ICS
1999, Denver
Informally discussed
posters
Pelvic
floor
Urinary
incontinence after caesarean section and vaginal delivery - a pilot study
P. Hughes, S. Jackson, P.
Smith, P. Abrams
Bristol Urological
Institute and Dept of Obstetrics and Gynaecology, Southmead Hospital,, Bristol,
UK
Aims of Study: The incidence of urinary incontinence after child birth is quoted to be up to 33% (1). Vaginal delivery causes pelvic floor denervation and Caesarean section protects against this (2,3). It is therefore proposed that vaginal delivery causes urinary incontinence whilst Caesarean section is protective. Retrospective cohort studies (4) would support this hypothesis but prospective studies are lacking. We are therefore undertaking a large prospective study to compare the prevalence of symptoms of urinary incontinence before and after both vaginal delivery and elective Caesarean section. Our preliminary findings are presented here.
Methods: Nullipara women identified as planning to deliver by elective Caesarean section (CS) and those planning a spontaneous vaginal delivery (SVD) were asked to fill in a questionnaire (Bristol Female Urinary Tract Symptom questionnaire-BFLUTS (5)) antenatally. This questionnaire has been validated against perineal pad tests. Follow up was by a postal repeat BFLUTS questionnaire at 6 weeks postpartum. The groups were matched for age and birthweight.
Results: Currently 10 women have been delivered by elective Caesarean section and 20 women have had a spontaneous vaginal delivery. Further numbers will be presented. The median age of the elective Caesarean Section group was 29.5 years (range 23-42 years) and of the SVD group was 28 years (range 20-35 years). The median birth weight of the elective CS was 3.32 kg (range 2.78-4.52 kg) and that of the SVD group was 3.75kg (range 2.8-4.4 kg).
CS SVD CS 6wks SVD 6wks
antenatal antenatal postnatal postnatal
n=10 n=20 n=10 n=20
Does urine leak when you are physically
Active, exert yourself, cough or sneeze?
No 60% 25% 80% 60%
Yes 40% 75% 20% 40%
Do your urinary symptoms interfere with
Physical activity (eg walking, dancing,
Swimming)?
No 90% 65% 100% 85%
Yes 10% 35% 0 15%
Conclusions: These preliminary results show there is a lower incidence of symptoms of stress incontinence at 6 weeks after an elective Caesarean Section than after a spontaneous vaginal delivery. We acknowledge the present deficiencies of these figures: the numbers are small, there is a slightly lower birthweight in the elective CS group and that more women in the SVD group reported symptoms of stress incontinence antenatally. This is a pilot study of a large ongoing study and full statistical analysis will be performed with larger numbers in the future.
References