EVALUATION OF URINARY INCONTINENCEOF TWIN PREGNANCIES ACCORDING TO THEIR MODE OF DELIVERY. JUMODA-CPSTUDY. RESULTS AT 3 MONTHS POSTPARTUM.
R. DE TAYRAC1, F.BECHARD 1, C. CASTELLI 1, S. ALONSO 1,E. VINTEJOUX 2, F. GOFFINET 3, V. LETOUZEY 4,T. SCHMITZ 5;
1Caremeau Univ. Hosp., Nîmes,France, 2Arnaud de Villeneuve Univ. Hosp., Montpellier,France, 3Inserm UMR 1153, Obstetrical, Perinatal andPaediatric Epidemiology Res. Team (EPOPé), Ctr. for Epidemiology andStatistics Sorbonne Paris Cité (CRESS), DHU Risks in pregnancy,Paris Descartes Univ., Paris, France, 4Caremeau Univ.Hosp., Nimes, France, 5Robert Debre Univ. Hosp., Paris,France.
Introduction: Female urinaryincontinence (UI) can lead to impaired quality of life for women. Itis therefore imperative to identify UI risk factors and proposeprevention strategies. Postpartum IU is a consequence of pregnancyand delivery resulting from neuromuscular lesions and/or alterationof vesico-urethral support systems. In case of twin pregnancies,previous studies shown UI rate ranging from 20 to 40% at 20 monthsafter delivery . Some individual factors appear to besignificantly associated with the risk of postpartum UI such asobesity, smoking, maternal age, prenatal IU and a total intrauterineweight >3400gr. The delivery route does not seem to have a greatinfluence on the level of bothered UI, both in the studies onsingletons  and on twins , but UI was not primarily intended tobe studied. A study specifically designed on post-partum UI was thennecessary in particular with the increase rate of multiple pregnancy(+ 68% in 30 years).
Objective: To compare the rate ofurinary incontinence at 3 months of delivery between the primiparouswomen giving birth of twins by vaginal route and cesarean sectionafter 34 weeks.
Methods: Comparative multicenterprospective cohort on primiparous women giving birth after 34 weeksof two live twins. We considered as the primary endpoint the 3-monthpost-partum UI rate defined by responses 1 to 5 to the first questionof ICI-Q, namely the presence of urinary incontinence, whatever itstype, severity and its impact. The hypothesis formulated being toshow a difference of 10% between the two delivery routes. Taking anexpected rate in the vaginal group of 50%, an alpha risk of 5%, apower of 90%, a total of 1080 deliveries was necessary. Based on anon-response/loss of follow-up of 50%, the number of patientsrequired was 2160. Considering the data obtained from the literature,the prenatal parameters studied were: total weight of children,preterm pregnancy, initial BMI, smoking and weight gain duringpregnancy. The significance of the primary endpoint was assessedusing a Fisher test and secondary endpoints using Chi2 tests. The12-month UI rate and other perineal consequences will be presentedelsewhere.
Results: 2812 primiparous women with no previoushistory of UI and whom gave birth after 34 weeks of two live twinswere included from 172 French units between February 2014 to March2015. Of these, 1734 responded (61.7%), including 813 vaginaldeliveries (46.9%) and 921 caesarean section (53.1%). Finally, 1155ICI-Q questionnaires were completed at 3 months post-partum (between60 and 124 days). Respondent women were older (32±5 vs 31±6 yo) andhave gave birth more often vaginally (47 vs 44%).) in comparison tonon-respondent. In the caesarean section group, women were older (32[29-36] vs 31 [28-34] yo), had a more important weight at the time ofdelivery (79 [71-88] vs 76 [69-86] Kg) and the first twin was mostlynon-cephalic presentation (58 vs 97%). On the 1155 patients, 296 hadUI on ICI-Q at 3-month post-partum (26% [23% - 28%]). Regarding themode of delivery, 197 patients had UI after vaginal delivery (66.55%)and 99 after caesarean section (33.45%) (p<.0001; OR 2.77 95%CI[2.10 - 3.66]). On multivariate analysis, only vaginal delivery (OR3.073 [2.300 - 4.105]) and a BMI >25 at the beginning of pregnancy(OR 1.620 [1.188-2.209]) were independently associated with 3-monthpost-partum UI. Other factors, such as obstetrical manoeuvers onfirst twin, maternal age >25 yo and tabacco use were notsignificantly associated with 3-month post-partum UI.
Conclusions:The prevalence of urinary incontinence at 3 months post-partum was26% after the birth of twins, and vaginal delivery was an independentrisk factor.
References: 1. [Impact of twin gestation onthe risk of postpartum stress incontinence]. Gynecol Obstet Fertil2010. 2. Maternal outcomes at 3 months after planned caesareansection versus planned vaginal birth for twin pregnancies in the TwinBirth Study: a randomised controlled trial. BJOG 2015.