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Database - Alliance francophone pour l'accouchement respecté (AFAR)

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Created on : 18 Aug 2018
Modified on : 18 Aug 2018

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Bibliographical entry (without author) :

Urinary stress incontinence and other maternal outcomes two years after Caesarean or vaginal birth for twin pregnancy: a multicentre randomized trial. BJOG

Author(s) :

Eileen K Hutton, Mary E Hannah, Andrew R Willan, Susan Ross, Alexander C Allen, B Anthony Armson, Amiram Gafni, KS Joseph, Kathryn Mangoff, Arne Ohlsson, J Johanna Sanchez, Elizabeth V Asztalos, Jon FR Barrett

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Résumé (français)  :

Chez les femmes ayant une grossesse gémellaire et sans antécédents d’incontinence urinaire à l’effort, une stratégie de prise en charge via une césarienne programmée par rapport à l’accouchement vaginal réduit le risque d’incontinence urinaire à l’effort deux ans après l’accouchement. Nos résultats montrent que la prévalence mais non la gravité de l’incontinence urinaire à l’effort était associée au mode d’accouchement.

Abstract (English)  :

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.

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Keywords :

➡ c-section/caesarean ; incontinence/prolapsus

Author of this record :

Alison Passieux — 18 Aug 2018

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