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Comparison of postpartum incontinence outcomes after vacuum-assisted and forceps-assisted deliveries in a tertiary maternity unit

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Abstract

Introduction and hypothesis

Forceps-assisted deliveries are an established risk factor for pelvic organ prolapse and pelvic floor injury. However, specific comparison of incontinence outcomes between vacuum-assisted and forceps-assisted deliveries are scarce in the literature. We aimed to compare the initial impact of vacuum and forceps deliveries on new-onset urinary and faecal incontinence as well as pelvic floor muscle strength, with the hypothesis that incontinence outcomes were poorer after forceps- than after vacuum-assisted delivery.

Methods

This is a retrospective cohort study of incontinence outcomes in patients who had primary vacuum- or forceps-assisted delivery. The study population included 108 postpartum patients who had undergone operative vaginal delivery (63 vacuum-assisted, 45 forceps-assisted), met the inclusion criteria and attended the postpartum assessment service. Outcomes studied were the presence and severity of symptoms manifesting beyond 1 month postpartum — faecal incontinence and stress, urgency and mixed urinary incontinence — as well as pelvic floor muscle strength scores based on the modified Oxford scale.

Results

Prevalence of new-onset urinary and faecal incontinence was 35.6% in the forceps group and 30.2% in the vacuum group. The data suggest that there is no significant difference in the prevalence of new-onset incontinence symptoms (p = 0.70, difference in prevalence [forceps − vacuum]: 5.4%, 95% CI −0.25, +0.15), frequency (p = 0.40) and amount (p = 0.48) of urine leakage or mean muscle strength scores (p = 0.89).

Conclusion

In our maternity unit, we observed that type of operative vaginal delivery was not associated with significant differences in urinary incontinence and pelvic floor muscle strength outcomes.

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Authors and Affiliations

  1. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Li Shan Sng

  2. Women’s Health Unit, Department of Physiotherapy, Singapore General Hospital, Singapore, Singapore

    Wan Hui Yip & Stella Yan Chai Hong

  3. Programme in Health Services & Systems Research (HSSR), Duke-NUS Medical School, Singapore, Singapore

    Stephanie Man Chung Fook-Chong

  4. Urogynaecology Unit, Department of Obstetrics & Gynaecology, Singapore General Hospital, Singapore, Singapore

    Wei Keat Andy Tan & Jason Shau Khng Lim

  5. Maternal Fetal Medicine Unit, Department of Obstetrics & Gynaecology, Singapore General Hospital, Singapore, Singapore

    Devendra Kanagalingam

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  1. Li Shan Sng
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Contributions

L.S. Sng: study design, data collection, management and analysis, manuscript writing; W.H. Yip: data collection and management, manuscript editing; Y.C.S. Hong: data collection and management; S.M.C. Fook-Chong: statistical methodology; W.K.A. Tan: data collection and management; D. Kanagalingam: project development, manuscript editing; S.K.J. Lim: project development, data collection, manuscript editing.

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Correspondence to Jason Shau Khng Lim.

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Supplementary Information

Supplementary Table 1

Modified Oxford Scale (PNG 102 kb)

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Sng, L.S., Yip, W.H., Hong, S.Y.C. et al. Comparison of postpartum incontinence outcomes after vacuum-assisted and forceps-assisted deliveries in a tertiary maternity unit. Int Urogynecol J 33, 1529–1537 (2022). https://doi.org/10.1007/s00192-021-04952-2

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  • DOI: https://doi.org/10.1007/s00192-021-04952-2

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