title: Antenatal screening for postpartum urinary incontinence in nulliparous women: a pilot study.
abstract: Antenatal screening for postpartum urinary incontinence in nulliparous women: a pilot study.
  
  
  OBJECTIVE
  To examine the utility of joint mobility scoring (JMS) as a screening test for postpartum urinary incontinence.
  
  
  METHODS
  A prospective cohort study in a teaching hospital involving 150 nulliparous women. JMS was calculated. The incidence of incontinence and pad use was recorded. Univariate and multiple logistic regression analyses were used to identify factors independently associated with incontinence.
  
  
  RESULTS
  Hundred and three women completed the study. 43.7% of subjects were incontinent antenatally and 4.9% remained incontinent at the study end. JMS was normally distributed and similar in continent and incontinent women. Elbow hyperextension (>180 degrees ) was associated with postnatal incontinence (odds ratio 10.6; 95% CI 1.24, 90.8). Elbow hyperextension had a sensitivity of 80%, specificity of 75%, positive predictive value of 14%, and negative predictive value of 99% for postnatal incontinence.
  
  
  CONCLUSIONS
  Joint hypermobility score is not a useful screening test. Elbow hyperextension is associated with an increased likelihood of postnatal urinary incontinence. It is unclear whether this test has clinical utility outside a research setting.
authors.affiliation: University of Liverpool, Department of Obstetrics & Gynaecology, Liverpool Women's Hospital, Crown Street, Liverpool L8 7SS, UK. tincello@liv.ac.uk
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Tincello
authors.forename: Elisabeth J
authors.initials: EJ
authors.lastname: Adams
authors.forename: David H
authors.initials: DH
authors.lastname: Richmond
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004551:Elbow Joint; D005260:Female; D005865:Gestational Age; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis; D016015:Logistic Models; D016017:Odds Ratio; D010298:Parity; D010865:Pilot Projects; D011247:Pregnancy; D011446:Prospective Studies; D011644:Puerperal Disorders / Q000175:diagnosis*; D012680:Sensitivity and Specificity; D014549:Urinary Incontinence / Q000175:diagnosis*