title: Urinary incontinence among mothers of multiples: the protective effect of cesarean delivery.
abstract: OBJECTIVE
  The purpose of this study was to assess the impact of delivery mode on the risk of urinary incontinence among women with previous multiple childbirth.
  
  
  METHODS
  A 77-item questionnaire was administered to 733 mothers of multiples. Multivariate regression was used to control for potentially confounding variables.
  
  
  RESULTS
  The mean rate of stress urinary incontinence among women who were delivered by cesarean-only delivery was 39.6%, which was significantly lower than the 60.4% among women who reported previous vaginal births (P =.005). Cesarean-only delivery was associated with a markedly reduced risk (odds ratio, 0.52; P =.002) after controlling for age, parity, and body mass index by multivariate regression. Weaker associations were found for age (odds ratio, 1.08), body mass index (odds ratio, 1.06), and parity (odds ratio, 1.46). Urge incontinence was associated with parity, body mass index, and age, but not delivery mode (P =.76).
  
  
  CONCLUSIONS
  Vaginal delivery represents a major risk factor for stress incontinence among mothers of multiples. Delivery by cesarean delivery only confers an independent protective effect.
authors.affiliation: Division of Urogynecology and Reconstructive Pelvic Surgery, Evanston Northwestern Healthcare, Northwestern University Medical School, IL 60201, USA. rgoldberg@enh.org
authors.forename: Roger P
authors.initials: RP
authors.lastname: Goldberg
authors.forename: Christina
authors.initials: C
authors.lastname: Kwon
authors.forename: Sanjay
authors.initials: S
authors.lastname: Gandhi
authors.forename: Laxmi V
authors.initials: LV
authors.lastname: Atkuru
authors.forename: Mark
authors.initials: M
authors.lastname: Sorensen
authors.forename: Peter K
authors.initials: PK
authors.lastname: Sand
mesh_terms: D000328:Adult; D000368:Aged; D002585:Cesarean Section; D003226:Congresses as Topic; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009035:Mothers; D015205:Northwestern United States / Q000453:epidemiology; D011247:Pregnancy; D011272:Pregnancy, Multiple; D015995:Prevalence; D011644:Puerperal Disorders / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014549:Urinary Incontinence / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control