Obstetric history in women with surgically corrected adult urinary incontinence or pelvic organ prolapse

Study Objective. To compare obstetric histories of women who had surgical c orrection of urinary incontinence or pelvic organ prolapse with a similar g roup who did not. Design. Case control study (Canadian Task Force classification II-2). Setting. Urban, community-based, private practice teaching hospital. Patients. four hundred eighty women (age 57.4 +/- 13.0 yrs) who underwent c orrective surgery for urinary incontinence, pelvic organ prolapse, or both, and whose obstetric history was obtainable through chart review. The contr ol group was composed of 150 women (age 50.7 +/- 9.6 yrs) having routine sc reening mammography who completed a questionnaire regarding obstetric, gyne cologic, and urologic history. Measurements and Main Results. Patients and controls did not differ signifi cantly in terms of age, race, height, weight, body mass index, or smoking h istory. Women who underwent surgery were of greater parity (2.5 +/- 1.2 vs 2.0 +/- 1.2, p <0.001), less often nulliparous (3% vs 18%, p <0.001) less l ikely to have had a cesarean delivery (4% vs 15%, p <0.001), and more likel y to have had a vaginal delivery (94% vs 77%, p <0.001) than those with no surgery. The odds ratio of patients who had a vaginal delivery compared wit h controls was 4.7 (2.3-8.3), and that for cesarean delivery was 0.22 (0.11 -0.43). Analysis of specific delivery information found that, compared with controls, patients were older by 4 years at time of their first delivery ( 28.9 +/- 4.9 vs 24.9 +/- 4.9 yrs, p <0.001) and more commonly received epid ural analgesia intrapartum (87% vs 40%, p = 0.004). Comparisons within the patient group, categorized by indication for surgery, revealed that women w ho had surgery for either prolapse alone or for both prolapse and incontine nce were most likely to have had vaginal deliveries (85% incontinence alone vs 94% prolapse alone vs 97% both, p <0.001). Conclusion. Increased parity, vaginal childbirth, maternal age at time of d elivery, and use of epidural analgesia are associated with need for operati ve correction of pelvic organ prolapse or adult urinary incontinence. Conve rsely, cesarean delivery is associated with less need for surgical correcti on of incontinence or pelvic organ prolapse.