Cesarean section: Does it really prevent the development of postpartum stress urinary incontinence? A prospective study of 363 women one year after their first delivery
Cesarean section: Does it really prevent the development of postpartum stress urinary incontinence? A prospective study of 363 women one year after their first delivery
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DOI：
10.1002/nau.10166
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发表时间：
2004-01-01
影响因子：
2
通讯作者：
Gordon, D
中科院分区：
文献类型：
--
作者：
Groutz, A;Rimon, E;Gordon, D
目的：年轻女性压力性尿失禁（SUI）通常是阴道分娩时骨盆底损伤的结果。剖宫产分娩是否可以预防此类损伤值得怀疑。我们进行了一项前瞻性研究，以比较自然阴道分娩与择期剖宫产或因梗阻性分娩而进行的剖宫产术后1年的产妇SUI患病率。方法：连续363例产妇在分娩后立即被招募，并随访1年。在招募时询问妇女在怀孕前是否经历过SUI。怀孕前有SUI的人被排除在外。因此，仅分析了新生儿相关SUI病例。根据分娩方式将患者分为三个亚组：自然阴道分娩（n = 145）、择期剖宫产（n = 118）和因难产而进行的剖宫产（n = 100）。择期剖宫产的患者不进行试产。在平均宫颈扩张8.7 +/- 1.6 cm和停止184 +/- 24 min时进行梗阻性分娩的剖宫产。分析每个亚组的产后SUI的患病率、频率和严重程度，以及人口统计学和产科参数。结果：三个亚组在母亲年龄、体重和身高方面具有可比性。自然阴道分娩（10.3%）和因难产行剖宫产（12%）的产后SUI患病率相似。而择期剖宫产术后SUI发生率为3.4%，与未试产组比较，差异有统计学意义（P < 0.05）。每个亚组中约有一半的症状性患者报告中度或重度症状，然而，只有15-18%的患者表示希望进一步评估。结论：自然阴道分娩和梗阻性产行剖宫产后，产后SUI的患病率相似。很有可能，在这种情况下，骨盆底损伤已经太广泛，无法通过手术干预来预防。相反，择期剖宫产，没有尝试的劳动，被发现与产后SUI的患病率显着降低。预防骨盆底损伤是否应作为选择性剖宫产的指征尚未确定。(C)2003 Wiley-Liss，Inc.
Aims: Stress urinary incontinence (SUI) in young women is usually the result of pelvic floor injury during vaginal delivery. Whether cesarean section delivery may prevent such injury is questionable. We undertook a prospective study to compare the prevalence of SUI among primiparae 1 year after spontaneous vaginal delivery versus elective cesarean section, or cesarean section performed for obstructed labor. Methods: Three hundred and sixty-three consecutive primiparae were recruited immediately after delivery and were followed for 1 year. Women were asked upon recruitment whether they had ever experienced SUI before pregnancy. Those who had SUI before pregnancy were excluded. Thus, only cases of de novo childbirth-associated SUI were analyzed. Patients were divided into three subgroups according to the mode of delivery: spontaneous vaginal delivery (n = 145), elective cesarean section (n = 118), and cesarean section performed for obstructed labor (n = 100). Patients who underwent elective cesarean section were not given a trial of labor. Cesarean sections for obstructed labor were performed at a mean cervical dilatation of 8.7 +/- 1.6 cm and arrest of 184 +/- 24 min. Prevalence, frequency, and severity of postpartum SUI, as well as demographic and obstetric parameters, were analyzed in each subgroup. Results: The three subgroups were comparable with respect to maternal age, weight, and height. Prevalence of postpartum SUI was similar after spontaneous vaginal delivery (10.3%) and cesarean section performed for obstructed labor (12%). However, SUI was significantly less common following elective cesarean section with no trial of labor (3.4%, P < 0.05). Approximately half of the symptomatic patients in each subgroup reported either moderate or severe symptoms, however, only 15-18% expressed their desire for further evaluation. Conclusions: Prevalence of postpartum SUI is similar following spontaneous vaginal delivery and cesarean section performed for obstructed labor. It is quite possible that pelvic floor injury in such cases is already too extensive to be prevented by surgical intervention. Conversely, elective cesarean section, with no trial of labor, was found to be associated with a significantly lower prevalence of postpartum SUI. Whether the prevention of pelvic floor injury should be an indication for elective cesarean section is yet to be established. (C) 2003 Wiley-Liss, Inc.