title: First vaginal delivery at an older age: Does it carry an extra risk for the development of stress urinary incontinence?
abstract: OBJECTIVE
  First delivery at an older age is not an uncommon event in modern obstetric practice. The present study was undertaken to compare the prevalence of postpartum stress urinary incontinence (SUI) according to maternal age and mode of delivery.
  
  
  METHODS
  Fifty two consecutive elderly primiparae (mean age 40.0 +/- 1.8) who underwent spontaneous vaginal delivery, 42 consecutive elderly primiparae (mean age 40.7 +/- 3.6) who underwent elective cesarean section, and 92 consecutive young primiparae (mean age 26.2 +/- 2.5) who underwent spontaneous vaginal delivery were interviewed 1-2 years postpartum about the symptom of SUI. Women who had SUI before pregnancy were not enrolled. Obstetric data were collected from computerized hospital records.
  
  
  RESULTS
  The prevalence of SUI 1-2 years after spontaneous vaginal delivery was significantly higher in elderly compared with younger primiparae (38.5% vs. 9.8%, respectively). Elderly primiparae who underwent elective cesarean section had a significantly lower prevalence of postpartum SUI than those delivered vaginally (16.7% vs. 38.5%, respectively). Further comparison of stress-incontinent versus continent elderly primiparae failed to reveal significant demographic or obstetric differences, except for increased prevalence of SUI during pregnancy among incontinent patients (45% vs. 19%, respectively).
  
  
  CONCLUSIONS
  First vaginal delivery at an older age carries an increased risk for postpartum SUI. Stress-incontinent women also had higher prevalence of SUI during pregnancy. This finding implies that the pathophysiologic process of SUI begins during pregnancy, prior to active labor and delivery. Nonetheless, elective cesarean section in these women has a protective effect and lowers the risk of developing postpartum SUI.
authors.affiliation: Urogynecology and Pelvic Floor Unit, Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. agroutz@yahoo.com
authors.forename: Asnat
authors.initials: A
authors.lastname: Groutz
authors.forename: Limor
authors.initials: L
authors.lastname: Helpman
authors.forename: Ronen
authors.initials: R
authors.lastname: Gold
authors.forename: David
authors.initials: D
authors.lastname: Pauzner
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Lessing
authors.forename: David
authors.initials: D
authors.lastname: Gordon
mesh_terms: D000328:Adult; D000367:Age Factors; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008423:Maternal Age; D011247:Pregnancy; D015995:Prevalence; D012307:Risk Factors; D014550:Urinary Incontinence, Stress / Q000453:epidemiology*