Journal Reading

Differences In Urinary Incontinence Symptoms And

Pelvic Floor Structure Changes During Pregnancy
Between Nulliparous And Multiparous Women
Dan Luo, Ling Chen, Xiajuan Yu, Li Ma, Wan Chen, Ning Zhou and Wenzhi Cai
PeerJ, DOI 10.7717/peerj.3615

Shandy Suwanto Putra

DIVISI UROGINEKOLOGI DAN BEDAH REKONSTRUKSI PANGGUL

DEPARTEMEN OBSTETRI DAN GINEKOLOGI
UNIVERSITAS HASANUDDIN
2018
 Introduction
URINARY INCONTINENCE (UI)
during pregnancy
Common  16,8-72%

Risk of UI doubled 15 years after UI during first pregnancy

(Dolan,2003)

Mainly focused on nulliparous women > multiparous

Pathophysiology  pregnancy-associated pelvic floor

changes (Clement et al., 2013). Changes involved the levator
hiatal dimensions and the position and mobility of the bladder
neck (BN) (Dietz et.al)
 AIM

To assess and compare the differences in

the symptomatology of UI during pregnancy
and the morphology of the pelvic floor
anatomy between nulliparous and
multiparous women
 Materials and Methods
358 singleton pregnant women
In Shenzhen July 2016-January 2017

Exclution Criteria:
• history of UI before pregnancy
• history of abdominal and vaginal surgery
• diabetes and hypertension;
• placenta previa, threatened abortion
• amniotic fluid abnormalities, fetal growth
restriction, or vaginal bleeding

Elimination Criteria :
• failure to complete all investigation
content
• unreliable pelvic ultrasound data

(Cont’d
 Materials and Methods
Interview age,gestational weeks, BMI, constipation during pregnancy,
number of pregnancies, prior abortions/miscarriages, and
delivery history.
UI diagnosed using International Consultation of
Incontinence Questionnaire-Short Form (ICIQ-SF).

Transperineal Voluson E8 system with a 59 MHz three-dimensional

ultrasound auto sweep transducer.

2 and 3 dimensional cross-sectional sonograms of the

pelvic floor in the resting position and at maximal
Valsalva maneuver were collected.

performed by 3 experienced investigators who were

blinded to all other information.

Measure of: bladder neck vertical position (BNVP); α

angle; β angle ; γ angle, Hiatal Area

Analysis SPSS 13.0 and GraphPad Prism 5.0; significance :0.05

 P=0,002 P<0,005

47,9
31,8
 Limitations

1. its cross-sectional design.

2. Women should ideally be examined before, during, and

after their pregnancy preexisting differences in the
pelvic floor anatomy and the absence of UI before,
during, and after pregnancy

3. Could not eliminate the possibility unable to push

downward to the extent required for the
VMunderestimation of the actual pelvic floor
parameters.
Conclusion

multiparous women had a higher prevalence of

UI and more severe UI symptoms than did
nulliparous women, which could be associated
with weaker pelvic floor support.