Groutz Asnat, Rimon Eli, Peled Simona, Gold Ronen, Pauzner David, Lessing Joseph B, Gordon David
Urogynecology and Pelvic Floor Unit, Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Israel.
Neurourol Urodyn. 2004;23(1):2-6. doi: 10.1002/nau.10166.
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.
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.
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.
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.
年轻女性压力性尿失禁（SUI）通常是阴道分娩时盆底损伤的结果。剖宫产是否可预防此类损伤尚存在疑问。我们进行了一项前瞻性研究，比较自然阴道分娩、择期剖宫产或因梗阻性难产而行剖宫产的初产妇产后1年SUI的发生率。
363例连续的初产妇在产后立即纳入研究，并随访1年。招募时询问女性孕前是否曾经历过SUI。孕前有SUI的女性被排除。因此，仅分析与分娩相关的新发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）和因梗阻性难产而行剖宫产（n = 100）。接受择期剖宫产的患者未进行试产。因梗阻性难产而行剖宫产时的平均宫颈扩张为8.7±1.6 cm，停滞时间为184±24分钟。分析每个亚组中产后SUI的发生率、频率和严重程度，以及人口统计学和产科参数。
三个亚组在产妇年龄、体重和身高方面具有可比性。自然阴道分娩后（10.3%）和因梗阻性难产而行剖宫产（12%）后产后SUI的发生率相似。然而，未进行试产的择期剖宫产术后SUI明显较少见（3.4%，P < 0.05）。每个亚组中约一半有症状的患者报告有中度或重度症状，然而，只有15 - 18%的患者表示希望进一步评估。
自然阴道分娩和因梗阻性难产而行剖宫产术后产后SUI的发生率相似。在这种情况下，盆底损伤很可能已经过于广泛，无法通过手术干预预防。相反，未进行试产的择期剖宫产与产后SUI的发生率显著较低相关。盆底损伤的预防是否应作为择期剖宫产的指征尚待确定。
