title: Is prenatal urethral descent a risk factor for urinary incontinence during pregnancy and the postpartum period?
abstract: OBJECTIVE
  Obstetric trauma during childbirth is considered a major risk factor for postpartum urinary incontinence (UI), particularly stress urinary incontinence. Our aim was to investigate the relation between postpartum UI, mode of delivery, and urethral descent, and to define a group of women who are particularly at risk of postnatal UI.
  
  
  METHODS
  A total of 186 women were included their first pregnancy. Validated questionnaires about urinary symptoms during pregnancy, 2 and 12 months after delivery, were administered. Urethral descent was assessed clinically and by ultrasound at inclusion. Multivariate logistic regression analysis was used to determine the risk factors for UI during pregnancy, at 2 months and 1 year after first delivery.
  
  
  RESULTS
  The prevalence of UI was 38.6, 46.5, 35.6, and 34.4 % at inclusion, late pregnancy, 2 months postpartum, and 1 year postpartum respectively. No significant association was found between UI at late pregnancy and urethral descent assessed clinically or by ultrasound. The only risk factor for UI at 2 months postpartum was UI at inclusion (OR 6.27 [95 % CI 2.70-14.6]). The risk factors for UI at 1 year postpartum were UI at inclusion (6.14 [2.22-16.9]), body mass index (BMI), and urethral descent at inclusion, assessed clinically (7.21 [2.20-23.7]) or by ultrasound. The mode of delivery was not associated with urethral descent.
  
  
  CONCLUSIONS
  Prenatal urethral descent and UI during pregnancy are risk factors for UI at 1 year postpartum. These results indicate that postnatal UI is more strongly influenced by susceptibility factors existing before first delivery than by the mode of delivery.
authors.affiliation: Department of Gynaecology and Obstetrics, Intercommunal Hospital Center of Poissy-Saint-Germain-en-Laye, Poissy, France. acpizzofe@gmail.com.|Research Unit EA7285, Risk and Safety in Clinical Medicine for Women and Perinatal Health, Versailles St-Quentin University, Montigny-le-Bretonneux, France. acpizzofe@gmail.com.
authors.forename: Anne-Cécile
authors.initials: AC
authors.lastname: Pizzoferrato
authors.affiliation: Department of Gynaecology and Obstetrics, Intercommunal Hospital Center of Poissy-Saint-Germain-en-Laye, Poissy, France.|Research Unit EA7285, Risk and Safety in Clinical Medicine for Women and Perinatal Health, Versailles St-Quentin University, Montigny-le-Bretonneux, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Fauconnier
authors.affiliation: Department of Gynaecology and Obstetrics, Intercommunal Hospital Center of Poissy-Saint-Germain-en-Laye, Poissy, France.
authors.forename: Georges
authors.initials: G
authors.lastname: Bader
authors.affiliation: Department of Gynaecology and Obstetrics, University Hospital of Nîmes, Nîmes, France.
authors.forename: Renaud
authors.initials: R
authors.lastname: de Tayrac
authors.affiliation: Department of Gynaecology and Obstetrics, Intercommunal Hospital Center of Poissy-Saint-Germain-en-Laye, Poissy, France.
authors.forename: Julie
authors.initials: J
authors.lastname: Fort
authors.affiliation: INSERM CIC1402, University Hospital of Poitiers, Poitiers University, Poitiers, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Fritel
mesh_terms: D000328:Adult; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D049590:Postpartum Period; D011247:Pregnancy; D011446:Prospective Studies; D011644:Puerperal Disorders / Q000453:epidemiology*; D012307:Risk Factors; D014463:Ultrasonography; D014521:Urethra / Q000000981:diagnostic imaging*; D014549:Urinary Incontinence / Q000453:epidemiology*
keywords: Mode of delivery; Perineal ultrasound; Urethral mobility; Urinary incontinence