分娩方式对产后妇女粪失禁及尿失禁的影响

目的 调查女性产后粪失禁和尿失禁的发生率及其相关因素.方法 电话随访2006年10月1日至2007年9月30日在北京大学第一医院妇产科分娩的产妇,共纳入2012例妇女,收集其产后6个月内粪失禁和尿失禁的症状.采用Logistic回归法分析分娩方式与尿失禁和粪失禁的关系.结果 (1)参与调查的2012例产后妇女,14例(0.70％)有粪失禁症状.Logistic回归分析显示,粪失禁与阴道产钳助产(OR=20.09,95％ CI:3.64～110.90,P=0.000)和会阴侧切术分娩相关(OR=6.11,95％ CI:1.29～28.80,P=0.024).(2)2012例妇女中产后尿失禁、压力性尿失禁(stress urinary incontinence,SUI)、急迫性尿失禁(urge urinary incontinence,UUI)、混合性尿失禁(mixed urinary incontinence,MUI)的发病率分别为10.04％(202例)、8.15％ (164例)、0.94％(19例)和0.94％(19例).Logistic回归分析显示,与SUI相关的因素有:母亲年龄(OR=1.07,95％ CI:1.04～1.11,P=0.000)、母亲分娩前体重(OR=1.04,95％CI:1.02～1.06,P=0.001)、新生儿头围(OR=1.20,95％ CI:1.05～1.39,P=0.010)、会阴侧切术分娩(OR=4.96,95％ CI:3.05～8.07,P=0.0005)、阴道自然分娩(OR=5.22,95％ CI:2.53～10.76,P=0.000)和阴道产钳助产(OR=9.20,95％ CI:4.07～20.79,P=0.000).与UUI相关的因素有:产妇分娩前体重(OR=1.51,95％CI:1.12～2.05,P=0.008).与MUI相关的因素有:产妇分娩前体重(OR=1.06,95％ CI:1.00～1.11,P=0.049)、第二产程时限(OR=1.01,95％ CI:1.00～1.03,P=0.010)、会阴侧切术分娩(OR=7.76,95％ CI:1.42～42.52,P=0.017)和阴道产钳助产(OR=15.21,95％ CI:1.61～143.44,P=0.018).(3)产后4d和产后42 d SUI的发病率较高分别为7.95％和9.10％.结论 (1)本院产后妇女粪失禁和尿失禁的发病率较先前报道的其他地区的发病率低.(2)阴道分娩是妇女产后粪失禁和尿失禁发生的高危因素,特别是阴道产钳助产和会阴侧切术分娩.(3)母亲的年龄、分娩前体重、新生儿出生时头围、阴道自然分娩、产钳助产、会阴侧切术是发生尿失禁的高危因素.     

Body mass index, recreational physical activity and female urinary incontinence in Gansu, China

Objective

To elucidate the influence of recreational physical activity, body mass index (BMI), and waist circumference on the risk of specific types of urinary incontinence.

Study design

We conducted a population-based cross-sectional survey in Gansu, China among 2603 women aged 20 years or older.

Results

The study found that BMI was positively associated with urinary incontinence (P for trend = 0.008) and the association was mainly observed for stress urinary incontinence (OR = 1.4, 95% CI: 1.1, 1.9 for BMI = 24.0-27.9 kg/m²; OR = 2.3, 95% CI: 1.5, 3.6 for BMI ≥ 28.0 kg/m²; P for trend = 0.0005). A positive association between stress incontinence (OR = 1.7, 95% CI: 1.2, 2.5) and waist circumference was observed for women who had waist circumference between 70 cm and 75 cm compared to waist circumference less than 70 cm. Recreational physical activity was inversely associated with overall and mixed urinary incontinence (P for trend <0.0001 for both). A significant interaction between physical activity and waist circumference was found for overall (P = 0.0007) and stress incontinence (P = 0.001).

Conclusions

The findings that physical activity inversely associated with urinary incontinence and its interaction with waist circumference warrant further investigation, particularly in prospective studies.     

Preoperative determinants for failure of transobturator tapes in the management of female urodynamic stress incontinence

Objectives

To determine significant preoperative risk factors for failure of transobturator tapes.

Methods

Secondary analysis of data from the E-TOT (Evaluation of Transobturator Tapes) study. Patient-reported outcomes (n = 310) and objective outcomes (n = 297) were analyzed using univariate and multivariate analyses.

Results

On univariate analysis, body mass index (BMI) ≥  35, maximum urethral closure pressure (MUCP) ≤ 30 cm H₂O, preoperative mixed incontinence on urodynamics, history of at least one previous incontinence procedure, and preoperative symptoms of urgency, nocturia, or urgency incontinence were associated with failure. On multivariate regression, BMI ≥ 35 (OR 6.37; 95% CI, 1.73-23.44; P = 0.005), nocturia (OR 2.18; 95% CI, 1.04-4.58; P = 0.039), urgency incontinence (OR 3.35; 95% CI, 1.07-10.51; P = 0.039), and previous incontinence surgery (OR 2.33; 95%CI, 1.1-5.48; P = 0.048) were independently associated with patient-reported failure. MUCP ≤ 30 cm H₂O (OR 7.06; 95% CI, 2.85-17.48; P < 0.001) and previous incontinence procedure (OR 6.22; 95%CI, 2.34-16.52; P < 0.001) were independently associated with objective failure.

Conclusion

History of previous incontinence surgery was the only independent risk factor for failure of transobturator tapes based on both the patient-reported and objective outcome.     

Postpartum evaluation of stress urinary incontinence among primiparas

Objective

To assess the prevalence of postpartum stress urinary incontinence (SUI); the relationship between postpartum SUI and mode of delivery; and the association between SUI and other obstetric factors.

Method

In this prospective study, 1000 primiparas with no history of UI were recruited and followed up for 4 months after delivery. The χ² and Fisher's Exact tests were used to calculate the effects of the nominal variables.

Result

The prevalence of postpartum SUI was 14.1%, and the mode of delivery was significantly associated with SUI. The prevalence rates were 15.9% after vaginal delivery, 10.7% after elective cesarean section (CS), and 25% after CS performed for obstructed labor. The prevalence of postpartum SUI was similar following spontaneous vaginal delivery and CS performed for obstructed labor (P = .21). Meanwhile, elective CS with no trial of labor was found to be associated with a significantly lower prevalence of postpartum SUI (P = .01; χ² = 12.42). A maternal body mass index greater than 30 before pregnancy and fetal weight higher than 3000 g appeared to be associated with an increased rate of SUI (P = .001; χ² = 17.6 and P = .000; χ² = 22.5, respectively).

Conclusion

Elective CS significantly reduced the rate of postpartum SUI.     

Incontinencia anal postparto y control evolutivo hasta los doce meses

Objectives

To determine the prevalence of anal incontinence (AI) of faeces and gases, as well as the factors associated with the pregnancy, delivery and postpartum.

Design

Twelve-month follow-up study with visits at 2, 6 and 12 months.

Settings

Vic General Hospital as a basic general hospital in the Osona region (Central Catalonia, Spain).

Subject of the study

Women who had a live birth at full-term between the 1^st of January 2001 and the 31^st of March 2002.

Methodology

During admission for childbirth, data were collected on the mother (age, parity, body mass index, symptoms of incontinence during pregnancy), the type of delivery (vaginal, caesarean) and the foetus (weight, cranial circumference). Two months after parturition, the mothers were examined by a gynaecologist to detect and establish the clinical diagnosis of anal incontinence by means of a specific protocol. The women were asked whether they had symptoms of involuntary release of faeces or gases: women with symptoms of AI underwent a pelvic examination before being referred to a specialist in coloproctology for an assessment. Women with symptoms of AI at 2 months postpartum were recalled at 6 months for a new clinical assessment by the gynaecologist, and after 12 months all those who had shown persistence of symptoms at 6 months were contacted by phone. The prevalence of anal incontinence at 2 months postpartum was calculated and also the association of symptoms with maternal, foetal and delivery factors.

Results

A total of 531 women were visited at 2 months postpartum. Of these, 11 were diagnosed with anal incontinence. At 12 months post partum, 4 (36.4%) of these 11 women continued to have symptoms of incontinence. The prevalence of anal incontinence at 2 months after delivery was 2.1% (95% CI: 1.0-3.7) and was associated with primiparity (Odds ratio [OR] = 7.21, P = 0.029) and forceps use (OR = 5.54, P = 0.021).

Conclusions

The prevalence of AI symptoms at 12 months after parturition was low but in a half of the patients the symptoms were prevalent for more than 6 months. Primiparity and forceps use are associated with the AI symptoms at 2 months postpartum.     

A prospective study of pelvic floor dysfunctions related to delivery

Objective

To estimate the prevalence and impact on quality of life of urinary incontinence (UI) and anal incontinence (AI) three months after first delivery; to identify risk factors involved in UI or AI; to evaluate possible changes in sexual behaviour and anatomical modifications of pelvic floor after childbirth.

Study design

A multicenter prospective study, in six Italian Ob/Gyn departments, of nulliparous women who delivered at term (37-42 weeks of gestation) between April and September 2005. A structured questionnaire investigated several maternal and obstetric variables. UI and AI were assessed by administration of the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and according to Wexner's Continence Grading Scale, at 2-3 days post-partum and at 3 months after delivery. Changes in sexual behaviour, and pelvic floor condition after delivery, were also recorded. Statistical analysis included comparison of means (Mann-Whitney or Student's t-test) and proportions (Chi-square test). Multiple logistic regression analysis was performed including variables that were significant in univariate comparisons.

Results

Of 960 enrolled women, 744 were evaluated 3 months after delivery and included in final analysis. The prevalences of UI and AI at that time were 21.6% and 16.3%, respectively. Onset of incontinence during pregnancy was an independent predictor for persistent UI (Odds Ratio (OR) 4.6, Confidence Interval (CI) 3.1-6.8, p < 0.001) and AI (OR 3.6, CI 2.2-6.1, p < 0.001). Family history of urinary or anal incontinence were respectively associated with UI (OR 2.6, CI 1.6-4.0, p < 0.001) and AI (OR 2.4, CI 1.4-4.0, p < 0.001) 3 months after delivery. Among obstetric factors, vaginal delivery was a strong risk factor for UI (OR 3.3, CI 2.0-5.3, p < 0.001). The sexual score improved 3 months after delivery in 72.4% of women. Urogynaecological evaluation showed a significant association between grade 1-2 anterior prolapse, urethral hypermobility and UI.

Conclusion

New onset of UI or AI during pregnancy, positive family history and vaginal delivery are independent risk factors for the persistence of symptoms of UI and AI in the early postpartum period. Adequate counselling and the implementation of targeted strategies to prevent or early identify these conditions are therefore mandatory to improve the patient's quality of life.     

Risk factors for urinary incontinence among women aged 60 or over with hypertension in Taiwan

ObjectiveTo assess the associated risk factors and the prevalence of urinary incontinence (UI) among women with hypertension (H/T) aged 60 or over in Taiwan.Materials and MethodsA total of 2410 women aged 60 or over were selected by a multistage random sampling method and a total of 1519 women completed the face-to-face interviews. Only women who answered “yes” to the question “Do you have H/T?” were included in the H/T sample. The factors were assessed by frequency and Pearson's χ² test using a significance level of p < 0.05. Logistic regression was used to investigate the significance of dichotomous dependent variables.ResultsA total of 39.7% (602 women) interviewees had H/T, among which 39.9% (240 women) had UI symptoms. The prevalence of UI among women aged 60 or over with or without H/T was significantly different (p = 0.006). Risk factors were age [odds ratio (OR) = 1.043, 95% confidence interval (CI) 1.016–1.071, per year], diabetes mellitus (DM) (OR = 1.653, 95% CI 1.105–2.474), previous urinary diseases (OR = 3.462, 95% CI 2.260–5.301), and body mass index (BMI; OR = 1.060, 95% CI 1.012–1.110, per unit). There was no significant association between UI and drug allergy, smoking, hysterectomy, hormone therapy, or gynecological surgery.ConclusionUI can be a frequent and annoying problem for aged women. In women with H/T, UI is significantly related to risk factors such as age, DM, BMI, and urinary diseases. In addition, BMI is considered a key risk factor for H/T. Therefore, effective control of BMI would help in controlling H/T and UI in aged women.     

Prevalence and impact of urinary incontinence among female athletes

Objective

To assess the prevalence of urinary incontinence (UI) in a group of female athletes and to explore its impact on their lives.

Methods

In total, 106 female athletics, basketball, and indoor football athletes were recruited. Data were collected through a questionnaire and a focus group and analyzed via Pearson's χ² test, 2-way analysis of variance, and thematic analysis.

Results

Urinary incontinence was experienced by 41.5% of the athletes. Its prevalence across the 3 types of sport was similar and was not affected by age. However, athletes who experienced UI had a lower body weight (P = 0.011) and a lower body mass index (P = 0.035). Most (95.5%) athletes had never discussed their condition with a health professional. In the focus group, all athletes described preventive urination to avoid urine leakage. It was mentioned that UI affected their performance and made them feel uncomfortable and frustrated.

Conclusion

Urinary incontinence is a prevalent condition among athletes that is not openly discussed. However, it causes regular changes in their physical performance and daily life. More research is needed to increase awareness of UI and to design interventions.     

Prevalence and Risk Factors for Urinary and Fecal Incontinence Four Months After Vaginal Delivery

ObjectiveTo determine the prevalence of and risk factors for urinary and fecal incontinence four months after vaginal delivery.MethodsAll patients who had vaginal deliveries at a tertiary care hospital over a three-month period were approached during their postpartum hospital stay regarding participation in the study. Participants underwent a telephone interview at four months after their delivery to determine the presence and type of any incontinence.ResultsOf 632 patients, 145 (23%) had stress incontinence, 77 (12%) had urge incontinence, 181 (29%) had any urinary incontinence and 23 (4%) had fecal incontinence. In univariate analysis, stress incontinence was found to be increased in patients ≥30 years of age (26.2%) compared with patients < 30 years of age (19.3%) (RR 1.4; 95% CI 1.0–1.8, P = 0.05). Urge incontinence was increased in patients who had a forceps delivery (21%) compared with no forceps delivery (9%) (RR 2.2; 95% CI 1.4–3.6, P = 0.005), an episiotomy (32.4%) compared with no episiotomy (18.7%) (RR 1.9; 95% CI 1.2–2.9, P < 0.01) and a longer second stage of labour (108 min vs. 77 min, P = 0.01). The prevalence of any urinary incontinence was increased with forceps delivery (15.5%) compared with no forceps delivery (8.7%) (RR 1.5; 95% CI 1.1–2.1, P = 0.01) and maternal age of ≥30 years (34.1%) compared to < 30 years (23.5%) (RR 1.5; 95% CI 1.1–1.9, P = 0.003). In multivariate analysis, the two variables that remained significant for any urinary incontinence were maternal age ≥30 years (P < 0.01) and forceps delivery (P < 0.01). There were no identified risk factors for fecal incontinence.ConclusionUrinary incontinence is common in women at four months post partum. Fecal incontinence is less common. Maternal age and forceps assisted delivery were risk factors for urinary incontinence.     

Concomitant surgical correction of occult stress urinary incontinence by TOT in patients with pelvic organ prolapse

Objectives

To assess the post-operative urinary incontinence states of pelvic organ prolapse cases operated on with concomitant trans-obturator tape (TOT) procedure.

Study design

Urodynamic evaluation of 79 patients with pelvic organ prolapse, before and after operation, while reducing the prolapsed organs by ring forceps placed bilaterally on the anterolateral sulcuses avoiding urethral compression. According to urodynamic tests, 25 patients were diagnosed as having occult stress urinary incontinence.

Results

Post-operative overactive bladder, stress urinary incontinence and mixed incontinence were found in three (12%), two (8%) and one (4%) patients of the occult stress urinary incontinence group, respectively. The corresponding numbers were six (11%), five (9%) and three (6%) in the continent group. No significant difference was found between the groups in terms of post-operative overactive bladder symptoms, stress urinary incontinence and mixed incontinence (Kruskal-Wallis test, X² = 0.52, p = 0.820).

Conclusions

This retrospective study suggests that a complete pre-operative urodynamic evaluation, including urodynamic tests at the time of POP reduction by placing ring forceps on the anterolateral sulcuses, is an efficient method for the diagnosis of occult symptomatic stress urinary incontinence (SUI). Prospective randomized studies are needed to establish the benefits and the risks of concomitant prophylactic surgery in patients with pelvic organ prolapse.     

Tension-free vaginal tape-obturator in the treatment of stress urinary incontinence: a prospective study with five-year follow-up

Objective

To investigate the prevalence of anal incontinence (AI) in woman with urinary incontinence (UI) and pelvic organ prolapse (POP). We also evaluated the impact on quality of life (QoL).

Study design

One hundred and ninety patients with UI or POP and 73 controls were recruited. AI was investigated by the Wexner index and the prevalence rates were obtained in all groups. Patients with AI completed the Fecal Incontinence Quality of Life questionnaire (FIQL). QoL was assessed using the Medical Outcome Study 36-item Short Form Health Survey (SF-36).

Results

AI prevalence was 40.54% in the UI group and 27.91% in the POP group (p < 0.0001). In the UI and POP groups correlations were found between the Wexner score and the domains of the FIQL and SF36.

Conclusion

The UI group had higher prevalence of AI than the other groups. The AI adversely affected the QoL of patients.     

Short vs long second stage of labour: is there a difference in terms of postpartum anal incontinence?

Objective

Our purpose was to determine if prolonged second-stage labour independently increases postpartum anal incontinence.

Study design

360 primiparous women were studied retrospectively after vaginal delivery of term cephalic singletons, including a group with short second-stage labour (<30 min, n = 163) and a group with a prolonged second stage (>90 min, n = 197). A quality of life questionnaire on anal incontinence (FIQOL) was sent out at 15 months after delivery.

Results

184 women (96 with short second-stage labour and 88 with a prolonged second stage) answered the questionnaire (response rate 51%). Flatus incontinence was reported after prolonged second-stage labour in 9.1% of women vs 15.6% after short second stage (p = 0.18). Fecal incontinence was reported after prolonged second-stage labour in 2.3% vs 5.2% after a short second stage (p = 0.45).

Conclusion

We suggest that prolonged second stage of labour should not be associated with an increased risk of postpartum incontinence.     

Tension-free vaginal tape-obturator in the treatment of stress urinary incontinence: a prospective study with five-year follow-up

Objectives

To evaluate the medium-term outcomes of using tension-free vaginal tape-obturator (TVT-O) in the treatment of patients with stress urinary incontinence (SUI).

Study design

Between December 2004 and November 2005, 103 patients with SUI were enroled and treated with TVT-O with inside-out modification. A minimum five-year follow-up (median, 65 months) was obtained from 100 patients (99.6%). Preoperative and postoperative evaluations were performed for all patients. The objective success rate of the TVT-O procedure was evaluated by a negative stress test. The secondary outcomes measured included one- and five-year subjective success rates, together with the pre- and post-operative urodynamic parameters, complications, quality of life (QOL) analysis, and patient satisfaction.

Results

Among the 103 patients, 18 (17.4%) had postoperative voiding difficulties and needed urethral bladder catheterization for various periods. After the TVT-O procedure, complete disappearance of SUI occurred in 87.4% of patients, while improvement was found in about 92%. In addition, there was no difference in the cure rate between year 1 and year 5 after the procedure (P > 0.05). In 90 patients, frequency and urge symptoms were significantly improved five years after the procedure (P < 0.005), and maximal flow rates were decreased (P < 0.05). However, the severity of obstructive symptoms and postvoid residual volumes at five years were not improved compared with one year after the procedure (P = 0.10 and P = 0.33 respectively). Finally, compared to pre-operation, incontinence severity degree and QOL scale scores were largely improved after the operation (P < 0.001), while no difference was found between years 1 and 5 (P = 0.11and P = 0.09 respectively).

Conclusions

Our result shows that the TVT-obturator, a novel mid-urethral sling, is a safe and effective procedure for the treatment of female SUI. Medium-term therapeutic results appear promising but further evaluation of long-term therapeutic outcomes is needed.     

A 5-year follow-up study comparing Burch colposuspension and transobturator tape for the surgical treatment of stress urinary incontinence

Objective

To compare the effectiveness of transobturator tape (TOT) and Burch colposuspension in the treatment of stress urinary incontinence (SUI).

Methods

The present retrospective study included 770 patients who underwent SUI surgery with Burch colposuspension (n = 498) or TOT (n = 272). Clinical follow-up occurred at 2 weeks, 3, 6, and 12 months, and annually thereafter. Objective and subjective cure rates and intra- and postoperative complications were assessed.

Results

Among patients who had SUI surgery without another concomitant procedure, the Burch group had a significantly longer mean operation time (41.48 ± 10.61 minutes versus 23.77 ± 10.49 minutes; P < 0.001) and a significantly longer length of hospital stay (3.11 ± 0.49 days versus 1.98 ± 0.40 days; P < 0.001), compared with the TOT group. The rates of unintended functional outcomes were lower among women undergoing TOT than among those undergoing the Burch procedure (long-term voiding dysfunction 0.7% versus 4.2%, P = 0.007; urinary retention 10.7% versus 26.9%, P < 0.001). The 5-year cure rates were similar in the 2 groups (objective cure rate, 73.9% versus 77.5%, P = 0.574; subjective cure rate, 76.8% versus 81.7%, P = 0.416).

Conclusion

In terms of efficacy, TOT appears equal to Burch colposuspension; however, TOT has fewer unintended functional outcomes than Burch colposuspension.     

Complications of mid-urethral slings for treatment of stress urinary incontinence

Objective

To compare the incidence of complications associated with the use of retropubic tension-free vaginal tape (TVT) and transobturator tension-free vaginal tape (TVT-O) for the management of stress urinary incontinence (SUI).

Methods

In a cross-sectional study, 1081 patients were treated for SUI via mid-urethral slings, and the outcomes of those treated via TVT and those treated via TVT-O were compared. Patients who suffered from recurrent or mixed urinary incontinence were excluded.

Results

Group 1 included patients treated via TVT (n = 207) and group 2 included those treated with TVT-O (n = 570). There was a higher incidence of bladder perforation (5.4% versus 0.6%; P = 0.001) and hematoma formation (9.1% versus 1.5%; P = 0.001) in group 1 than in group 2. Compared with group 1, there was higher incidence of vaginal wall perforation in group 2 (0.0% versus 3.8%, P = 0.044). The rate of intraoperative complications was not related to patient age, body mass index, or parity. Of the patients who did not leak urine during a cough test 1 month after surgery, 90.9% still had a negative cough test at the long-term follow-up.

Conclusion

TVT-O was superior to TVT with regard to the incidence of bladder perforation and hematoma formation, but it resulted in more vaginal wall injuries.     

Association of GSTP1 −313A/G polymorphisms and endometriosis risk: a meta-analysis of case–control studies

Objectives

In view of the controversies surrounding the association of glutathione S-transferases (GST) P1 with endometriosis, a meta-analysis of GSTP1 −313A/G polymorphism with endometriosis risk was performed.

Study design

The relevant studies were identified through a search of PubMed, Excerpta Medica Database (Embase), Elsevier Science Direct and Chinese Biomedical Literature Database (CBM) until March 2013. The association between GSTP1 −313A/G polymorphism and endometriosis risk was pooled by odds ratios (ORs) together with their 95% confidence intervals (95% CIs).

Results

A total of eight case–control studies were eventually identified. We found that GSTP1-313A/G polymorphism was not associated with endometriosis risk in the overall population (A vs. G: OR = 1.02, 95% CI = 0.97–1.07, P = 0.511; AA vs. GG: OR = 1.02, 95% CI = 0.98–1.06, P = 0.359; GA vs. GG: OR = 1.03, 95% CI = 0.98–1.08, P = 0.299; AA vs. GA/GG: OR = 1.01, 95% CI = 0.96–1.07, P = 0.621; AA/GA vs. GG: OR = 1.00, 95% CI = 0.97–1.03, P = 0.972). In the sub-group analysis based on ethnicity, a significant association was found in Caucasians under the recessive model (AA vs. GA/GG: OR = 1.28, 95% CI = 1.08–1.53, P = 0.006).

Conclusions

GSTP1 −313A/G polymorphism may not be associated with endometriosis risk, while the observed increase in risk of endometriosis may be due to small-study bias. Considering the limited sample size and ethnicity included in our meta-analysis, an updated meta-analysis will be urgently needed when further larger and well-designed studies are published.     

A nomogram model predicting the risk of postpartum stress urinary incontinence in primiparas: A multicenter study

Stress urinary incontinence (SUI) is a common gynecological urinary system disease, and globally, 200 million or more people suffer from it. However, the existing literature mostly focuses on postpartum urinary incontinence (UI) or UI in middle-aged and elderly people, with little focus on primiparas. To analyse urinary incontinence prevalence and its risk factors in primiparas and establish a nomogram prediction model, 360 parturients were recruited from three hospitals between April and September 2021. A homemade electronic questionnaire was used to investigate the general demographic and perinatal characteristics of primiparas. The SUI was diagnosed by the physicians. Logistic regression analysis of independent risk factors for SUI and a nomogram prediction model were established. Ninety people were diagnosed as SUI. The number of pregnancies (OR = 3.322, 95% CI = 1.473–7.492), residence (OR = 5.451, 95% CI = 2.725–10.903), occupation (OR = 3.393, 95% CI = 1.144–10.064), education level (OR = 3.551, 95% CI = 1.223–10.308), delivery method (OR = 10.270, 95% CI = 4.090–25.789), and oxytocin use (OR = 2.166, 95% CI = 1.142–4.109) were independent risk factors for SUI. The C-index of the nomogram prediction model was 0.798 (95% CI = 0.749–0.846). The POPDI score, CRADI score, UDI score, and PFDI scores of women with SUI were significantly higher than those of non-SUI women, while I-QOL scores were significantly lower than those of non-SUI women. In conclusion, the prevalence of SUI among primiparas in Fuyang, China, was 25.00%, which exhibited a large impact on the quality of life of puerperae. The present study successfully established an individualized nomogram prediction model of SUI for primiparas with good discrimination and diagnostic efficiency, which was helpful for the early clinical identification of high-risk primiparas with SUI.     

The impact of pregnancy and vaginal delivery on urinary incontinence

Objective

To identify women who had urinary incontinence (UI) before, during, and after pregnancy, and to determine whether women with symptoms of UI during pregnancy were the same women who had urinary incontinence postpartum.

Methods

All primigravid women who delivered within 1 year (1999) at the Charité Hospital in Berlin received a questionnaire about UI at 5 different time points during pregnancy and the postpartum period.

Results

Of 610 eligible women, 411 (67.4%) completed the questionnaire. The prevalence of urinary incontinence increased significantly in the second half of pregnancy (26.3%, P < 0.001). Although the overall number of women who reported UI within 6 weeks after delivery (28.5%) was almost the same as the number reporting UI in the second half of pregnancy, approximately every second women changed from being continent to incontinent and vice versa.

Conclusion

The group of women who experienced UI postpartum was different from the group that experienced UI before delivery and vice versa. Pregnancy itself may influence pelvic floor function in a different way compared with vaginal delivery.     

Fecal incontinence in pregnancy and post partum

Objective

To assess the prevalence of fecal incontinence (FI) during pregnancy and post partum, and to determine any associations with demographic and birth variables.

Methods

Secondary analysis of 240 primiparous women conducted during pregnancy and post partum. Women were asked at various time points if they had lost control over their stool or bowel movements, and if they were practicing Kegel exercises. Associations of bowel symptoms with demographic and birth data were evaluated.

Results

Most participants were white (87%), with a median age of 30 years (range, 18-42 years). Women who reported fecal incontinence at 1 year were more educated than those who did not report it. No other demographic or birth data were associated with fecal incontinence at 1 year.

Conclusions

Prevalence of FI during pregnancy and post partum is low and not linked to low-risk birth. Furthermore, when FI occurs it is often sporadic. This should be reassuring to patients and providers alike.