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International Urogynecology Journal

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01-05-2010 | Original Article

Obstetric risk factors and pelvic floor dysfunction 20 years after first delivery

Authors: Lucia M. Dolan, Paul Hilton

Published in: International Urogynecology Journal | Issue 5/2010

Abstract

Introduction and hypothesis

Intrapartum events at first delivery and subsequent childbearing are associated with long-term pelvic floor dysfunction (PFD).

Methods

Primigravidae delivered between 1983–1986 were identified; current addresses traced through the UK National Health Service database (N = 3002). Women completed screening and Sheffield Pelvic Floor Questionnaires (Sheffield-PAQ ©). Maternity data were obtained from Standard Maternity Information System. Primary outcomes were urinary incontinence (UI), anal incontinence (AI), and prolapse (POP).

Results

Primary response was 62.1%; 53.8% (n = 985) had ≥1 PFD symptom and in 71.5% symptoms were bothersome. UI (OR 0.47 95% CI 0.28, 0.81) and fecal incontinence (FI; OR 0.32 95% CI 0.13, 0.77) risks were lower after first delivery by cesarean section (CS). However, 25% had UI and 12% had FI after delivering exclusively by CS. Obesity was a risk factor independent of obstetric history.

Conclusions

CS provides incomplete or poorly sustained pelvic floor protection by middle age. Obese women were at highest risk and had the most severe symptoms.

Hannestad YS, Rortveit G, Sandvik H, Hunskaar S (2000) A community-based epidemiological survey of female urinary incontinence: the Norwegian EPINCONT study. J Clin Epidemiol 53(11):1150–1157CrossRefPubMed

Farrell SA, Allen VM, Baskett TF (2001) Parturition and urinary incontinence in primiparas. Obstet Gynecol 97(3):350–356CrossRefPubMed

Glazener CM, Herbison GP, MacArthur C, Lancashire R, McGee MA, Grant AM et al (2006) New postnatal urinary incontinence: obstetric and other risk factors in primiparae. BJOG 113(2):208–217CrossRefPubMed

Schytt E, Lindmark G, Waldenström U (2004) Symptoms of stress incontinence 1 year after childbirth: prevalence and predictors in a national Swedish sample. Acta Obstet Gynecol Scand 83(10):928–936PubMed

Chaliha C, Kalia V, Stanton SL, Monga A, Sultan AH (1999) Antenatal prediction of postpartum urinary and fecal incontinence. Obstet Gynecol 94(5 Pt 1):689–694CrossRefPubMed

Wilson P, Herbison R, Herbison G (1996) Obstetric practice and the prevalence of urinary incontinence three months after delivery. BJOG 103(2):154–161CrossRef

Rortveit G, Daltveit AK, Hannestad YS, Hunskaar S (2003) Urinary incontinence after vaginal delivery or cesarean section. N Engl J Med 348(10):900–907CrossRefPubMed

Fornell E, Wingren G, Kjolhede P (2004) Factors associated with pelvic floor dysfunction with emphasis on urinary and fecal incontinence and genital prolapse: an epidemiological study. Acta Obstet Gynecol Scand 83(4):383–389CrossRef

MacArthur C, Glazener C, Wilson P, Lancashire R, Herbison G, Grant A (2006) Persistent urinary incontinence and delivery mode history: a six-year longitudinal study. BJOG 113(2):218–224CrossRefPubMed

10.

Macarthur C, Glazener C, Lancashire R, Herbison P, Wilson D, Grant A (2005) Faecal incontinence and mode of first and subsequent delivery: a six-year longitudinal study. BJOG 112(8):1075–1082CrossRefPubMed

11.

Hiller L, Radley S, Mann CH, Radley SC, Begum G, Pretlove SJ et al (2002) Development and validation of a questionnaire for the assessment of bowel and lower urinary tract symptoms in women. BJOG 109(4):413–423CrossRefPubMed

12.

Radley SC, Jones GL, Tanguy EA, Stevens VG, Nelson C, Mathers NJ (2006) Computer interviewing in urogynaecology: concept, development and psychometric testing of an electronic pelvic floor assessment questionnaire in primary and secondary care. BJOG 113(2):231–238CrossRefPubMed

13.

Chu S, Kim S, Schmid C, Dietz P, Callaghan W, Lau J et al (2007) Maternal obesity and risk of cesarean delivery: a meta-analysis. Obes Rev 8(5):385–394CrossRefPubMed

14.

Donnelly V, Fynes M, Campbell D, Johnson H, O'Connell P, O'Herlihy C (1998) Obstetric events leading to anal sphincter damage. Obstet Gynecol 92(6):955–961CrossRefPubMed

15.

Johanson RB, Rice C, Doyle M, Arthur J, Anyanwu L, Ibrahim J et al (1993) A randomised prospective study comparing the new vacuum extractor policy with forceps delivery. BJOG 101(4):363–364

16.

Lal MH, Mann C, Callender R, Radley S (2003) Does cesarean delivery prevent anal incontinence? Obstet Gynecol 101(2):305–312CrossRefPubMed

17.

Fynes M, Donnelly V, O'Connell P, O'Herlihy C (1998) Cesarean delivery and anal sphincter injury. Obstet Gynecol 92(4 Pt 1):496–500CrossRefPubMed

18.

Dolan L, Hosker G, Mallett V, Allen R, Smith A (2003) Stress incontinence and pelvic floor neurophysiology 15 years after the first delivery. BJOG 110(12):1107–1114CrossRefPubMed

19.

Viktrup L, Rortveit G, Lose G (2006) Risk of stress urinary incontinence twelve years after the first pregnancy and delivery. Obstet Gynecol 108(2):248–254PubMed

20.

Viktrup L, Lose G (2001) Do fertile women remember the onset of stress incontinence? Recall bias 5 years after 1st delivery. Acta Obstet Gynecol Scand 80(10):952–955PubMed

21.

Wolin LH (1969) Stress incontinence in young, healthy nulliparous female subjects. J Urol 101(4):545–549PubMed

22.

MacArthur C, Bick DE, Keighley MR (1997) Faecal incontinence after childbirth. BJOG 104(1):46–50CrossRef

23.

Lukacz ES, Lawrence JM, Contreras R, Nager CW, Luber KM (2006) Parity, mode of delivery, and pelvic floor disorders. Obstet Gynecol 107(6):1253–1260PubMed

24.

Tegerstedt G, Maehle-Schmidt M, Nyren O, Hammarstrom M (2005) Prevalence of symptomatic pelvic organ prolapse in a Swedish population. Int Urogynecol J Pelvic Floor Dysfunct 16(6):497–503CrossRefPubMed

25.

Rortveit G, Brown JS, Thom DH, Van Den Eeden SK, Creasman JM, Subak LL (2007) Symptomatic pelvic organ prolapse: prevalence and risk factors in a population-based, racially diverse cohort. Obstet Gynecol 109(6):1396–1403PubMed

26.

Tegerstedt G, Miedle A, Maehle-Schmidt M, Nyren O, Hammarstrom M (2005) A short-form questionnaire identified genital organ prolapse. J Clin Epidemiol 58(1):41–46CrossRefPubMed

Title: Obstetric risk factors and pelvic floor dysfunction 20 years after first delivery
Authors: Lucia M. Dolan
Paul Hilton
Publication date: 01-05-2010
Publisher: Springer-Verlag
Published in: International Urogynecology Journal / Issue 5/2010
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-009-1074-8

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Obstetric risk factors and pelvic floor dysfunction 20 years after first delivery

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

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