Abstract : The objective was to specify the effect of preventive obstetrical practices, episiotomy and caesarean, on female urinary incontinence (UI).
The first cohort comes from 2 maternity wards promoting opposite policies for episiotomy. A preliminary investigation had determined the number of necessary subjects. Criteria of inclusion were a 1st alive and term childbirth in cephalic presentation and an up to date postal address. Out of 774 women who met these conditions, we received 627 answers (81%). The other sample is from GAZEL cohort made up of employees voluntary for medical research. Out of 3114 women aged 50-62 who received the questionnaire, 2640 returned it (85%).
Four years after childbirth, risk factors for stress UI are age, pre-existent UI, pregnancy UI, labour duration and mode of delivery. Comparison between the maternity wards that had a policy of systematic episiotomy and those that had a restrictive policy does not show any result in favour of a systematic use.
For women around fifty, risk factors for severe stress UI are parity, obesity, diabetes, previous surgery of UI and a young age at first childbirth. Mode of delivery does not have any effect.
The effect of mode of delivery on stress UI attenuates with age and is not measurable any more after 50, which is the average age for stress UI surgery. The risk related to the effect of pregnancy is still identifiable at this age. This attenuation with age of delivery consequences is in favour of a mechanism of deterioration of continence related to pregnancy and whatever the mode of childbirth. Our results suggest that prevention of stress UI by interventions at childbirth, episiotomy or caesarean, is ineffective.