Prevalence and risk factors of persistent stress urinary incontinence at three months postpartum in Indonesian women

Latar belakang: Cara persalinan serta beberapa faktor risiko demografi dan obstetri tertentu berhubungan dengan inkontinensia urin tekanan (IUT) pascapersalinan. Penelitian ini bertujuan menilai prevalensi kejadian IUT pascapersalinan, hubungan cara persalinan, serta faktor risiko demografi, dan obstetri tertentu dengan IUT pascapersalinan. Metode: Penelitian kohort observasional prospektif melibatkan semua perempuan primipara yang menjalani perawatan pascapersalinan. Sebanyak 400 primipara tanpa riwayat inkontinensia urin sebelumnya yang memenuhi kriteria dan bersedia ikut penelitian diikuti sampai 3 bulan pascapersalinan. Dilakukan analisis bivariat dengan uji kai kuadrat dilanjutkan dengan analisis multivariat uji regresi logistik untuk mendapatkan faktor risiko yang berpengaruh terhadap IUT pascapersalinan. Hasil: Prevalensi IUT pascapersalinan adalah 8,8%. Cara persalinan secara bermakna berhubungan dengan IUT pascapersalinan, perempuan yang menjalani persalinan pervaginam lebih banyak yang mengalami IUT (14,1%) dibandingkan perempuan yang menjalani persalinan seksio sesar (7,1%) dengan OR=2,1 (IK 95%=1,05-4,31), risiko ini meningkat bila persalinan pervaginam tersebut dibantu dengan alat (vakum) dengan OR=9,1 (IK 95%=3,9-21,6), namun tidak ada perbedaan statistik kejadian IUT pada seksio sesar yang dilakukan darurat dibandingkan dilakukan secara terencana dengan OR=0,84 (IK 95%=0,28-2,57). Analisis multivariat memperlihatkan faktor risiko IMT ≥30 kg/m2 saat persalinan, persalinan dengan alat/vakum, berat lahir bayi ≥3360 g, dan lama kala dua ≥60 menit berhubungan dengan kejadian IUT 3 bulan pascapersalinan. Kesimpulan: Inkontinensia urin tekanan meningkat pada periode pascapersalinan dini wanita primipara. Walaupun persalinan per vaginam meningkatkan kejadian IUT pascapersalinan, seksio sesar terencana ataupun seksio sesar darurat tanpa persalinan per vaginam tidak meningkatkan risiko IUT. factors have a relationship to postpartum stress urinary incontinence (SUI). For that reason, the objective of this study was to assess the prevalence of postpartum stress urinary incontinence (SUI), the relationship between postpartum SUI and mode of delivery; and the association between SUI and other demographic and obstetric factors. Methods: In this prospective observational cohort study, all primiparous women who were under postpartum care in obstetric and gynecologic ward were recruited. Four hundreds primiparous women with no history of urinary incontinence (UI) who fulfilled the criteria and would like to participate in this study were followed up for three months after delivery. The analysis was done using Stata 12. Bivariate analysis using Chi-square test and multivariate analysis using logistic regression test were done to obtain associated risk factors to postpartum SUI. Results: The prevalence of postpartum SUI was 8.8%. The mode of delivery was significantly associated with postpartum SUI, there were more women who got vaginal delivery that had stress urinary incontinence (14.1%) compared to women caesarean section (7.1%) with OR=2.1 (95% CI=1.05-4.31), this risk increased when vaginal delivery was assisted with vacuum instrument (OR=9.1, 95% CI=3.9-21.6). There was no statistical difference of stress urinary incontinence incidences in patients with emergency or elective caesarean section with OR=0.84 (95% CI=0.28-2.57). Based on multivariate analysis BMI ≥30 kg/m2 at labor, vacuum assisted delivery, birth weight more than 3,360 g, and second stage labor more than 60 minutes appeared to be associated with an increased rate of postpartum SUI. Conclusion: Stress urinary incontinence increased in the early postpartum period of a primiparous woman. Although vaginal delivery increased the risk of postpartum SUI, elective nor emergency caesarean delivery without vaginal delivery id not appear to increase the risk of stress urinary incontinence.