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Prediction Models for Postpartum Urinary and Fecal Incontinence in Primiparous Women

Jelovsek, J. Eric MD, MMEd*; Piccorelli, Annalisa PhD; Barber, Matthew D. MD, MHS*; Tunitsky-Bitton, Elena MD*; Kattan, Michael W. PhD

Female Pelvic Medicine & Reconstructive Surgery:
doi: 10.1097/SPV.0b013e31828508f0
Original Articles
Abstract

Objectives: This study aimed to develop and internally validate a nomogram that facilitates decision making between patient and physician by predicting a woman’s individual probability of developing urinary (UI) or fecal incontinence (FI) after her first delivery.

Methods: This study used Childbirth and Pelvic Symptoms Study data, which estimated the prevalence of postpartum UI and FI in primiparous women after vaginal or cesarean delivery. Two models were developed using antepartum variables, and 2 models were developed using antepartum plus labor and delivery variables. Urinary incontinence was defined by a response of leaking urine “sometimes” or “often” using the Medical, Epidemiological, and Social Aspects of Aging Questionnaire. Fecal incontinence was defined as any involuntary leakage of mucus, liquid, or solid stool using the Fecal Incontinence Severity Index. Logistic regression models allowing nonlinear effects were used and displayed as nomograms. Overall performance was assessed using the Brier score (zero equals perfect model) and concordance index (c-statistic).

Results: A total of 921 women enrolled in the Childbirth and Pelvic Symptoms Study, and 759 (82%) were interviewed by telephone 6 months postpartum. Two antepartum models were generated, which discriminated between women who will and will not develop UI (Brier score = 0.19, c-statistic = 0.69) and FI (Brier score = 0.10, c-statistic = 0.67) at 6 months and 2 models were generated (Brier score = 0.18, c-statistic= 0.68 and Brier score = 0.09, c-statistic = 0.68) for predicting UI and FI, respectively, for use after labor and delivery.

Conclusions: These models yielded 4 nomograms that are accurate for generating individualized prognostic estimates of postpartum UI and FI and may facilitate decision making in the prevention of incontinence.

In Brief

This study demonstrates 4 nomograms that can accurately generate individualized estimates of postpartum urinary and fecal incontinence to facilitate decision making in the prevention of incontinence.

Author Information

From the *Obstetrics, Gynecology & Women’s Health Institute, and †Lerner Research Institute, Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH.

Reprints: J. Eric Jelovsek, MD, MMEd, Obstetrics, Gynecology, & Women’s Health Institute, 9500 Euclid Ave, Desk A81 Cleveland, OH 44195. E-mail: jelovsj@ccf.org.

The authors have declared they have no conflicts of interest.

Presented at the American Urogynecologic Society (AUGS) 2011 Annual Conference. Award for Best Clinical/Nonsurgical Paper.

This study demonstrates 4 nomograms that can accurately generate individualized estimates of postpartum urinary and fecal incontinence to facilitate decision making in the prevention of incontinence.

© 2013 by Wolters Kluwer Health | Lippincott Williams & Wilkins