Prolaps og urininkontinens hos fertile kvinder – omfang og behandling

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Prolaps og urininkontinens hos fertile kvinder – omfang og behandling

Prolaps og urininkontinens hos

fertile kvinderomfang og

behandling

Overlæge

Karin Glavind

Gyn. afd. Aalborg.


Prolapse

• 1.What is the prevalence in the fertile age?

• 2. What is the importance of vaginal births

contra caesarean births?

• 3. What is the importance of multiparity?

• 4. What about surgery for POP in fertile women?

• 5. Which mode of deliverance after POP

surgery?


Prevalence in fertile age ?

• Unknown

• What is the definition of POP?

• 50%-75% of parous women have some

degree of prolapse


•Life time risk of having surgery for

stress urinary incontinence or POP

is 11%

•7% for prolapse

Olsen 97


POPQ – Stage in 497 Women

(18 – 60+ years) Swift S: Cur Opin 02


Vaginal parity and POP

• Cross-sectional study of 290 women

• 72 POP

• A single vaginal birth increased odds of

prolapse (OR 9.73)

• Additional vaginal births no increase in the

odds

• Caesarean births not associated with POP

Quiroz LH. J Repro Med 2010


Risk of POP surgery in relation to

mode of childbirth ?

• Cohort study - Caesarean section 33,167 –

vaginal delivery 63,229

• Mean follow-up 26.9 years

• 58 (0.2%) contra 1306 (2.2%)

• Crude absolute incidence rate (number

per 10,000 person years) 0.7 and 8.1

Leijonhufvud Å Am J Obstet Gynecol 2011


Risk of POP surgery in relation to

mode of childbirth ?

• 135 caesarean sections to spare one

operation for prolapse

• After at least 3 vaginal deliveries 20-

fold increased risk for POP surgery

Leijonhufvud Å Am J Obstet Gynecol 2011


Birth after prolapse surgery ?

• Manchesteroperation induces infertility up

to 60-80% and increases risk of

miscarrriage and premature labour

Brubaker ICI 05

• Annecdotal cases of vaginal birth after

sacrospinous fixation of uterus

Kovac 93


Questionnaire among audience

• How many would

perform prolapse

operation on a fertile

woman with desire for

more children?

• How many would

perform caesarean

section afterwards?


Recommendations.

• If possible have your children before

prolapse operation

• Perform caesarean section on patients

with prior POP surgery


Incontinence

• 1. What is the prevalence in the fertile age?

• 2. What is the importance of vaginal births

contra caesarean births?

• 3. What is the importance of multiparity?

• 4. What about surgery for incontinence in fertile

women?

• 5.Which mode of deliverance after surgery for

incontinence surgery?


Percentage

Total

20-24

25-29

30-34

35-39

40-44

45-49

50-54

Age

55-59

60-64

65-69

70-74

75-79

80-84

85-89

90+

Prevalence of UI (any leakage) in

women 20+. EPINCONT study, 2000

45

40

35

30

25

20

15

10

5

0


Prevalence (%)

Prevalence of UI by age group and

severity. EPINCONT study, Hannestad 2000

40

35

30

25

20

15

10

5

0

20-

24

25-

29

30-

34

35-

39

40-

44

45-

49

Age

Severe

Slight

50-

54

55-

59

60-

64

65-

69

70-

74

Moderate

Unknown

75-

79

80-

84

85+


Diagnosis distribution . Stress

symptom in 70-90 %

Urge 10%

Stress

40-50%

Mixed 30-40%


Risk of incontinence surgery in

relation to mode of childbirth ?

• Cohort study - Caesarean section 33,167 –

vaginal delivery 63,229

• 136 (0.4%) contra 723 (1.2%)

• Crude absolute incidence rate (number

per 10,000 person years) 1.7 and 4.5

Leijonhufvud Å Am J Obstet Gynecol 2011


Risk of incontinence surgery in

relation to mode of childbirth ?

• 357 caesarean sections to spare one

operation for SUI

• After at least 3 vaginal deliveries 5-

fold risk of SUI

Leijonhufvud Å Am J Obstet Gynecol 2011


Pregnancy following incontinence

surgery ?

• Questionnaire to 304 members of AUGS

• 149 respondents

• 99 had performed continence surgery on

women with desire for future childbearing

(114 patients). 22 declined to perform

surgery

• 40% - always cesarean section

Dainer Int Urogynecol J 98


Incontinence after delivery and

postoperative interval between

surgery and pregnancy

• 40 vaginal deliveries (73% continent) and

47 cesarean deliveries (95% continent)

• 3-6 months – 27%

• 6-24 months – 44%

• >24 months – 4%

• Never 16%

Dainer Int Urogynecol J 98


Pregnancy and delivery after midurethral

sling procedures.

• Litterature includes few case-stories

• Case stories on vaginal delivery after TVT

without recurrence of SUI

• 20 pregnancies after TVT or TOT

Recurrence 2/10 (20%) af vaginal delivery

and 1/8 (12.5%) after caesarean section

(Panel 2008)


Pregnancy and delivery after midurethral

sling procedures.

• The position of the tape not influenced by

pregnancy and delivery (ultrasound)

• Evidencebased recommendations do not

exist

• A prophylactic caesarean section is not

recommended

Kohorst 2010, Groenen 2007


Questionnaire among audience

• How many would

perform incontinence

operation on a fertile

woman with a desire

for more children?

• How many would

perform caesarean

section afterwards?


Recommendations

• If possible have your children before

incontinence surgery

• Caesarean section is optional


Spørgeundersøgelse i

jordemoderstuderendeklassen

• Hvem af jer ønsker elektivt sectio for at

beskytte jer selv mod inkontinens og

prolaps senere i livet ved en i øvrigt

normal graviditet og forventeligt normal

fødsel?

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