Pizzoferrato A C, Briant A R, Le Grand C, Gaichies L, Fauvet R, Fauconnier A, Fritel X
Department of Obstetrics and Gynecology, La Miletrie University Hospital, Poitiers, France; Poitiers University, INSERM CIC 1402, Poitiers, France.
Clinical Research Department, Caen University Hospital, Caen 14000, France.
J Gynecol Obstet Hum Reprod. 2023 Mar;52(3):102536. doi: 10.1016/j.jogoh.2023.102536. Epub 2023 Jan 14.
It is likely that the pathophysiology of urinary incontinence (UI) differs between women who are incontinent before the first delivery and those whose incontinence occurs after. In this systematic review, we aimed to assess the association between the mode of delivery and the risk of postpartum UI in primiparous women with and without prenatal UI.
We searched MEDLINE, Cochrane, Web of Science, Embase and CINHAL databases. Prospective studies including primiparous women during their pregnancy with a comparison of the rate of postpartum UI in women who underwent cesarean delivery or vaginal delivery according to continence status before delivery were included. The Risk Ratio (RR) was calculated with a 95% confidence interval (95% CI) using the total number of events and patients extracted from the individual studies. A subgroup comparison analysed the potential influence of women's prenatal continence status. Heterogeneity was estimated using I² statistics.
The risk of postpartum UI was significantly higher after vaginal delivery than after cesarean section (RR 1.80, 95% CI 1.48- 2.18). According to the subgroup test, the postpartum UI risk following a vaginal delivery, compared to cesarean section, was significantly higher in the subgroup of continent women during pregnancy (RR 2.57, 95% CI 2.17-3.04) than in the subgroup of incontinent pregnant women (1.56, 95% CI 1.27-1.92).
The effect of a cesarean section in preventing postpartum UI appears controversial, particularly in women with prenatal UI.
首次分娩前即出现尿失禁（UI）的女性与产后出现尿失禁的女性，其尿失禁的病理生理学可能有所不同。在这项系统评价中，我们旨在评估分娩方式与有或无产前尿失禁的初产妇产后尿失禁风险之间的关联。
我们检索了MEDLINE、Cochrane、科学网、Embase和CINHAL数据库。纳入前瞻性研究，这些研究纳入了孕期的初产妇，并根据分娩前的尿失禁状况比较了剖宫产或阴道分娩女性的产后尿失禁发生率。使用从各个研究中提取的事件总数和患者总数计算风险比（RR）及其95%置信区间（95%CI）。亚组比较分析了女性产前尿失禁状况的潜在影响。使用I²统计量估计异质性。
阴道分娩后产后尿失禁的风险显著高于剖宫产（RR 1.80，95%CI 1.48 - 2.18）。根据亚组检验，与剖宫产相比，孕期尿失禁女性亚组中阴道分娩后的产后尿失禁风险（RR 2.57，95%CI 2.17 - 3.04）显著高于尿失禁孕妇亚组（1.56，95%CI 1.27 - 1.92）。
剖宫产在预防产后尿失禁方面的效果似乎存在争议，尤其是对于产前有尿失禁的女性。
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