Li Shan Sng1, Wan Hui Yip2, Stella Yan Chai Hong2, Stephanie Man Chung Fook-Chong3, Wei Keat Andy Tan4, Devendra Kanagalingam5, Jason Shau Khng Lim6. 1. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. 2. Women's Health Unit, Department of Physiotherapy, Singapore General Hospital, Singapore, Singapore. 3. Programme in Health Services & Systems Research (HSSR), Duke-NUS Medical School, Singapore, Singapore. 4. Urogynaecology Unit, Department of Obstetrics & Gynaecology, Singapore General Hospital, Singapore, Singapore. 5. Maternal Fetal Medicine Unit, Department of Obstetrics & Gynaecology, Singapore General Hospital, Singapore, Singapore. 6. Urogynaecology Unit, Department of Obstetrics & Gynaecology, Singapore General Hospital, Singapore, Singapore. lim.shau.khng@singhealth.com.sg.
Abstract
INTRODUCTION AND HYPOTHESIS: Forceps-assisted deliveries are an established risk factor for pelvic organ prolapse and pelvic floor injury. However, specific comparison of incontinence outcomes between vacuum-assisted and forceps-assisted deliveries are scarce in the literature. We aimed to compare the initial impact of vacuum and forceps deliveries on new-onset urinary and faecal incontinence as well as pelvic floor muscle strength, with the hypothesis that incontinence outcomes were poorer after forceps- than after vacuum-assisted delivery. METHODS: This is a retrospective cohort study of incontinence outcomes in patients who had primary vacuum- or forceps-assisted delivery. The study population included 108 postpartum patients who had undergone operative vaginal delivery (63 vacuum-assisted, 45 forceps-assisted), met the inclusion criteria and attended the postpartum assessment service. Outcomes studied were the presence and severity of symptoms manifesting beyond 1 month postpartum - faecal incontinence and stress, urgency and mixed urinary incontinence - as well as pelvic floor muscle strength scores based on the modified Oxford scale. RESULTS: Prevalence of new-onset urinary and faecal incontinence was 35.6% in the forceps group and 30.2% in the vacuum group. The data suggest that there is no significant difference in the prevalence of new-onset incontinence symptoms (p = 0.70, difference in prevalence [forceps - vacuum]: 5.4%, 95% CI -0.25, +0.15), frequency (p = 0.40) and amount (p = 0.48) of urine leakage or mean muscle strength scores (p = 0.89). CONCLUSION: In our maternity unit, we observed that type of operative vaginal delivery was not associated with significant differences in urinary incontinence and pelvic floor muscle strength outcomes.
INTRODUCTION AND HYPOTHESIS: Forceps-assisted deliveries are an established risk factor for pelvic organ prolapse and pelvic floor injury. However, specific comparison of incontinence outcomes between vacuum-assisted and forceps-assisted deliveries are scarce in the literature. We aimed to compare the initial impact of vacuum and forceps deliveries on new-onset urinary and faecal incontinence as well as pelvic floor muscle strength, with the hypothesis that incontinence outcomes were poorer after forceps- than after vacuum-assisted delivery. METHODS: This is a retrospective cohort study of incontinence outcomes in patients who had primary vacuum- or forceps-assisted delivery. The study population included 108 postpartum patients who had undergone operative vaginal delivery (63 vacuum-assisted, 45 forceps-assisted), met the inclusion criteria and attended the postpartum assessment service. Outcomes studied were the presence and severity of symptoms manifesting beyond 1 month postpartum - faecal incontinence and stress, urgency and mixed urinary incontinence - as well as pelvic floor muscle strength scores based on the modified Oxford scale. RESULTS: Prevalence of new-onset urinary and faecal incontinence was 35.6% in the forceps group and 30.2% in the vacuum group. The data suggest that there is no significant difference in the prevalence of new-onset incontinence symptoms (p = 0.70, difference in prevalence [forceps - vacuum]: 5.4%, 95% CI -0.25, +0.15), frequency (p = 0.40) and amount (p = 0.48) of urine leakage or mean muscle strength scores (p = 0.89). CONCLUSION: In our maternity unit, we observed that type of operative vaginal delivery was not associated with significant differences in urinary incontinence and pelvic floor muscle strength outcomes.
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Authors: Riikka M Tähtinen; Rufus Cartwright; Johnson F Tsui; Riikka L Aaltonen; Yoshitaka Aoki; Jovita L Cárdenas; Regina El Dib; Kirsi M Joronen; Sumayyah Al Juaid; Sabreen Kalantan; Michal Kochana; Malgorzata Kopec; Luciane C Lopes; Enaya Mirza; Sanna M Oksjoki; Jori S Pesonen; Antti Valpas; Li Wang; Yuqing Zhang; Diane Heels-Ansdell; Gordon H Guyatt; Kari A O Tikkinen Journal: Eur Urol Date: 2016-02-10 Impact factor: 20.096