BACKGROUND AND PURPOSE: 

• Women who have undergone midurethral sling surgery (retropubic or transobturator approach) for the treatment of stress urinary incontinence (SUI) are often cautioned to avoid subsequent pregnancies 
• Minimal data available as to whether or not future pregnancy is truly a contraindication  
• Bergman et al. (Obstetrics & Gynecology, 2018) examined whether subsequent childbirth affects the outcomes following midurethral sling surgery 

METHODS: 

• Population-based cohort study 
• Participants: Women with a delivery after midurethral sling surgery  
  • Identified using the validated Swedish nationwide health care registers 
  • Control group: No deliveries after sling surgery  
  • Case group: Women with ≥1 deliveries matched to control group based on year of surgery and age at surgery  
• Data derived using the Urogenital Distress Inventory and the Incontinence Impact Questionnaire  
• Primary outcome 
  • Symptomatic SUI 
  • Defined as an answer of moderate to great bother on the question “Do you experience urine leakage related to physical activity, coughing or sneezing?” (Urogenital Distress Inventory) 
• Secondary outcomes  
  • Total Urogenital Distress Inventory score 
  • Urogenital Distress Inventory subscale scores 
  • Incontinence Impact Questionnaire scores 

RESULTS: 

• Data was collected from 728 women 
  • The response rate was 74%; 163 in the study group (64 with vaginal delivery and 95 with cesarean delivery) and 374 women in the control group were included in the analysis 
• The rate of SUI was 36 of 163 (22%) in the study group and 63 of 375 (17%) in the control group 
• In a multivariate regression analysis of SUI rate, there was no significant difference between the groups (odds ratio [OR] 1.2, 95% CI 0.7–2.0) 
• Vaginal childbirth after midurethral sling surgery did not increase the risk of SUI compared with cesarean delivery (22% vs 22%, OR 0.6, 95% CI 0.2–1.4) 
• There were no significant differences in Urogenital Distress Inventory and Incontinence Impact Questionnaire scores between groups 

CONCLUSION: 

• Authors recognize limitation due to lack of objective outcome data 
  • However, symptom relief is usually considered the primary outcome  
• Childbirth after midurethral sling surgery does not appear to increase risk for stress urinary incontinence compared to women with no deliveries, regardless of mode of delivery 

Learn More – Primary Sources: 

Associations Between Childbirth and Urinary Incontinence After Midurethral Sling Surgery

Related ObG Topics:

Surgery for Urinary Incontinence – When the Sling’s the Thing

Midurethral Tape and Repeat Surgery for Stress Incontinence: Is the 2nd Time the Charm?

Prolapse and Stress Incontinence: Burch Procedure vs Midurethral Sling