Position in the second stage of labour and de novo onset of post-partum urinary incontinence.
OBJECTIVE
The aim of this study was to evaluate the role of the maternal position at the time of delivery on the onset of de novo symptoms of urinary incontinence (UI) in the post-partum period.


METHODS
This prospective study evaluated the data of consecutive women undergoing labour and delivery, between January 2014 and July 2014. We included only women with a singleton pregnancy undergoing vaginal delivery. During the study period, patients chose to deliver in the position that they considered the most comfortable. The onset of UI was evaluated according to the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-sf).


RESULTS
Overall, 716 primiparous women were included in the study. Sixty women refused the 12-week post-partum interview (8.4%). Women were divided in two groups: 296 women (45.1%) who chose an upright position during delivery (group 1) and 360 women (54.9%) who chose a supine position (group 2). Group 1 had a significantly lower episiotomy rate, but a higher rate of greater than second degree perineal tears. In group 1 we found a significantly lower rate of de novo UI (40.5% vs 48.9%, p = 0.03) and in particular of stress urinary incontinence. Via multivariate analysis, birth position was the only factor correlating with the occurrence of urinary incontinence in the post-partum period (OR: 1.52; 95%CI: 1.06, 2.18; p = 0.02).


CONCLUSIONS
Upright positions at delivery are related to a lower episiotomy rate and a higher rate of greater than second degree perineal tears. Supine positions are an independent risk factor for the onset of de novo UI.
Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Piazza Biroldi 1, 21100, Varese, Italy. mauserati@hotmail.com.
Maurizio
M
Serati
Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Piazza Biroldi 1, 21100, Varese, Italy.
Maria Carmela
MC
Di Dedda
Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Piazza Biroldi 1, 21100, Varese, Italy.
Giorgio
G
Bogani
Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Piazza Biroldi 1, 21100, Varese, Italy.
Paola
P
Sorice
Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Piazza Biroldi 1, 21100, Varese, Italy.
Antonella
A
Cromi
Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Piazza Biroldi 1, 21100, Varese, Italy.
Stefano
S
Uccella
Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Piazza Biroldi 1, 21100, Varese, Italy.
Martina
M
Lapenna
Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Piazza Biroldi 1, 21100, Varese, Italy.
Marco
M
Soligo
Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Piazza Biroldi 1, 21100, Varese, Italy.
Fabio
F
Ghezzi
D000328:Adult; D004841:Episiotomy / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007748:Labor Stage, Second; D022125:Lacerations / Q000453:epidemiology; D056888:Patient Positioning / Q000009:adverse effects* / Q000379:methods; D010502:Perineum / Q000293:injuries; D011187:Posture; D011247:Pregnancy; D011446:Prospective Studies; D014550:Urinary Incontinence, Stress / Q000453:epidemiology*
Labour; Stress urinary incontinence; Upright position; Urinary incontinence