Wilson P D, Herbison R M, Herbison G P
Department of Obstetrics and Gynaecology, University of Otago Medical School, Dunedin, New Zealand.
Br J Obstet Gynaecol. 1996 Feb;103(2):154-61. doi: 10.1111/j.1471-0528.1996.tb09668.x.
To examine the relation between obstetric factors and the prevalence of urinary incontinence three months after delivery.
2134 postal questionnaires sent between August 1989 and June 1991.
Teaching hospital in Dunedin, New Zealand.
All women three months postpartum who were resident in the Dunedin area.
Prevalence of urinary incontinence.
1505 questionnaires were returned (70.5% response rate). At three months postpartum 34.3% of women admitted to some degree of urinary incontinence with 3.3% having daily or more frequent leakage. There was a significant reduction in the prevalence of incontinence for women having a caesarean section, in particular in primiparous women with a history of no previous incontinence (prevalence of incontinence following a vaginal delivery 24.5%, following a caesarean section 5.2% P = 0.002). There was little difference between elective caesarean sections and those carried out in the first and second stages of labour. The odds ratios for women having a caesarean section were 0.4 (95% confidence interval (CI) 0.2.-0.7) (all women and all primiparae) and 0.2 (95% CI 0.0-0.6) (primipara with no previous incontinence) in comparison with those having a normal vaginal delivery. The prevalence of incontinence was also significantly lower in women having had two caesarean sections (23.3%; P = 0.05) but similar in those women having three or more caesarean sections (38.9%) in comparison with those women who delivered vaginally (37.7%). Other significant independent odds rations were found for daily antenatal pelvic floor exercises (PFE) (0.6, 95% CI 0.4-0.9), parity > or = 5 (2.2, 95% CI 1.0-4.9) and pre-pregnancy body mass index (1.07, 95% CI 1.04-1.10).
Adverse risk factors for urinary incontinence at three months postpartum are vaginal delivery, obesity and multiparity (> or = 5). Caesarean section and daily antenatal PFE appear to be protective, although not completely so.
探讨产科因素与产后三个月尿失禁患病率之间的关系。
1989年8月至1991年6月期间邮寄了2134份调查问卷。
新西兰达尼丁的教学医院。
所有居住在达尼丁地区的产后三个月妇女。
尿失禁患病率。
共收回1505份问卷（回复率70.5%）。产后三个月时，34.3%的女性承认有某种程度的尿失禁，其中3.3%的女性每天或更频繁地漏尿。剖宫产女性的尿失禁患病率显著降低，尤其是既往无尿失禁史的初产妇（阴道分娩后尿失禁患病率为24.5%，剖宫产术后为5.2%，P = 0.002）。择期剖宫产与在第一产程和第二产程进行的剖宫产之间差异不大。与正常阴道分娩的女性相比，剖宫产女性的比值比为0.4（95%置信区间（CI）0.2 - 0.7）（所有女性和所有初产妇），以及0.2（95%CI 0.0 - 0.6）（既往无尿失禁史的初产妇）。有两次剖宫产史的女性尿失禁患病率也显著较低（23.3%；P = 0.05），但与阴道分娩的女性（37.7%）相比，有三次或更多次剖宫产史的女性（38.9%）患病率相似。还发现其他显著的独立比值比与每日产前盆底肌锻炼（PFE）（0.6，95%CI 0.4 - 0.9）、产次≥5（2.2，95%CI 1.0 - 4.9）和孕前体重指数（1.07，95%CI 1.04 - 1.10）有关。
产后三个月尿失禁的不良风险因素包括阴道分娩、肥胖和多产（≥5）。剖宫产和每日产前盆底肌锻炼似乎有保护作用，尽管并非完全如此。
