Évaluation des conséquences périnéales des grossesses gémellaires à 3 et à 12 mois du postpartum en fonction de leur mode d’accouchement : étude JUMODA-CP

Abstract : Introduction: Female urinary incontinence (UI) can lead to impairment of the quality of life in women during the postpartum period (PP). Recent studies show a rate of UI of 20-40% for twin pregnancies at 20 month postpartum. The delivery mode does not appear to influence the rate of UI among mothers of singletons or twins but no study have directly assessed perineal outcomes in twin pregnancies (a growing trend, + 68% in the last 30 years). Goal: To compare UI rates at 3 and 12 months postpartum between primiparae delivering twins vaginally (VD) and by Cesarean section (CS) after 34 weeks. Material and methods: This comparative multicenter prospective cohort included primiparae who gave birth after 34 weeks to living twins among the patients included in the study JUMODA (National “PHRC”). The main endpoint was the UI rate at 3 months defined by answers 1 to 5 in the first question of the ICIQ-SF. Results: A total of 2812 patients without history of UI were included in 172 French maternity hospitals between February 2014 and March 2015. 1734 responded at 3 months (61.7%) and 1155 ICIQ-SF questionnaires were completed, for 556 VD (48%) and 599 CS (52%). The UI overall rate at 3 months (26%) was statistically higher in VD than in CS (35.4% vs16.6%, p < 0.0001) as well as at 12 months (38% vs 24%, p < 0.0001). After multivariate analysis, risk factors for UI at 3 months were: VD (OR 3,062 IC95% [2, 3-4, 076], p < 0.0001) and BMI > 25 in early pregnancy (OR 1.635 IC 95% [1, 206-2, 218], p = 0, 0023). Risk factors are the same at 12 months with: presence of a pre-existing medical condition prior to pregnancy and the lack of pathology during pregnancy. Conclusion: Vaginal delivery is a risk factor for UI at 3 and 12 months after a twin birth.
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Fanny Béchard. Évaluation des conséquences périnéales des grossesses gémellaires à 3 et à 12 mois du postpartum en fonction de leur mode d’accouchement : étude JUMODA-CP. Gynécologie et obstétrique. 2017. ⟨dumas-02068365⟩

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