First vaginal delivery at an older age: Does it carry an extra risk for the development of stress XXXX ?

@entity1 @entity59970 @entity322
AIMS: First delivery at an older age is not an uncommon event in modern obstetric practice. The present study was undertaken to compare the prevalence of postpartum stress @entity322 (SUI) according to maternal age and mode of delivery. METHODS: Fifty two consecutive elderly primiparae (mean age 40.0 +/- 1.8) who underwent spontaneous vaginal delivery, 42 consecutive elderly primiparae (mean age 40.7 +/- 3.6) who underwent elective cesarean section, and 92 consecutive young primiparae (mean age 26.2 +/- 2.5) who underwent spontaneous vaginal delivery were interviewed 1-2 years postpartum about the symptom of SUI. @entity1 who had SUI before pregnancy were not enrolled. Obstetric data were collected from computerized hospital records. RESULTS: The prevalence of @entity59970 -2 years after spontaneous vaginal delivery was significantly higher in elderly compared with younger primiparae (38.5% vs. 9.8%, respectively). Elderly primiparae who underwent elective cesarean section had a significantly lower prevalence of postpartum SUI than those delivered vaginally (16.7% vs. 38.5%, respectively). Further comparison of stress-incontinent versus continent elderly primiparae failed to reveal significant demographic or obstetric differences, except for increased prevalence of SUI during pregnancy among incontinent @entity1 (45% vs. 19%, respectively). CONCLUSIONS: First vaginal delivery at an older age carries an increased risk for postpartum SUI. Stress-incontinent @entity1 also had higher prevalence of SUI during pregnancy. This finding implies that the pathophysiologic process of SUI begins during pregnancy, prior to active labor and delivery. Nonetheless, elective cesarean section in these @entity1 has a protective effect and lowers the risk of developing postpartum SUI.
