Does planned caesarean compared with planned vaginal birth lower the risk of problematic urinary stress, fecal or flatal incontinence?.
Women between 32 0/7 and 38 6/7 weeks gestation with twin pregnancy were randomised to planned caesarean or planned vaginal birth.
106 centers in 25 countries.
2305 /2804 enrolled in the study completed questionnaires at two years (82.2%follow up): 1155 in the planned caesarean group, 1150 in the planned vaginal birth group.
A structured self-administered questionnaire two years postpartum.
The primary maternal outcome and a secondary outcome of the Twin Birth Study was problematic urinary stress incontinence, or fecal, or flatal incontinence at two years.
Women in the planned caesarean group had lower problematic urinary stress incontinence rates compared with women in the planned vaginal birth group (93/1147 [8.11%] vs 140/1143 [12.25%], odds ratio, 0.63; 95% confidence interval, 0.47 to 0.83; p=0.001). Among those with problematic urinary stress incontinence, quality of life (measured by IIQ-7) was not different for planned caesarean vs planned vaginal birth groups (mean [SD]: 18.4 [21.0] vs 19.1 [21.5], p=0.82). There were no differences in problematic fecal or flatal incontinence or other maternal outcomes.
Among women with twin pregnancy and no prior history of urinary stress incontinence, a management strategy of planned caesarean compared with planned vaginal birth reduces risk of problematic urinary stress incontinence at two years postpartum. Our findings show that prevalence but not severity of urinary stress incontinence was associated with mode of birth. This article is protected by copyright. All rights reserved.
BJOG : an international journal of obstetrics and gynaecology. 2018 Jul 14 [Epub ahead of print]
Eileen K Hutton, Mary E Hannah, Andrew R Willan, Susan Ross, Alexander C Allen, B Anthony Armson, Amiram Gafni, K S Joseph, Kathryn Mangoff, Arne Ohlsson, J Johanna Sanchez, Elizabeth V Asztalos, Jon F R Barrett, Twin Birth Study Collaborative Group
Department of Obstetrics and Gynecology Division of Midwifery, McMaster University, Hamilton, Ontario, Canada., Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada., Program in Child Health Evaluative Sciences SickKids Research Institute Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada., Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, Alberta, Canada., Department of Paediatrics, IWK Health Centre Dalhousie University, Halifax, Nova Scotia, Canada., Department of Obstetrics and Gynaecology IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada., Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada., Department of Obstetrics and Gynaecology, and the School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada., The Centre for Mother, Infant, and Child Research, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada., Department of Paediatrics, Mount Sinai Hospital University of Toronto, Toronto, Ontario, Canada., Department of Newborn & Developmental Paediatrics, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada., Department of Obstetrics and Gynaecology Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.