or cesarean section. The total fetal weight and maternal age did not appear as risk factors in our study. Any woman who had an instrumental delivery for twins should be followed up by a pelvic floor specialist.
Available from: Fernando Luiz Cardoso
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ABSTRACT: It was to test the validity and reliability of an online version of the Female Sexual Function Index (FSFI).
An online version of the FSFI was compared to the pen and paper traditional version. Physiotherapy students in three cities were randomly allocated to two groups - G-pp/ol (n=126) and G-ol/pp (n=147). G-pp/ol women replied to th FSFI using the traditional pen and paper method, while G-ol/pp women answered an online version of the same questionnaire. Data were collected ageing after 15 days, when G-pp/ol women answered the online version while G-ol/pp women answered on paper. All data were transferred to SPSS software. Demographic differences between the test two groups were determined by Student's t-test or Fisher exact (95%CI; p>0.05). Association and correlation between the responses of G-pp/ol and G-ol/pp were assessed for each sample by the t-test and Pearson's coefficient. An identical strategy was used for intragroup comparisons.
A total of 273 women participated in the study and 28 (10.2%) giving up the second collection. There were no demographic differences between groups. Fifteen of the 19 FSFI questions were associated and correlated between the two groups in both test and the retest. The intragroup analysis revealed that all FSFI questions and scores were associated and weakly correlated for the same group during both test and retest.
The online version of the FSFI showed acceptable validity and reliability when compared to the paper version, and can justify the choice of this modality, especially in studies involving private questions.
Revista brasileira de ginecologia e obstetrićia: revista da Federação Brasileira das Sociedades de Ginecologia e Obstetrícia 10/2013; 35(10):469-474. DOI:10.1590/S0100-72032013001000008
Available from: Julio Elito
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ABSTRACT: The aims of this study were to compare perineal distensibility between women with twin and singleton pregnancies and to correlate these women's perineal distensibility with anthropometric data. This prospective cross-sectional case-control study was conducted among nulliparous women, of whom 20 were pregnant with twins and 23 with a single fetus. Perineal distensibility was evaluated in the third trimester by means of Epi-no, which was introduced into the vagina and inflated up to the maximum tolerable limit. It was then withdrawn while inflated and its circumference was measured. The unpaired Student's t-test was used to compare perineal distensibility in the two groups and Pearson's correlation coefficient (r) was used to correlate the pregnant women's perineal distensibility with their anthropometric data. There was no difference in perineal distensibility between the twin group (16.51 ± 2.05 cm) and singleton group (16.13 ± 1.67 cm) (P = 0.50). There was a positive correlation between perineal distensibility and abdominal circumference (r = 0.36; P = 0.01). The greater the abdominal circumference was, the greater the perineal distensibility was, regardless of whether the pregnancy was twin or singleton.
ISRN obstetrics and gynecology 03/2014; 2014:124206. DOI:10.1155/2014/124206
Available from: Fabiana Flores Sperandio
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