title: [Postpartum urinary and fecal incontinence in gemelar pregnancy according to route and mode of delivery].
abstract: BACKGROUND
  The incidence of multiple pregnancies increased in the last two decades. Several studies seeking the incidence of pelvic floor pathology, particularly urinary incontinence and its risk factors, conclude that a previous cesarean and vaginal delivery even more, carry an increased risk for developing urinary and fecal incontinence, compared with patients nulligravida.
  
  
  OBJECTIVE
  To determine the different risk factors for urinary incontinence after a twin pregnancy.
  
  
  METHODS
  331 women from 20 to 50 years of age without symptoms prior to pregnancy were interviewed, attending antenatal care of twin pregnancy in the Hospital La Paz, Madrid. The interview included the ICIQ-SF (International Consultation on Incontinence Questionnaire-Short Form). We recorded maternal age, gestational age, parity, episiotomy, weights of both newborns, the need for urinary protectors and fecal or gas incontinence.
  
  
  RESULTS
  The prevalence of urinary incontinence postpartum according ICIQ-SF >0 was 23%; 20.4% in the caesarean group, 25.3% in the eutocic delivery group and 35.5% in the instrumental delivery group (p = 0.033). The prevalence of moderate to severe incontinence (ICIQ-SF >6) was 14.8%; 12.3% in caesarean group, 14.5% in the eutocic delivery group and 32.3% in the instrumental delivery group (p = 0.005). The prevalence of fecal incontinence was 3.4%; 4.8% in eutocic delivery group, 1.9% in the caesarean group and 9.7% in the instrumental delivery group (p = 0.058).
  
  
  CONCLUSIONS
  The risk of urinary incontinence after a twin pregnancy was higher among patients who had an instrumental delivery when compared with patients with eutocic delivery or cesarean section. The total fetal weight and maternal age did not appear as risk factors in our study. Any woman who had an instrumental delivery for twins should be followed up by a pelvic floor specialist.
authors.affiliation: Departamento de Ginecología y Obstetricia, Hospital Universitario La Paz, Madrid, Espana. marxichos@hotmail.com
authors.forename: Marcos Javier
authors.initials: MJ
authors.lastname: Cuerva González
authors.forename: Nayara
authors.initials: N
authors.lastname: López Carpintero
authors.forename: Miranda María
authors.initials: MM
authors.lastname: de la Calle Fernández
authors.forename: Ramón
authors.initials: R
authors.lastname: Usandizaga
authors.forename: Antonio
authors.initials: A
authors.lastname: González
mesh_terms: D000328:Adult; D001724:Birth Weight; D002585:Cesarean Section; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000009:adverse effects / Q000379:methods*; D004841:Episiotomy; D005242:Fecal Incontinence / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008875:Middle Aged; D009772:Obstetrical Forceps; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011247:Pregnancy; D011272:Pregnancy, Multiple; D011644:Puerperal Disorders / Q000453:epidemiology* / Q000209:etiology; D011795:Surveys and Questionnaires; D014427:Twins; D014549:Urinary Incontinence / Q000453:epidemiology* / Q000209:etiology; D055815:Young Adult