RESUMO
STUDY OBJECTIVE: To evaluate urinary incontinence (UI) risk factors in primiparous adolescents between 7 and 48 months after vaginal delivery. DESIGN: Cohort study. SETTING: Physical Therapy Laboratory on Women's Health and Pelvic Floor at the Federal University of Pernambuco. PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: Cohort follow-up time was 7-48 months after delivery, guaranteeing that no participant presented with UI until 7 months after the infant's birth. Primiparous adolescents aged 10-19 years were included in the study, and those who had UI during pregnancy were excluded. Sample size was estimated at 140 volunteers, considering the calculation for logistic regression, with 20 observation units for each of the 7 variables proposed in the theoretical model developed for the study. The volunteers answered the evaluation form, providing information on the outcome of interest and possible risk factors. Univariate logistic regression analysis was performed. RESULTS: The following risk factors for UI were identified in primiparous adolescents after vaginal delivery: episiotomy (Relative risk [RR]a, 2.75; 95% confidence interval [CI], 1.22-6.06), large newborn for gestational age (RRa, 4.58; 95% CI, 1.68-12.46) and less than six prenatal appointments (RRa, 2.51; 95% CI, 1.05-6.04). CONCLUSION: Professionals working in maternal health care should pay special attention to primigravid mothers, guide prenatal appointments, avoid routine episiotomy, and use obstetric practices recommended by the World Health Organization.
Assuntos
Peso ao Nascer , Episiotomia/efeitos adversos , Cuidado Pré-Natal/estatística & dados numéricos , Incontinência Urinária/etiologia , Adolescente , Estudos de Casos e Controles , Criança , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Paridade , Gravidez , Fatores de Risco , Incontinência Urinária/epidemiologiaRESUMO
OBJECTIVE: To investigate predictive factors for the time to cessation of urinary incontinence (UI) and estimate the median time for its cessation in primiparous adolescents after vaginal delivery. METHODS: A cohort study with 102 adolescents aged 10-19 years with UI after vaginal delivery was developed in the Physical Therapy Laboratory for Women's Health and Pelvic Floor at the Federal University of Pernambuco between June 2017 and December 2019. Participants responded to the assessment form, providing information on the outcome of interest and possible predictive factors. For statistical analysis, the Cox regression model and the Kaplan-Meier method were used. RESULTS: Risk factors identified for the outcome of interest were: age 15-19 years (adjusted hazard ratio [HRa ] 1.37, 95% confidence interval [CI] 0.11-2.8); non-instrumental delivery (HRa 2.95. 95% CI 1.19-7.53); adoption of vertical position during the expulsion stage of delivery (HRa 2.19, 95% CI 1.28-3.84); and absence of episiotomy (HRa 2.01, 95% CI 1.2-3.44). The median time to cessation of UI was 16 months (10-29). CONCLUSION: Health professionals should reflect on obstetric practices adopted during delivery in adolescents, especially among 10-14-year-olds, regarding the use of episiotomy, instrumental delivery, and parturient position during the expulsion stage of delivery.
