First Vaginal Delivery at an Older Age: Does It Carry an Extra Risk for the Development of Stress Urinary Incontinence?

Aims: First delivery at an older age is not an uncommon event in modern obstetric practice. Thepresentstudy wasundertakento compare theprevalence ofpostpartumstressurinary incontinence(SUI) according to maternal age and mode of delivery. Methods: Fifty two consecutiveelderly primiparae (mean age 40.0 1.8) who underwent spontaneous vaginal delivery, 42 consecu-tive elderly primiparae (mean age 40.7 3.6) who underwent elective cesarean section, and 92 con-secutive young primiparae (meanage 26.2 2.5)whounderwentspontaneous vaginaldelivery wereinterviewed 1^2 years postpartum about the symptom of SUI. Women who had SUI beforepregnancy were not enrolled. Obstetric data were collected from computerized hospitalrecords. Results: The prevalence of SUI 1^2 years after spontaneous vaginal delivery was signi¢-cantly higher in elderly compared with younger primiparae (38.5% vs. 9.8%, respectively). Elderlyprimiparae who underwent elective cesarean section had a signi¢cantly lower prevalence of post-partum SUI than those delivered vaginally (16.7% vs. 38.5%, respectively). Further comparison ofstress-incontinent versus continent elderly primiparae failed to reveal signi¢cant demographic orobstetric diierences, except for increased prevalence of SUI during pregnancy among incontinentpatients (45% vs. 19%, respectively).Conclusions: First vaginal delivery at an older age carries anincreased risk for postpartum SUI. Stress-incontinent women also had higher prevalence ofSUI during pregnancy.This ¢nding implies that the pathophysiologic process of SUI begins duringpregnancy,prior to active labor and delivery.Nonetheless, elective cesarean section inthese womenhas a protective eiect and lowers the risk of developing postpartum SUI. Neurourol.Urodynam. 2007 Wiley-Liss, Inc.Key words: childbirth; elderly primiparae; maternal age; pregnancy; stress urinaryincontinence