Clinical Study On The Relationship Between Delivery Ways And Postpartum Urinary Incontinence

Background and Objective:Female pelvic floor disorders include pelvic organprolapse,stress urinary incontinence,fecal incontinence and postpartum sexualdysfunction.POP and SUI is one of chronic diseases affecting the quality ofwomen’s life. Stress urinary incontinence is defined as the loss of urinewith effort (an increase in intra-abdominal pressure which overcomes the urethralresistance in the absence of a true bladder contraction). SUI is so prevalent that it hasa significant impact on the affected patients’ physical,psychological and social life.Given the objective severity of SUI and the subjective bother to the individual, stressurinary incontinence is also called "social cancer". With the extension of human life,The number of women who suffered the gynecological and urinary system diseases islarger and larger, It will bring heavy economic burden on the government andindividuals. So prevention of SUI should be on the agenda.Many research are beingconducted to find the cause of SUI.The etiology of genuine stress incontinence andfemale pelvic organ prolapse is thought to be multifactorial. A variety of clinicalepidemiology studies show the risk factors of SUI include age,pregnancy,childbirth,maternity,illness of urinary and nerve damage of pelvic floor muscle etc.Pregnancy andchildbirth is considered to be one of the most important risk factors for stress urinaryincontinence,with congenital,hormonal,and other factors also contributing. It isgenerally believed that pelvic trauma caused by vaginal delivery is a major cause ofstress urinary incontinence. Pregnancy and childbirth can lead to a temporary urinaryincontinence of a significant number of women.Women after delivery are in a special period.The pelvic floor hurt during childbirth,has not been well recovered. So theoccurrence of SUI is on a high level after childbirth. The definition of postpartumurinary incontinence is Stress urinary incontinence owing to pregnancyand delivery.The prevalence of stress incontinence during pregnancy reported in theliterature ranges from20to67%. There is no effective method to cure postpartumurinary incontinence.Ultrasound in the diagnosis of SUI has a unique advantage.Theultrasound depending on its economic, convenient, noninvasive, reproducible, and otheradvantages will become the main diagnostic imaging tool of stress urinary incontinenceas well as pelvic floor dysfunction diseases. Two-dimensional ultrasound has a highresolution imaging of pelvic soft tissue at all levels. The pubic symphysis, urethra,bladder, vagina and rectum-anal canal connection department were clearly showed inthe sagittal plane of trans-perineal ultrasound at resting state and Valsalva state.In short,the ultrasound has a unique display of superior anatomy of the pelvic floor and providesreference for the clinical diagnosis of stress incontinence from the morphological pointof view. We undertook a prospective study to compare the prevalence of PPUI afternatural vaginal delivery versus elective cesarean section and cesarean sectionperformed for obstructed labor. The bladder neck mobility and urinary rotationangle were measured through transperineal ultrasound6and10weeks after deliveryrespectively to explore the relationship between different delivery ways and stressurinary incontinence in primigravidas.Methods:The study was performed on primiparae who delivered in the firstaffiliated hospital of An Hui Medical University. Development of PPUI from6weeks till10weeks after delivery was studied. The study population wasdivided into two groups according to the mode of delivery:69Consecutiveprimiparae who underwent natural vaginal delivery,46Consecutive primiparae whounderwent cesarean section. Women in the elective cesarean section and in the cesarean section performed for obstructed labor were merged into on CS group. Those who had SUI before pregnancy were excluded.The mobility of urethrovesical junction (UVJ-M) and urinary rotation angle were measured by sonographic6and10weeks after delivery respectively. The diagnostic standards of SUI:the complaint of involuntary leakage of urine when one coughs, sneezes, moves.The incidence of SUI at different delivery ways and the variations in UVJ-M and urethral rotation angle at6weeks or10weeks after delivery were considered.Results:1.General data:The research included primigravidas after NVS with a mean age of27.02y±2.35y, fetal weight of3.44±0.35Kg,gestation times of1.25±0.48, BMI of26.45±2.50, and primigravidas after CS with a mean age of26.86±2.54y, fetal weight of3.57±0.46Kg, gestation times of1.32±0.67, BMI of27.3±2.80. No significant differences were found between the two groups (NVS group and CS group).2.Incidence of SUI at6weeks after delivery:Regarding the mode of delivery incidence of SUI showed significant difference. The total incidence of SUI after NVS delivery was26.09%, and the SUI incidence after CS delivery was10.87%.The difference is significant between NVS group and CS group.3.The variations of mobility of urethrovesical junction and urethral rotation angle with different delivery ways3.1The UVJ-M of vaginal delivery and cesarean section at6weeks after delivery was10.44±2.71mm and5.38±2.21mm.The urethral rotation angle of vaginal delivery and cesarean section at6weeks after delivery was33.65±7.62°and23.67±6.33°.3.2The UVJ-M of vaginal delivery and cesarean section at10weeks after delivery was8.29±2.44mm and5.02±1.83mm, The urethral rotation angle of vaginal delivery and cesarean section at10weeks after delivery were28.70±6.71°snd20.9±5.48°.The difference between different delivery ways was significant (P<0.05).Conclusion:The study revealed that the persistency of PPUI can be up to10weeks postpartum regardless of type of delivery. Based on our study, Cesarean section was associated with a lower risk of urinary incontinence when comparing with vaginal delivery.But it may not protect against all primigravidas。 CS could have a protective role in postpartum SUI in contrast with NVD, among patients without history of SUI up to10weeks postpartum.2.Cesarean section, with no trial of labor, was found to be associated with a significant lower prevalence of postpartum urinary incontinence. However further investigations on a larger sample of patients are needed to validate these results.