An evaluation of the relationship between the prevalence of postpartum urinary incontinence and intrapartum factors: Comparison between spontaneous delivery and assisted delivery

Abstract

Purpose
The purpose of this study was to identify intrapartum factors that are associated with the prevalence of urinary incontinence in the early postpartum period (3-5 days after delivery) and 3 months after delivery and to compare the prevalence of urinary incontinence after spontaneous delivery with its prevalence after assisted delivery and clarify the difference.
Subjects and Methods
A retrospective cohort study was conducted with 421 parturients who had given birth to a single full-term infant by vaginal delivery on obstetrics and gynecology units in metropolitan Tokyo as the subjects. After conducting a self-report questionnaire survey in regard to urinary incontinence in the early postpartum period, the responders were followed up for 3 months and requested to reply to the same questionnaire again. Intrapartum information was obtained from the medical records, and factors associated with urinary incontinence at the two points in time were assessed by means of a multivariate logistic regression analysis.
Results
Replies to the early questionnaire were obtained from 403 of the 421 puerperants, and the prevalence was 30.8%. Replies to the questionnaire at 3 months after delivery were obtained from 286 patients (follow-up rate: 71.0%), and 44.7% of those who had early urinary incontinence had symptoms. Early urinary incontinence was more common in primipara (p=0.013). The rate was higher among women who had urinary incontinence during pregnancy (p=0.004), and early urinary incontinence was more common in women who had undergone an episiotomy (p=0.006). By contrast, BMI when not pregnant and the presence or absence of urinary incontinence during pregnancy were associated with urinary incontinence 3 month after delivery (p=0.045 and p<0.001, respectively), and there were no significant associations with any of the intrapartum factors. The prevalence of early urinary incontinence was significantly lower in the spontaneous delivery group than in the assisted delivery group (p<0.001), but there was no difference between the two groups at 3 months after delivery.
Conclusions
About half of the patients with early urinary incontinence also had symptoms at 3 months after delivery. Early urinary incontinence occurred in a high percentage of the primipara and it was more common in women who had undergone an episiotomy.
The prevalence of early urinary incontinence was lower in the spontaneous delivery group than in the assisted delivery group, and spontaneous delivery was beneficial in maintaining pelvic floor function, but there was no difference at 3 months after delivery, and the influence of delivery had waned.