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Urinary stress incontinence and other maternal outcomes 2 years after caesarean or vaginal birth for twin pregnancy: a multicentre randomised trial
Author(s) -
Hutton EK,
Hannah ME,
Willan AR,
Ross S,
Allen AC,
Armson BA,
Gafni A,
Joseph KS,
Mangoff K,
Ohlsson A,
Sanchez JJ,
Asztalos EV,
Barrett JFR
Publication year - 2018
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.15407
Subject(s) - medicine , obstetrics , urinary incontinence , pregnancy , caesarean section , stress incontinence , odds ratio , gynecology , randomized controlled trial , surgery , genetics , biology
Objective Does planned caesarean compared with planned vaginal birth lower the risk of problematic urinary stress, faecal, or flatal incontinence? Design Women between 32 0/7 and 38 6/7 weeks of gestation with a twin pregnancy were randomised to planned caesarean or planned vaginal birth. Setting The trial took place at 106 centres in 25 countries. Population A total of 2305 of the 2804 women enrolled in the study completed questionnaires at 2 years (82.2% follow‐up): 1155 in the planned caesarean group and 1150 in the planned vaginal birth group. Methods A structured self‐administered questionnaire completed at 2 years postpartum. Main outcome measures The primary maternal outcome of the Twin Birth Study was problematic urinary stress, or fecal, or flatal incontinence at 2 years Results 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%) versus 140/1143 (12.25%); odds ratio, 0.63; 95% confidence interval, 0.47–0.83; P = 0.001]. Among those with problematic urinary stress incontinence, quality of life (measured using the Incontinence Impact Questionnaire, IIQ ‐7) was not different for planned caesarean versus planned vaginal birth groups [mean ( SD ): 18.4 (21.0) versus 19.1 (21.5); P = 0.82]. There were no differences in problematic faecal or flatal incontinence, or in other maternal outcomes. Conclusions Among women with a twin pregnancy and no prior history of urinary stress incontinence, a management strategy of planned caesarean compared with planned vaginal birth reduces the risk of problematic urinary stress incontinence at 2 years postpartum. Our findings show that the prevalence but not the severity of urinary stress incontinence was associated with mode of birth. Funding Canadian Institutes of Health Research ( CIHR ) (grant no. MCT‐63164). Tweetable abstract For women with twins, planned caesarean compared with planned vaginal birth is associated with decreased prevalence but not severity of urinary stress incontinence at 2 years.