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Medline ® Abstract for Reference 77

of 'Urinary incontinence and pelvic organ prolapse associated with pregnancy and childbirth'

Risk of postpartum urinary incontinence associated with pregnancy and mode of delivery.
Foldspang A, Hvidman L, Mommsen S, Nielsen JB
Acta Obstet Gynecol Scand. 2004;83(10):923.
AIM: The aim was to estimate the postpartum urinary incontinence (PP UI) impact of precursory UI during pregnancy (PR UI) and delivery performed by cesarean section (CS) vs. vaginal childbirth (VC).
METHODS: Among the members of two population samples, in total 8610 women aged 20-59 years, 1232 had their first childbirth and 642 their second childbirth within 13-120 months prior to responding to a questionnaire that included information on PR UI occurrence, mode of delivery and PP UI occurrence.
RESULTS: CS was applied in 12.2% of first childbirths, and 87.8% thus delivered vaginally; PR UI during the pregnancy leading to the first childbirth was reported by 15.6%, and a total of 26.3% reported PP UI. An increased PP UI occurrence was reported following VC (28.3% vs. 12.0% in women undergoing CS, p<0.001) and after PR UI (first childbirth, 66.7% vs. 18.8% in women not reporting PR UI, p<0.0001). Among cases of PP UI following the first childbirth, 56.1% and 69.5% of cases could be attributed to PR UI and VC, respectively.
CONCLUSIONS: The highest PP UI risks were found among women complaining of PR UI, which manifested itself as a crucial, independent precursor of PP UI. Because of the high frequency of VC, more than seven out of 10 cases of UI following the first childbirth, however, seemed to be attributable to VC. The present data did not lend significant support to the assumption that the PP UI risk is also lowered after a subsequent delivery by CS.
Department of Epidemiology and Social Medicine, University of Aarhus, Skejby, Denmark. af@mph.au.dk