Mode of Delivery and Severe Stress Incontinence: A Cross Sectional Study Among 2625 Perimenopausal Women

Abstract

Three hundred patients were enrolled in a double-blind, randomized, controlled study designed to investigate the ability of supplemental perioperative oxygen to reduce wound infection. Participants were age 18 to 80 years, had no coexisting serious medical conditions, and were scheduled to undergo elective colorectal surgery at one of 14 participating hospitals in Spain. No patients undergoing minor or laparoscopic surgery were included. Anesthesia and antibiotic prophylaxis were standardized for the study. Patients were randomized by computer-generated codes to receive an oxygen/air mixture of 30% or 80% fraction of inspired oxygen (F10 2 ) intraoperatively and postoperatively for 6 hours. After 6 hours, oxygen was given only in amounts needed to maintain 92% saturation. Postoperative care was determined by the attending surgeon who was unaware of the patient's oxygen group.Wounds were inspected daily and surgical site infections (SSI) were diagnosed according to the definitions of the Centers for Disease Control and Prevention. Infections occurring during the first 14 days were considered for analysis.Nine patients did not meet inclusion criteria. Of the remaining 291 patients, 143 received 30% and 148 received 80% oxygen. The 2 groups were similar in clinical characteristics, including preoperative laboratory studies and risk of infection score. Surgical characteristics, including length of operative procedure, blood loss, and transfusion rate, were also similar between the 2 groups.Fifty-seven patients (19.3%) developed a wound infection. The incidence of wound infection was 35 of 143 (24%) in the 30% F10 2 group and 22 of 148 (14.9%) in the 80% F10 2 patients (P ϭ 0.04). The risk of SSI was 39% lower in the high oxygen group compared with those who received less oxygen (relative risk, 0.61; 95% confidence interval [CI], 0.38-0.98). Other measures of surgical outcome, including return of bowel function, ability to tolerate solid food, ambulation, suture removal, and duration of hospitalization, were not significantly different for the 2 treatment groups. When patients who developed wound infections were compared with those without infection, the group with SSI had a longer time to ambulation (mean, 4.9 vs 3.9 days; P ϭ 0.008), a longer time to staple removal (11.6 vs 10.1 days; P ϭ 0.007), and were in the hospital longer (15.1 vs 10.7 days; P ϭ 0.001).Two patients, both in the 30% oxygen group, died of sepsis during the study period. After multivariate analysis of possible confounding variables, the relative risk of wound infection in patients who received 80% oxygen was 0.46 (95% CI, 0.22-0.95; P ϭ 0.04) compared with those who received 30% oxygen. EDITORIAL COMMENT(In the United States these days, surgical wound infection occurs after less than 1% of abdominal or vaginal hysterectomies. This is a marked reduction in the last 20 years brought about largely because of prophylactic antibiotics. More than 25 prospective, randomized studies have shown the effectiveness of prophylactic antibiotics in reducing pos...

Maternal and neonatal individual risks and benefits associated with caesarean delivery: multicentre prospective study

“…On the positive side, there is a clear short term protective effect for vaginal complications that could eventually reduce long term consequences, although this remains to be confirmed. [16][17][18] Our results can be used by providers of obstetric care and women and their families during the decision making process regarding mode of delivery in the absence of a life threatening clinical situation. There is a clear demand for such information, 19 and guidance is expected from medical personnel.…”

Parturition events and risk of urinary incontinence in later life

“…The parturition events examined were defined a priori based on categories used in previous studies of post‐partum urinary incontinence as: ever induced, ever prolonged first stage of labor (>12 hr), ever prolonged second stage of labor (>1 hr), ever augmentation of labor with oxytocin, ever instrumental delivery, ever spinal, saddle or epidural anesthesia, ever pudendal anesthesia, and ever episiotomy, ever 3rd or 4th degree tear, and ever birth weight ≥4,000 g. Age at first birth was dichotomized at <23 years versus ≥23 years old while age at last birth was dichotomized at ≤34 and >34 years old. These age cut points were chosen to facilitate comparison with prior reports of the association between urinary incontinence and age at first and last births 10–13. Continuous variables were also modeled using linear and restricted cubic spline functions to improve the fit of the data, with knots chosen empirically using stepwise selection 14.…”

Stress Urinary Incontinence

“…The prevalence of SUI ranges from 3% to 60%, varying with definition and age of population being reported. 7 SUI is statistically significantly more common in white women than in black women. 6 Similarly, a French mailed, self-administered questionnaire reported a prevalence of 7% for severe SUI in nulliparous women.…”