Risk of new-onset urinary incontinence 3 and 12 months after vaginal or cesarean delivery of twins: Part I
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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.
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.
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).
Vaginal delivery is a risk factor for UI at 3 months after twin birth.
KeywordsUrinary incontinence Twin pregnancy Postpartum Risk factors Vaginal delivery
This study was funded by the Nimes University Hospital (AOI GCS Merri Nîmes-Montpellier).
Compliance with ethical standards
Conflicts of interest
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.
- 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
- 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
- 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
- 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
- 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
- 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.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