Establishment and validation of a simple nomogram for predicting early postpartum stress urinary incontinence among women with vaginal delivery: a retrospective study

Abstract

Background Stress urinary incontinence (SUI) is a common public health issue that negatively impacts the quality of life for women worldwide, of which early detection and rehabilitation are consequently pivotal. The aim of this study is to establish a simple nomogram for identifying women at risk of postpartum SUI. Methods A retrospective study was conducted in a tertiary specialized hospital in Shanghai, China. The study included only women with singleton, full-term, and vaginal deliveries. 2,441 women who delivered from July 2019 to November 2019 were included in the training cohort, and 610 women who delivered from January 2022 to February 2022 were included in the validation cohort. SUI was determined by the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI-SF). Univariate and multifactorial logistical regression were used to identify independent risk factors for postpartum SUI and further construct the nomogram accordingly. Based on concordance statistics (C-statistics), calibration curves, and decision curve analyses, we evaluated the performance of the nomogram in the training cohort and the validation cohort. In addition, the model was validated internally in the training cohort through cross-validation. Results There were no significant statistically differences in important baseline data such as age, pre-pregnancy BMI, and parity between the training and validation cohorts. SUI was observed in 431 (17.6%) and 125 (20.5%) women in the training and validation cohorts, respectively. According to the regression analysis, age, parity, second stage of labor, infant weight, and forceps delivery were included in the nomogram. The nomogram had a C-statistic of 0.80 (95% confidence interval [CI] 0.74–0.85) for predicting SUI. C-statistics were stable in both internally cross-validated training cohort (mean 0.81) and validation cohort (0.83 [95% CI 0.79–0.87]). The nomogram’s calibration curve was near the ideal diagonal line. Additionally, the model exhibited a positive net benefit from the decision curve analysis. Conclusion We have created a nomogram that can be utilized to quantify the risk of postpartum SUI for women with vaginal delivery. The model might contribute to predicting early postpartum SUI, thereby facilitating the management of SUI.

Development and Validation of a Risk Prediction Model for Female Stress Urinary Incontinence in Rural Fujian, China

“…Whereas, after internal validation, the model had a C-index of 0.73, and the limited sample size may be one of the reasons affecting the efficacy of the prediction. 25 Another predictive model on postpartum UI included a total of 3051 socio-demographic and obstetric- 15 However, although numerous models can only predict the risk of SUI in specific populations, 12,[26][27][28] and predictive models that can be used as risk screening tools to reach a wider range of women are still rare. In 2019, the study by Xiao et al proposed that the bladder neck position (BNP) and the urethral rotation angle (URA) and the levator hiatus area (LHA) derived from 3D ultrasonography can potentially predict the occurrence of SUI in women of all ages with good accuracy.…”

“…12 Xiao et al predicted the risk of SUI development by translabial three dimensional (3D) ultrasound examination, and constructed several prediction models by combining different ultrasound indicators, with an accuracy of up to 77.8%, a specificity of up to 95.2%, and a sensitivity that could reach close to 70%. 13 Although the aforementioned prediction models can achieved good prediction results, most of the current prediction tools were limited to a specific period of time (postpartum and postoperative), 14,15 and more data are needed to support whether the prediction models for SUI can have a larger scope of application. 16 In addition, many of the predictive models relied on data from urodynamic tests and 3D ultrasound, which are difficult to obtain in rural areas where medical resources are scarce.…”

Feasibility of non-ablative photothermal 980nm laser endoluminal treatment for stress urinary incontinence

“…Stress urinary incontinence (SUI), which affects 1 in 3 women, is a common public health problem [1]. SUI is the involuntary loss of urine during physical activities with abdominal pressure, such as coughing, sneezing, and laughing [2]. Involuntary loss of urine is caused by a weakening of the urethral muscle, and the main factors are aging, pelvic surgery, and childbirth.…”

Development and validation of a Decision‐Making Ability Scale for postpartum urinary incontinence women engaging in pelvic floor physical therapy

“…Postpartum urinary incontinence (PPUI) is when urine uncontrollably leaks after delivery 1 due to the overexpansion of the pelvic floor ligaments and muscles during pregnancy and vaginal delivery, which relaxes the tissues supporting the urinary bladder floor and upper urethra. 2,3 It affects ~12.50% at 6 weeks postpartum and 6.8% at 6 months postpartum. 4 PPUI not only affects women's physical wellbeing but also their psychology and social economy.…”