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Saturday, February 15, 2014

Trailers (74): Mode of delivery and urinary incontinence

Chang et al. Association of mode of delivery with urinary incontinence and changes in urinary incontinence over the first year postpartum

Why should you read about this topic?

Elective cesarean delivery will not go away.  We need to know the postpartum experiences influenced by mode of delivery in order to counsel women facing the decision.

What were the authors trying to do?

To determine if there is an association between mode of delivery and prevalence and trend of severity of urinary incontinence in the first postpartum year

Who participated and in what setting?

Women (N=749) at least 18 years of age delivering at the National Taiwan University Hospital between 2010 and 2011.

What was the study design?

Prospective, observational, longitudinal questionnaire

What were the main outcome measures?

Self-reported ICIQ-Urinary Incontinence score

What were the results?

Women with vaginal delivery had a higher prevalence of any urinary incontinence throughout the first postpartum year than women with cesarean delivery.  However, there was no association between mode of delivery and interference with activities of daily living after 6 weeks postpartum.

What is the most interesting image in the paper?

Figure 2

What were the study strengths and weaknesses?

Strengths: validated questionnaire; longitudinal design.  Weaknesses: high (56%) drop-out rate; undisclosed power analysis

What does the study contribute for your practice?

Vaginal delivery was associated with a higher prevalence of any incontinence compared with cesarean delivery over most of the first postpartum year.  Although the prevalence for any urinary incontinence, and stress incontinence in particular, increased over the first year postpartum for women with vaginal delivery, the severity of the incontinence improved, yielding an improvement in scores for interference with daily life.