Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California, USA.
Neurourol Urodyn. 2011 Nov;30(8):1456-61. doi: 10.1002/nau.21166. Epub 2011 Jul 20.
To examine the association between specific events during vaginal deliveries and urinary incontinence later in life.
A retrospective cohort study of 1,521 middle-aged and older women with at least one vaginal delivery who were long-term members of an integrated health delivery system. Age, race/ethnicity, current incontinence status, medical, surgical history, pregnancy and parturition history, menopausal status, hormone replacement, health habits, and general health were obtained by questionnaire. Labor and delivery records, archived since 1948, were abstracted by professional medical record abstractors to obtain parturition events including induction, length of labor stages, type of anesthesia, episiotomy, instrumental delivery, and birth weight. The primary dependent variable was current weekly urinary incontinence (once per week or more often) versus urinary incontinence less than monthly (including no incontinence) in past 12 months. Associations of parturition events and later incontinence were assessed in multivariate analysis with logistic regression.
The mean age of participants was 56 years. After adjustment for multiple risk factors, weekly urinary incontinence significantly associated with age at first birth (P = 0.036), greatest birth weight (P = 0.005), and ever having been induced for labor (OR = 1.51; 95%CI = 1.06-2.16, P = 0.02). Risk of incontinence increased from OR = 1.35 (95%CI = 0.92-1.97, P = 0.12) for women with one induction to OR = 2.67 (95%CI = 1.25-5.71, P = 0.01) for women with two or more inductions (P = 0.01 for trend). No other parturition factors were associated with incontinence.
Younger age at first birth, greatest birth weight, and induction of labor were associated with an increased risk of incontinence in later life.
探讨阴道分娩过程中的具体事件与日后发生尿失禁的关系。
这是一项对长期参加综合性医疗服务系统的 1521 名经阴道分娩的中年及以上女性进行的回顾性队列研究。通过问卷获得年龄、种族/民族、当前失禁状况、医疗、手术史、妊娠和分娩史、绝经状态、激素替代、健康习惯和总体健康状况。自 1948 年以来，分娩记录由专业病历摘要员提取，以获得分娩事件，包括引产、产程各阶段时长、麻醉类型、会阴切开术、器械分娩和出生体重。主要因变量为当前每周尿失禁（每周一次或以上）与过去 12 个月中每月少于一次（包括无失禁）的尿失禁。采用多变量逻辑回归分析评估分娩事件与以后发生尿失禁的关系。
参与者的平均年龄为 56 岁。调整了多个危险因素后，每周尿失禁与首次分娩年龄（P=0.036）、最大出生体重（P=0.005）和曾因分娩而引产显著相关（OR=1.51；95%CI=1.06-2.16，P=0.02）。从 OR=1.35（95%CI=0.92-1.97，P=0.12），即仅引产 1 次的女性，风险增加到 OR=2.67（95%CI=1.25-5.71，P=0.01），即引产 2 次或更多次的女性（P=0.01 趋势）。其他分娩因素与失禁无关。
首次分娩年龄较小、出生体重较大和引产与日后发生尿失禁的风险增加有关。
