TO COMPARE THE INCIDENCE, RISK FACTORS, AND QUALITY OF LIFE OF WOMEN WITH URINARY INCONTINENCE AFTER CESAREAN SECTION AND VAGINAL DELIVERY- A CHORT STUDY
LIANG1, W. HSIEH 2, Y. LIN 3;
1Obstetrics and Gynecology, Chang Gung Mem. Hosp., Linkou Med. Cente, Taoyuan, Taiwan, 2Chang Gung memorial Hosp., Taoyuan City, Taiwan, 3Obstetrics and gynecology, Chang Gung Mem. Hosp., Tao-Yuan, Taiwan.
Introduction: Pregnancy and birth trauma are thought to be associated with the development of urinary incontinence (UI). Previous studies showed the reported prevalence of UI in women after delivery is 7-56% and declines rapidly within 6 months. Until now, there is no consensus with regard to the contributing factors of obstetric UI. UI can disturb life quality of women, but only few studies have been conducted to evaluate the impact of UI on the health-related quality of life of women after childbirth.
Objective: To compare the incidence, risk factors, and quality of life of women with urinary incontinence between cesarean section and vaginal delivery during pregnancy and 12 months after delivery.
Methods: 866 women delivering their newborns at a tertiary hospital were recruited. On the second or third postpartum day, they were asked to complete several questionnaires including demographic and obstetric data, Short Form 12 health survey (SF-12), Urogenital Distress Inventory Short Form (UDI-6), and Incontinence Impact Questionnaire Short Form (IIQ-7). All women were interviewed via telephone to answer the same questionnaires at 3 and 12 months postpartum.
Results: There were 446 (51.5%) self-reported UI women during pregnancy. Out of 560 women delivered vaginally, 110 (19.6%) replied with UI at 3 months postpartum and 70 (12.5%) had UI when follow-up at 12 months postpartum; in 306 women undergoing Cesarean delivery, 29 (9.5%) and 22 (7.2%) experienced UI at 3 and 12 months postpartum, respectively. Risk factors of UI during pregnancy included body weight and body mass index at first visit. At 3 months follow-up, contributing factors of persistent UI after vaginal delivery included parity, first and second stage of labor, and instrumental delivery; while the significant risk factor of persistent UI after Cesarean section was birth weight. At 12 months postpartum, parity stood out as the risk factor of persistent UI in vaginal delivery group, but no significant risk factor was found in Cesarean group. Women with UI during pregnancy featured worse mental component summary (MCS) score of SF-12, when compared to women without UI. At 3 and 12 months after delivery, women with persistent UI in vaginal delivery group had higher mean UDI-6 and IIQ-7 scores than those without UI.
Conclusions: Postpartum UI is more prevalent in the vaginal delivery group than Cesarean group. Both UI during pregnancy and after childbirth have negative impact on the quality of life in women undergoing vaginal delivery.
References: 1. Urinary incontinence in nulliparous women before and during pregnancy: prevalence, incidence, and associated risk factors. Int Urogynecol J. 2010;21:193-202. 2. Urinary incontinence after vaginal delivery or caesarean section. New Engl J Med. 2003;348:900-7. 3. Bothersome lower urinary tract symptoms 1 year after first delivery: prevalence and the effect of childbirth. BJU Int. 2006;98:89-95.