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Risk of new-onset urinary incontinence 3 and 12 months after vaginal or cesarean delivery of twins: Part I

  • Renaud de Tayrac
  • Fanny Béchard
  • Christel Castelli
  • Sandrine Alonso
  • Emmanuelle Vintejoux
  • François Goffinet
  • Vincent Letouzey
  • Thomas Schmitz
Original Article
  • 47 Downloads

Abstract

Introduction and hypothesis

Our purpose was to compare the prevalence of urinary incontinence (UI) 3 and 12 months after vaginal vs cesarean delivery of twins after 34 weeks of gestation.

Methods

This was a multicenter prospective cohort study conducted at 172 French maternity units and included 2812 primiparous women with twins with no prior history of UI. Participants were enrolled at the time of delivery and followed up to 12 months postpartum. The primary outcome was the prevalence of UI, both stress and urge, 3 months postpartum, based on the patient reporting any frequency of urine leakage to the first question of the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF). The Pelvic Floor Distress Inventory - Short Form 20 (PFDI-20), Pelvic Floor Impact Questionnaire - Short Form 7 (PFIQ-7), Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12), and Medical Outcome Study Short Form-12 (SF-12) were also used.

Results

The ICIQ-SF was completed by 1155 (39.8%) and 800 (27.5%) women, respectively, at 3 and 12 months postpartum; 556 (48%) had delivered vaginally and 599 (52%) by cesarean section. The prevalence of UI at 3 months was 26% overall and was significantly higher in the vaginal delivery group at both 3 months (35% vs 17% in the cesarean group, p < 0.0001) and 12 months postpartum (38% vs 24%, p < 0.0001). UI was predominantly stress or mixed. The risk factors for UI at 3 months, determined by multivariate modeling, were vaginal delivery [odds ratio (OR) 3.073, 95% confidence interval (CI) 2.3–4.105, p < 0.0001) and body mass index >25 in early pregnancy (OR 1.620, 95% CI 1.188–2.209, p = 0.0023).

Conclusions

Vaginal delivery is a risk factor for UI at 3 months after twin birth.

Keywords

Urinary incontinence Twin pregnancy Postpartum Risk factors Vaginal delivery 

Notes

Funding

This study was funded by the Nimes University Hospital (AOI GCS Merri Nîmes-Montpellier).

Compliance with ethical standards

Conflicts of interest

None.

Details of ethics approval

The study was approved by the Comité consultatif sur le traitement de l’information en matière de recherche dans le domaine de la santé and by the Commission Nationale de l’Informatique et des Libertés (autorization no. 913,448).

The study was recorded on Clinicaltrials.gov no. NCT02059746.

References

  1. 1.
    Ballanger P, Rischmann P. Female urinary incontinence. An overview of a report presented to the French urological association. Eur Urol. 1999;36:165–74.CrossRefGoogle Scholar
  2. 2.
    Faltin D-L. Epidemiology and definition of female urinary incontinence. J Gynecol Obstet Biol Reprod. 2009;38:S146–52.CrossRefGoogle Scholar
  3. 3.
    Stockil L, Thompson J, Briffa K, Smith A, Beales D, Straker L, et al. Urogenital symptoms: prevalence, bother, associations and impact in 22 year-old women of the Raine study. Int Urogynecol J. 2018.Google Scholar
  4. 4.
    Glazener CMA, 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;113:208–17.CrossRefGoogle Scholar
  5. 5.
    Viktrup L, Lose G. The risk of stress incontinence 5 years after first delivery. Am J Obstet Gynecol. 2001;185:82–7.CrossRefGoogle Scholar
  6. 6.
    Burgio KL, Zyczynski H, Locher JL, Richter HE, Redden DT, Wright KC. Urinary incontinence in the 12-month postpartum period. Obstet Gynecol. 2003;102:1291–8.PubMedGoogle Scholar
  7. 7.
    Wilson PD, Herbison RM, Herbison GP. Obstetric practice and the prevalence of urinary incontinence three months after delivery. Br J Obstet Gynaecol. 1996;103:154–61.CrossRefGoogle Scholar
  8. 8.
    Farrell SA, Allen VM, Baskett TF. Parturition and urinary incontinence in primiparas. Obstet Gynecol. 2001;97:350–6.PubMedGoogle Scholar
  9. 9.
    MacArthur C, Glazener CMA, Wilson PD, Lancashire RJ, Herbison GP, Grant AM. Persistent urinary incontinence and delivery mode history: a six-year longitudinal study. BJOG. 2006;113:218–24.CrossRefGoogle Scholar
  10. 10.
    Blondel B, Macfarlane A, Gissler M, Breart G, Zeitlin J, PERISTAT Study Group. Preterm birth and multiple pregnancy in European countries participating in the PERISTAT project. BJOG. 2006;113:528–35.CrossRefGoogle Scholar
  11. 11.
    Kulkarni AD, Jamieson DJ, Jones HW, Kissin DM, Gallo MF, Macaluso M, et al. Fertility treatments and multiple births in the United States. N Engl J Med. 2013;369:2218–25.CrossRefGoogle Scholar
  12. 12.
    Legendre G, Tassel J, Salomon L-J, Fauconnier A, Bader G. Impact of twin gestation on the risk of postpartum stress incontinence. Gynécologie Obstétrique Fertil. 2010;38:238–43.CrossRefGoogle Scholar
  13. 13.
    Hutton EK, Hannah ME, Ross S, Joseph KS, Ohlsson A, Asztalos EV, et al. Maternal outcomes at 3 months after planned caesarean section vs planned vaginal birth for twin pregnancies in the twin birth study: a randomised controlled trial. BJOG. 2015;122:1653–62.CrossRefGoogle Scholar
  14. 14.
    Hutton EK, Hannah ME, Willan AR, Ross S, Allen AC, Armson BA, et al. Urinary stress incontinence and other maternal outcomes 2 years after caesarean or vaginal birth for twin pregnancy: a multicentre randomised trial. BJOG. 2018.Google Scholar
  15. 15.
    Schmitz T, Prunet C, Azria E, Bohec C, Bongain A, Chabanier P, et al. Association between planned cesarean delivery and neonatal mortality and morbidity in twin pregnancies. Obstet Gynecol. 2017;129(6):986–95.CrossRefGoogle Scholar
  16. 16.
    Blondel B, Gonzales L, Raynaud P. French National Perinatal Survey 2016. INSEM and DREES. http://www.epopé-inserm.fr/wp-content/uploads/2017/10/ENP2016_rapport_complet.pdf [French].Google Scholar
  17. 17.
    Avery K, Donovan J, Peters TJ, Shaw C, Gotoh M, Abrams P. ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol Urodyn. 2004;23:322–30.CrossRefGoogle Scholar
  18. 18.
    de Tayrac R, Deval B, Fernandez H, Marès P, Mapi Research Institute. Development of a linguistically validated French version of two short-form, condition-specific quality of life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7). J Gynecol Obstet Biol Reprod. 2007;36:738–48.CrossRefGoogle Scholar
  19. 19.
    Fatton B, Letouzey V, Lagrange E, Mares P, Jacquetin B, de Tayrac R. [Validation of a French version of the short form of the pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ-12)]. J Gynecol Obstet Biol Reprod. 2009;38:662–7.CrossRefGoogle Scholar
  20. 20.
    Kosinski M, Ware JE, Turner-Bowker DM, Gandek B. User’s manual for the SF-12v2 health survey: with a supplement documenting the SF-12® health survey. QualityMetric incorporated: Lincoln; 2007.Google Scholar
  21. 21.
    MacArthur C, Wilson D, Herbison P, Lancashire RJ, Hagen S, Toozs-Hobson P, et al. Urinary incontinence persisting after childbirth: extent, delivery history, and effects in a 12-year longitudinal cohort study. BJOG. 2016;123:1022–9.CrossRefGoogle Scholar
  22. 22.
    Gyhagen M, Bullarbo M, Nielsen TF, Milsom I. A comparison of the long-term consequences of vaginal delivery versus caesarean section on the prevalence, severity and bothersomeness of urinary incontinence subtypes: a national cohort study in primiparous women. BJOG. 2013;120:1548–55.CrossRefGoogle Scholar
  23. 23.
    Linde JM, Nijman RJM, Trzpis M, Broens PMA. Urinary incontinence in the Netherlands: prevalence and associated risk factors in adults. Neurourol Urodyn. 2016 (in press).Google Scholar
  24. 24.
    Le diabète gestationnel. J Gynecol Obstet Biol Reprod. 2010;39:S139.CrossRefGoogle Scholar
  25. 25.
    Yohay D, Weintraub AY, Mauer-Perry N, Peri C, Kafri R, Yohay Z, et al. Prevalence and trends of pelvic floor disorders in late pregnancy and after delivery in a cohort of Israeli women using the PFDI-20. Eur J Obstet Gynecol Reprod Biol. 2016;200:35–9.CrossRefGoogle Scholar
  26. 26.
    Gyhagen M, Åkervall S, Milsom I. Clustering of pelvic floor disorders 20 years after one vaginal or one cesarean birth. Int Urogynecol J. 2015;26:1115–21.CrossRefGoogle Scholar
  27. 27.
    Gholitabar M, Ullman R, James D, Griffiths M, Guideline Development Group of the National Institute for Health and Clinical Excellence. Caesarean section: summary of updated NICE guidance. BMJ. 2011;343:d7108.CrossRefGoogle Scholar

Copyright information

© The International Urogynecological Association 2018

Authors and Affiliations

  • Renaud de Tayrac
    • 1
    • 2
  • Fanny Béchard
    • 1
  • Christel Castelli
    • 3
  • Sandrine Alonso
    • 3
  • Emmanuelle Vintejoux
    • 4
  • François Goffinet
    • 5
  • Vincent Letouzey
    • 1
  • Thomas Schmitz
    • 6
  1. 1.Department of Obstetrics and GynecologyCarémeau University HospitalNîmesFrance
  2. 2.Obs/Gyne DeptNimes University HorpitalNîmesFrance
  3. 3.Department of Biostatistics, Epidemiology, Public Health and Medical Information (BESPIM)Nîmes University HospitalNîmesFrance
  4. 4.Department of Obstetrics and GynecologyArnaud de Villeneuve University HospitalMontpellierFrance
  5. 5.INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), DHU Risks in PregnancyParis Descartes UniversityParisFrance
  6. 6.Department of Obstetrics and GynecologyRobert Debré University HospitalParisFrance

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