Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Shanghai Key Laboratory of Embryo Original Disease, Shanghai, China.
BMC Pregnancy Childbirth. 2023 Sep 16;23(1):666. doi: 10.1186/s12884-023-05952-4.
Although epidural analgesia is considered the gold standard for pain relief during labor and is safe for maternity and fetus, the association between the epidural analgesia and pelvic floor disorders remains unclear. Thus we estimate the association between epidural analgesia and early postpartum urinary incontinence (UI).
A propensity score-matched retrospective cohort study was conducted at a university-affiliated hospital in Shanghai, China. Primiparous women with term, singleton, and vaginal delivery between December 2020 and February 2022 were included. UI was self-reported by maternity at 42 to 60 days postpartum and was classified by International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF). Using logistic regression models, the associations between epidural analgesia and early postpartum UI were assessed.
Among 5190 participants, 3709 (71.5%) choose epidural anesthesia during labor. Analysis of the propensity-matched cohort (including 1447 maternal pairs) showed epidural anesthesia during labor was independently associated with UI in early postpartum period (aOR 1.50, 95% CI 1.24-1.81). This association was mainly contributed to stress UI (aOR 1.38, 95% CI 1.12-1.71) rather than urge UI (aOR 1.45, 95% CI 0.99-2.15) and mixed UI (aOR 1.52, 95% CI 0.95-2.45). Furthermore, we observed that the association between epidural anesthesia and UI was more pronounced among older women (≥ 35 y) and women with macrosomia (infant weight ≥ 4000 g), compared with their counterparts (both P for interaction < 0.01). After further analysis excluding the women with UI during pregnancy, the results remained largely consistent with the main analysis.
The findings support that epidural anesthesia was associated with SUI in the early postpartum period.
硬膜外镇痛被认为是分娩期间缓解疼痛的金标准，并且对母婴安全，但其与盆底功能障碍的关系仍不清楚。因此，我们评估了硬膜外镇痛与产后早期尿失禁（UI）的关系。
这是一项在中国上海一所大学附属医院进行的倾向评分匹配的回顾性队列研究。纳入 2020 年 12 月至 2022 年 2 月期间足月、单胎和阴道分娩的初产妇。产后 42 至 60 天由产妇自行报告 UI，并采用国际尿失禁咨询问卷-尿失禁简短问卷（ICIQ-UI SF）进行分类。使用逻辑回归模型评估硬膜外镇痛与产后早期 UI 的关系。
在 5190 名参与者中，3709 名（71.5%）在分娩期间选择硬膜外麻醉。对倾向评分匹配队列（包括 1447 对产妇）的分析表明，分娩期间硬膜外麻醉与产后早期 UI 独立相关（aOR 1.50，95%CI 1.24-1.81）。这种关联主要归因于压力性 UI（aOR 1.38，95%CI 1.12-1.71），而不是急迫性 UI（aOR 1.45，95%CI 0.99-2.15）和混合性 UI（aOR 1.52，95%CI 0.95-2.45）。此外，我们观察到硬膜外麻醉与 UI 之间的关联在年龄较大的女性（≥35 岁）和巨大儿（婴儿体重≥4000 克）中更为明显，与对照组相比（交互作用 P 值均<0.01）。进一步分析排除了妊娠期间 UI 的女性，结果与主要分析基本一致。
研究结果支持硬膜外麻醉与产后早期压力性尿失禁有关。
