title: Effects of delivery mode and sociodemographic factors on postpartum stress urinary incontinency in primipara women: A prospective cohort study.
abstract: BACKGROUND
  To determine the frequency of postpartum stress urinary incontinence (SUI) in women undergoing vaginal delivery or elective cesarean section and to investigate the sociodemographic determinants of SUI in a sample of Iranian patients.
  
  
  METHODS
  This prospective cohort study was performed during a 1-year period from 2014 to 2015 including 286 healthy nulliparous women in the third trimester of pregnancy without prepregnancy urinary incontinence. Participants were categorized based on the mode of delivery, i.e., vaginal delivery (n=148) and elective cesarean section (n=138). SUI was evaluated in all the participants before delivery and at 1 month, 6 months, and 12 months after delivery using a previously validated Persian questionnaire. The frequency of postpartum SUI was recorded in both study groups and was compared between them. We also determined the sociodemographic determinants of SUI.
  
  
  RESULTS
  Baseline characteristics were comparable. The frequency of postpartum SUI was significantly higher in vaginal delivery than in cesarean section after a 1-month (p<0.001), 6-month (p<0.001), and 12-month (p<0.001) period. Age was found to be associated with increased frequency of postpartum SUI in both vaginal delivery (p=0.021, r=0.286) and cesarean section groups (p=0.043, r=0.125). SUI was associated with tool-assisted vaginal delivery (p<0.001) and episiotomy (p<0.001). The birth weight was positively correlated with increased frequency of postpartum SUI in both vaginal delivery (p=0.011, r=0.546) and cesarean section (p=0.034, r=0.311). Patients with SUI had a significantly higher body mass index than the normal individuals (p=0.038). SUI was associated with lower income (p=0.028) and lower neighborhood residence (p=0.033).
  
  
  CONCLUSIONS
  Vaginal delivery is associated with a twofold increased risk of postpartum SUI in primipara women compared with elective cesarean section. Age and birth weight are the main risk factors of postpartum SUI in both modes of delivery. Tool-assisted delivery and episiotomy were determined as the risk factors of postpartum SUI in vaginal delivery.
authors.affiliation: Department Obstetrics and Gynecology, Fasa University of Medical Sciences, Fasa, Iran.
authors.forename: Roya
authors.initials: R
authors.lastname: Kokabi
authors.affiliation: Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran. Electronic address: yazdanpanahd@yahoo.com.
authors.forename: Dorna
authors.initials: D
authors.lastname: Yazdanpanah
mesh_terms: D000328:Adult; D001724:Birth Weight; D002585:Cesarean Section; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D008423:Maternal Age; D011247:Pregnancy; D011446:Prospective Studies; D011644:Puerperal Disorders / Q000209:etiology*; D014550:Urinary Incontinence, Stress / Q000209:etiology*
keywords: cesarean section; frequency; sociodemographic determinants; stress urinary incontinence; vaginal delivery