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#Grand Rounds

Is There Evidence to Discourage Childbirth After a Sling Procedure for Incontinence?

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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

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Related ObG Topics:

Practical info for your gynecology practice
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

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