Prevalence and factors associated with the occurrence of urinary incontinence during pregnancy / Prevalência e fatores associados à ocorrência de incontinência urinária na gestação

Abstract Objectives: to determine the prevalence of urinary incontinence (UI) during pregnancy, to identify and quantify the factors associated with gestational UI. Methods: a cross-sectional study carried out with women admitted for deliveries in all maternity wards in the city of Botucatu (São Paulo). Data were collected through a structured questionnaire, based on the literature, containing questions about the occurrence of UI, its types, risk factors and moments when urinary losses occurred. Associations between UI and the predictive variables were analyzed with logistic regression models. Results: 950 women were interviewed, out of which 472 complained of urinary losses during pregnancy, resulting in a prevalence of 49.68% (CI95%= 46.51 - 52.86). The majority (61.8%) were classified as mixed UI. Among the covariates investigated, smoking (OR= 4.56), illicit drugs use (OR= 25.14), stimulant foods (OR= 1.84), constipation (OR=1.99), hypertensive disorders during gestation (OR= 3.23), gestational diabetes mellitus (OR= 2.89), parity (OR= 1.52) and previous caesarean sections (OR= 2.56) increased the chance of urinary losses during pregnancy. Conclusions: there was a high prevalence of UI during pregnancy. This condition was strongly associated with lifestyle habits and gestational morbidities. Finally, it is worth high-lighting the fact that delivery via caesarean section increased the chance of UI in subsequent pregnancies.

Resumo Objetivos: estimar a prevalência de incontinência urinária (IU) na gestação, identificar e quantificar fatores associados à IU gestacional. Métodos: estudo transversal realizado com mulheres admitidas para o parto nas maternidades da cidade de Botucatu (São Paulo). Foi utilizado um questionário estruturado, baseado na literatura, contendo perguntas sobre a ocorrência de IU, seus tipos, fatores de riscos e momentos que ocorreram as perdas urinárias. Associações entre a ocorrência de IU e as variáveis preditoras foram analisadas por meio de modelos de regressão logística. Resultados: 950 mulheres foram entrevistadas, dessas 472 queixaram-se de perdas urinárias no período gestacional, resultando em uma prevalência de 49,68% (IC95%= 46,51 - 52,86), sendo a maioria (61,8%) classificada como IU mista. Entre as covariáveis investigadas, tabagismo (OR= 4,56), consumo drogas ilícitas (OR= 25,14), alimentos estimulantes (OR=1,84), constipação intestinal (OR= 1,99), distúrbios hipertensivos na gestação (OR=3,23), diabetes mellitus gestacional (OR= 2,89), paridade (OR=1,52) e parto cesárea (OR= 2,56) aumentaram a chance de perdas urinárias na gestação. Conclusões: houve uma alta prevalência de IU no período gestacional. Esta condição esteve fortemente associada à fatores como hábitos de vida e morbidades gestacionais. Por fim, merece destaque o achado que o parto via cesárea aumentou a chance de IU em gestação subsequente.

Impact of unilateral spatial neglect on chronic patient's post-stroke quality of life.

BACKGROUND: Unilateral spatial neglect (USN) is the prevalent feature in patients with right-sided stroke. It is diagnosed through the behavior inattention test (BIT) and has a negative impact on patients affecting both their functional capacity and quality of life. OBJECTIVE: Here, we aimed to evaluate the impact of USN on the quality of life of patients in the chronic phase of stroke. METHODS: This is a cross-sectional study with stroke patients with USN. After confirming the presence of stroke through neuroimaging examinations and of USN through the BIT, patients' quality of life was evaluated by using the EUROQOL scale. Spearman's correlation was used to validate the correlation between patients' USN and quality of life, with a p < .05 representing significant results. RESULTS: Eighteen individuals were included. When correlating the value of each domain of the EUROQOL scale with the results of the BIT, we observed a negative correlation between mobility (r = -0.97; p = .000), self-care (r = -0.82; p = .013), usual activities (r = -0.87; p = .005); pain or discomfort (r = -0.88; p = .004), anxiety or depression (r = -0.97; p = .000), and EUROQOL total score (r = -0.97, p = .000). CONCLUSION: After a correlation between the overall EUROQOL and BIT scores, we suggest that the higher the USN degree is in stroke patients, the worse their perceived quality of life tends to be.

[Effectiveness of an illustrated home exercise guide on promoting urinary continence during pregnancy: a pragmatic randomized clinical trial]. / Efetividade de um manual de exercícios domiciliares na promoção da continência urinária durante a gestação: um ensaio clínico aleatorizado pragmático.

PURPOSE: To evaluate the effectiveness of an illustrated home exercise guide targeting the pelvic floor muscles in promoting urinary continence during pregnancy. METHODS: A randomized clinical trial was performed with 87 participants, evaluated six times during pregnancy and divided into three groups: Gsup, supervised; Gobs, not supervised, and Gref, women who did not perform the home exercises program. A miction diary and perineometry were used to evaluate urinary incontinence (primary outcome) and pelvic floor muscle strength (secondary outcome), respectively. The Kruskal-Wallis test with post hoc Dunn's and chi-square and Z tests with Bonferroni correction were used for continuous variables and proportions, respectively, with the level of significance set at 5%. RESULTS: At the end of the study, 6.9% of pregnant women in the Gsup and Gobs had urinary incontinence, while 96.6% of Gref women were incontinent. Regarding pelvic floor muscle function, Gsup and Gobs had mean contractions of 10 and 8.9 cmH2O, respectively, while Gref had a value of 4.7 cmH2O. Both results were significant. CONCLUSION: An illustrated home exercise guide targeting the pelvic floor muscles is effective in promoting urinary continence during pregnancy, even without permanent supervision. clinicaltrials.gov Registry--NCT00740428.

Effectiveness of an illustrated home exercise guide on promoting urinary continence during pregnancy: a pragmatic randomized clinical trial / Efetividade de um manual de exercícios domiciliares na promoção da continência urinária durante a gestação: um ensaio clínico aleatorizado pragmático

PURPOSE: To evaluate the effectiveness of an illustrated home exercise guide targeting the pelvic floor muscles in promoting urinary continence during pregnancy.METHODS: A randomized clinical trial was performed with 87 participants, evaluated six times during pregnancy and divided into three groups: Gsup, supervised; Gobs, not supervised, and Gref, women who did not perform the home exercises program. A miction diary and perineometry were used to evaluate urinary incontinence (primary outcome) and pelvic floor muscle strength (secondary outcome), respectively. The Kruskal-Wallis test with post hoc Dunn's and chi-square and Z tests with Bonferroni correction were used for continuous variables and proportions, respectively, with the level of significance set at 5%.RESULTS: At the end of the study, 6.9% of pregnant women in the Gsup and Gobs had urinary incontinence, while 96.6% of Gref women were incontinent. Regarding pelvic floor muscle function, Gsup and Gobs had mean contractions of 10 and 8.9 cmH2O, respectively, while Gref had a value of 4.7 cmH2O. Both results were significant.CONCLUSION: An illustrated home exercise guide targeting the pelvic floor muscles is effective in promoting urinary continence during pregnancy, even without permanent supervision.

OBJETIVO: Avaliar a efetividade de um manual de orientação de exercícios domiciliares (MOED) para o assoalho pélvico (AP) na promoção da continência urinária em gestantes primigestas.MÉTODOS: Ensaio clínico com 87 participantes, avaliadas 6 vezes durante a gestação e divididas aleatoriamente em 3 grupos: Grupo supervisionado (Gsup), que praticou exercícios com supervisão; Grupo observado (Gobs), que praticou exercícios sem supervisão, e Grupo referência (Gref), que não praticou exercícios. Incontinência urinária (IU) (desfecho primário) e força muscular perineal (FMP) (desfecho secundário) foram avaliadas por intermédio de diário de perdas urinárias e perineometria, respectivamente. Foram utilizados o teste de Kruskal-Wallis, seguido do teste post hoc de Dunn, para variáveis contínuas, e o teste do χ2 e testes Z, com correções de Bonferroni, para proporções, com nível de significância de 5%.RESULTADOS: O Gsup e o Gobs apresentaram 6,9% de gestantes incontinentes, enquanto o Gref apresentou 96,6% de incontinentes. Quanto à FMP, o Gsup e o Gobs apresentaram valores médios de contração de 10 e 8,9 cmH2O, respectivamente, enquanto o Gref apresentou valor de 4,7 cmH2O. Ambos os resultados significantes.CONCLUSÃO: A utilização de um MOED é eficaz na promoção da continência urinária e no aumento da FMP em gestantes primigestas, independentemente de supervisão permanente.

Does hyperglycemia in pregnancy change fetal kidney growth? A longitudinal prospective study.

PURPOSE: To measure fetal renal volume in normoglycemic and hyperglycemic pregnancies. METHODS: A longitudinal prospective study was conducted and included 92 hyperglycemic and 339 normoglycemic pregnant women attended at the prenatal service of a hospital from Rio de Janeiro State. Ultrasound examinations were performed to estimate gestational age at baseline and the kidney volume was estimated using the prolate ellipsoid volume equation. RESULTS: Fetal kidney volume growth between normoglycemic and hyperglycemic pregnancies are significantly different. The fetal kidney volume growth in pregnancy is positively correlated with gestational age explained by these predictor equations, by group: normal renal volume = exp (6.186 + 0.09 × gestational week); hyperglycemic renal volume = exp (6.978 + 0.071 × gestational week) and an excessive growth pattern for hyperglycemic pregnancies may be established according to gestational age. CONCLUSION: This is important for early detection of abnormalities in pregnancy, particularly in diabetic mothers.

Does hyperglycemia in pregnancy change fetal kidney growth?: a longitudinal prospective study / A hiperglicemia na gravidez altera o crescimento renal fetal?: um estudo prospectivo longitudinal

PURPOSE: To measure fetal renal volume in normoglycemic and hyperglycemic pregnancies. METHODS: A longitudinal prospective study was conducted and included 92 hyperglycemic and 339 normoglycemic pregnant women attended at the prenatal service of a hospital from Rio de Janeiro State. Ultrasound examinations were performed to estimate gestational age at baseline and the kidney volume was estimated using the prolate ellipsoid volume equation. RESULTS: Fetal kidney volume growth between normoglycemic and hyperglycemic pregnancies are significantly different. The fetal kidney volume growth in pregnancy is positively correlated with gestational age explained by these predictor equations, by group: normal renal volume = exp (6.186+0.09×gestational week); hyperglycemic renal volume = exp (6.978+0.071×gestational week) and an excessive growth pattern for hyperglycemic pregnancies may be established according to gestational age. CONCLUSION: This is important for early detection of abnormalities in pregnancy, particularly in diabetic mothers.

OBJETIVO: O estudo foi desenvolvido para medir o volume renal fetal em gestações normoglicêmicas e hiperglicêmicas. MÉTODOS: Estudo prospectivo longitudinal, incluindo 92 gestantes hiperglicêmicas e 339 normoglicêmicas que procuraram o serviço pré-natal de um hospital no estado do Rio de Janeiro. A ultrassonografia foi realizada para estimar idade gestacional e volume renal foi estimado utilizando a equação de volume elipsoide. RESULTADOS: O crescimento fetal e os volumes renais entre gestações normoglicêmicas e hiperglicêmicas são estatisticamente distintos. O aumento do volume renal fetal na gravidez é correlacionada com a idade gestacional, de acordo com as seguintes equações preditores, por grupo: volume renal normal = exp (6,186+0,09×semana de gestação); e volume renal hiperglicêmico = exp (6,978+0,071×semana de gestação). CONCLUSÃO: Estes dados são importantes para detecção precoce de anormalidades na gravidez, principalmente em mães diabéticas.