Prevalence and risk factors of persistent stress urinary incontinence at three months postpartum in Indonesian women
Background: Mode of delivery and some certain risk factors have a relationship to postpartum stress urinary incontinence (SUI). For that reason, the objective of this study was 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 demographic and obstetric factors.
Methods: In this prospective observational cohort study, all primiparous women who were under postpartum care in obstetric and gynecologic ward were recruited. Four hundreds primiparous women with no history of urinary incontinence (UI) who fulfilled the criteria and would like to participate in this study were followed up for three months after delivery. The analysis was done using Stata 12. Bivariate analysis using Chi-square test and multivariate analysis using logistic regression test were done to obtain associated risk factors to postpartum SUI.
Results: The prevalence of postpartum SUI was 8.8%. The mode of delivery was significantly associated with postpartum SUI, there were more women who got vaginal delivery that had stress urinary incontinence (14.1%) compared to women caesarean section (7.1%) with OR=2.1 (95% CI=1.05-4.31), this risk increased when vaginal delivery was assisted with vacuum instrument (OR=9.1, 95% CI=3.9-21.6). There was no statistical difference of stress urinary incontinence incidences in patients with emergency or elective caesarean section with OR=0.84 (95% CI=0.28-2.57). Based on multivariate analysis BMI â¥30 kg/m2 at labor, vacuum assisted delivery, birth weight more than 3,360 g, and second stage labor more than 60 minutes appeared to be associated with an increased rate of postpartum SUI.
Conclusion: Stress urinary incontinence increased in the early postpartum period of a primiparous woman. Although vaginal delivery increased the risk of postpartum SUI, elective nor emergency caesarean delivery without vaginal delivery id not appear to increase the risk of stress urinary incontinence.
Amaro JL, Macharelli CA, Yamamoto H, Kawano PR, Padovani CV, Agostinho AD. Prevalence and risk factors for urinary and fecal incontinence in Brazilian women. Int Braz J Urol. 2009;35(5):592â7. http://dx.doi.org/10.1590/S1677-55382009000500011
Schultz SE, Kopec JA. Impact of chronic conditions. Health Rep. 2003;14(4):41â53.
Rortveit G, Daltveit AK, Hannestad YS, Hunskaar S. Urinary incontinence after vaginal delivery or cesarean section. N Engl J Med. 2003;348:900â7. http://dx.doi.org/10.1056/NEJMoa021788
Carpenter DA, Visovsky C. Stress urinary incontinence: a review of treatment options. AORN J. 2010;91(4):471â8. http://dx.doi.org/10.1016/j.aorn.2009.10.023
Wilson L, Brown JS, Shin GP, Luc KO, Subak LL. Annual direct cost of urinary incontinence. Obstet Gynecol. 2001;98(3):398â406. http://dx.doi.org/10.1097/00006250-200109000-00007
Holroyd-Leduc JM, Straus SE. Management of urinary incontinence in women: scientific review. JAMA. 2004;291(8):986â95. http://dx.doi.org/10.1001/jama.291.8.986
Thom DH, Rortveit G. Prevalence of postpartum urinary incontinence: a systematic review. Acta Obstet Gynecol Scand. 2010;89(12):1511â22. http://dx.doi.org/10.3109/00016349.2010.526188
Bajuadji HS. Stres inkontinensia urin pascapersalinan [thesis]. Jakarta: Universitas Indonesia; 2004. p. 71.
Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An International Urogynecological Association (IUGA) / International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010;21(1):5â26. http://dx.doi.org/10.1007/s00192-009-0976-9
Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89(4):501â6. http://dx.doi.org/10.1016/S0029-7844(97)00058-6
Memon HU, Handa VL. Vaginal childbirth and pelvic floor disorders. Womens Health (Lond Engl). 2013;9(3):1â18. http://dx.doi.org/10.2217/whe.13.17
Boyles SH, Li H, Mori T, Osterweil P, Guise JM. Effect of mode of delivery on the incidence of urinary incontinence in primiparous women. Obstet Gynecol. 2009;113(1):134â41. http://dx.doi.org/10.1097/AOG.0b013e318191bb37
Groutz A, Rimon E, Peled S, Gold R, Pauzner D, Lessing JB, et al. Cesarean section: does it really prevent the development of postpartum stress urinary incontinence? A prospective study of 363 women one year after their first delivery. Neurourol Urodyn. 2004;23(1):2â6. http://dx.doi.org/10.1002/nau.10166
McKinnie V, Swift SE, Wang W, Woodman P, O'Boyle A, Kahn M, et al. The effect of pregnancy and mode of delivery on the prevalence of urinary and fecal incontinence. Am J Obstet Gynecol. 2005;193(2):512â7. http://dx.doi.org/10.1016/j.ajog.2005.03.056
MacLennan AH, Taylor AW, Wilson DH, Wilson D. The prevalence of pelvic floor disorders and their relationship to gender, age, parity and mode of delivery. BJOG. 2000;107(12):1460â70. http://dx.doi.org/10.1111/j.1471-0528.2000.tb11669.x
Viktrup L, Lose G, Rolff M, Barfoed K. The symptom of stress incontinence caused by pregnancy or delivery in primiparas. Obstet Gynecol. 1992;79(6):945â9.
Viktrup L, Lose G. The risk of stress incontinence 5 years after first delivery. Am J Obstet Gynecol. 2001;185(1):82â7. http://dx.doi.org/10.1067/mob.2001.114501
Burgio KL, Zyczynski H, Locher JL, Richter HE, Redden DT, Wright KC. Urinary incontinence in the 12-month postpartum period. Obstet Gynecol. 2003;102(6):1291â8. http://dx.doi.org/10.1016/j.obstetgynecol.2003.09.013
Bradley CS, Rovner ES, Morgan MA, Berlin M, Novi JM, Shea JA, et al. A new questionnaire for urinary incontinence diagnosis in women: development and testing. Am J Obstet Gynecol. 2005;192(1):66â73. http://dx.doi.org/10.1016/j.ajog.2004.07.037
Rijal C. Prevalensi inkontinensia urin dan faktor-faktor risiko yang berhubungan pada wanita yang tinggal di panti werdha [thesis]. Jakarta: Universitas Indonesia; 2013. p. 55. Indonesian.
Dahlan MS. Mendiagnosis dan menatalaksana 13 penyakit statistik disertai aplikasi program stata. Jakarta: Penerbit Salemba Medika; 2010. p. 285. Indonesian.
Glazener CM, Herbison GP, MacArthur C, Lancashire R, McGee MA, Grant AM, et al. New postnatal urinary incontinence: obstetric and other risk factors in primiparae. BJOG. 2006;113(2):208â17. http://dx.doi.org/10.1111/j.1471-0528.2005.00840.x
Tincello DG, Adams EJ, Richmond DH. Antenatal screening for postpartum urinary incontinence in nulliparous women: a pilot study. Eur J Obstet Gynecol Reprod Biol. 2002;101(1):70â3. http://dx.doi.org/10.1016/S0301-2115(01)00502-4
National Instutes of Health. NIH state-of-the-science conference: Cesarean delivery on maternal request. William H. Natcher Conference Center. 2006.
Eftekhar T, Hajibaratali B, Ramezanzadeh F, Shariat M. Postpartum evaluation of stress urinaryincontinence among primiparas. Int J Gyneacol Obstet. 2006; 94(2):114â8. http://dx.doi.org/10.1016/j.ijgo.2006.04.042
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