Influência da hierarquização da assistência obstétrica e neonatal na região da DIR XI – SP no resultado materno e perinatal, período de 1995-2002

General Objective: to evaluate the influence of the Delivery and Newborn Assistance Hierarchyzation Program on maternal and perinatal results in the DIR XI –SP region, from 1995 to 2002. Specific Objectives: to calculate the number of deliveries, Caesarean rates, the cause of hospitalar maternal mortality (HMMC) and precocious perinatal mortality rates (PPMR), in maternity hospitals of low risk (Hospital Regional-Associação Beneficente dos Hospitais Sorocabana – HR-ABHS) and high risk (Hospital das Clínicas da Faculdade de Medicina de Botucatu – UNESP – HC-FMB). Methodology: descriptive and prospective study of hierarchyzation in delivery and newborn assistance, during eight years (1995-2002), in low risk (HR-ABHS) and high risk (HC-FMB) hospitals in the DIR XI region. The study included all the patients attended at these Services with daily record of standardized clinical protocol containing the following information: number of deliveries, Caesareans, maternal deaths, liveborns, stillborns and precocious neoborns (up to 7 days of age). The ?2 test and the calculus of simple linear correlation coefficient were used to assess the results. Results: the total of assisted deliveries in that period was 17748, being that, at the program settlement time, 410 deliveries/year at HR-ABHS and 1076/year at HC-FMB were performed. There was an increase of 2.5 times in the number of deliveries in low risk hospitals and, in high risk hospitals, that number was maintained. The number of deliveries in 2002 was similar for both Services. Caesarean rate decreased in both places, however, it was more accentuated in the low risk (HR-ABHS from 46.6% to 26.9%; ? < 0.0001) than in the high risk hospital (HC-FMB from 49.2% to 40.1%; ? < 0.0001). HMMC was lower at HR-ABHS (26.3 vs 128.7 / 100,000 liveborns; ? < 0.02). PPMR decreased in both Services, with more accentuated fall in the high risk hospital (HC-FMB from 60.8‰ to 26.2‰; ? < 0.00001) than in the low risk one (HR-ABHS from 9.7‰ to 6.7‰; ? < 0.04). Conclusions: The Delivery and Newborn Assistance Hierarchyzation Program improved the obstetric and perinatal assistance quality in the DIR XI – SP region: there was a decrease in Caesarean and perinatal mortality rates in both hospitals. Maternal mortality was higher in the high risk hospital, however, during two years, no death occurred in the tertiary hospital. There was no maternal mortality in the secondary hospital during six years. The importance of delivery and newborn hierarchyzation levels was proved by the decrease of Caesarean rates associated to diminished perinatal I mortality rate.Objetivo geral: avaliar a influência do Programa de Hierarquização da Assistência ao Parto e Recém-nascido no resultado materno e perinatal, na Região da DIR XI - SP, entre os anos de 1995 e 2002. Objetivos específicos: calcular o número de partos, taxas de cesárea, Razão de Mortalidade Materna hospitalar (RMMH) e taxas de Mortalidade Perinatal precoce (MPN I), nas maternidades de baixo (Hospital Regional - Associação Beneficente dos Hospitais Sorocabana – HR-ABHS) e alto risco (Hospital das Clínicas da Faculdade de Medicina de Botucatu – UNESP – HC-FMB). Metodologia: trabalho descritivo e prospectivo, da hierarquização no atendimento ao parto e ao recém-nascido, durante oito anos (1995-2002), em hospitais de baixo (HR-ABHS) e alto risco (HC-FMB), da região da DIR XI. Foram incluídas todas as pacientes atendidas nestes Serviços com registro diário de protocolo clínico padronizado com as seguintes informações: número de partos, cesáreas, mortes maternas, nativivos, natimortos e neomortos precoces (até 7 dias de vida). O teste do ?2 e o cálculo do coeficiente de correlação linear simples foram utilizados para avaliação dos resultados. Resultados: o total de partos assistidos no período foi de 17748, sendo que na implantação do programa eram realizados 410 partos / ano no HR-ABHS e 1076 partos / ano no HC-FMB. Houve aumento de 2,5 vezes no número de partos no hospital de baixo risco e manutenção do número de partos no alto risco. O número de partos em 2002 é semelhante nos dois Serviços. A taxa de cesárea declinou nos dois locais, porém, de forma mais acentuada no baixo risco (HR-ABHS de 46,6% para 26,9%; ? < 0,0001) que no alto risco (HC-FMB de 49,2% para 40,1%; ? < 0,0001). A RMMH foi menor no HR-ABHS (26,3 vs 128,7 / 100.000 nascidos vivos; ? < 0,02). A taxa de MPN I declinou nos dois serviços, com diminuição mais acentuada no alto risco (HC-FMB de 60,8‰ para 26,2‰; ? < 0,00001) do que no baixo risco (HR-ABHS de 9,7‰ para 6,7‰; ? < 0,04). Conclusões: o Programa de Hierarquização ao Parto e Recém-nascido melhorou a qualidade da assistência obstétrica e perinatal na região da DIR XI - SP: houve diminuição das taxas de cesárea e de mortalidade perinatal I nos dois hospitais. A morte materna foi mais freqüente no hospital de alto risco, mas durante dois anos não ocorreu nenhum óbito no hospital terciário. Não houve nenhum óbito materno no Hospital secundário durante seis anos. Comprovou-se a importância de níveis hierarquizados de assistência ao parto e recém-nascido, com a diminuição dos índices de cesárea associada à diminuição da taxa de mortalidade perinatal I

Influência da hierarquização da assistência obstétrica e neonatal na região da DIR XI – SP no resultado materno e perinatal, período de 1995-2002

General Objective: to evaluate the influence of the Delivery and Newborn Assistance Hierarchyzation Program on maternal and perinatal results in the DIR XI –SP region, from 1995 to 2002. Specific Objectives: to calculate the number of deliveries, Caesarean rates, the cause of hospitalar maternal mortality (HMMC) and precocious perinatal mortality rates (PPMR), in maternity hospitals of low risk (Hospital Regional-Associação Beneficente dos Hospitais Sorocabana – HR-ABHS) and high risk (Hospital das Clínicas da Faculdade de Medicina de Botucatu – UNESP – HC-FMB). Methodology: descriptive and prospective study of hierarchyzation in delivery and newborn assistance, during eight years (1995-2002), in low risk (HR-ABHS) and high risk (HC-FMB) hospitals in the DIR XI region. The study included all the patients attended at these Services with daily record of standardized clinical protocol containing the following information: number of deliveries, Caesareans, maternal deaths, liveborns, stillborns and precocious neoborns (up to 7 days of age). The ?2 test and the calculus of simple linear correlation coefficient were used to assess the results. Results: the total of assisted deliveries in that period was 17748, being that, at the program settlement time, 410 deliveries/year at HR-ABHS and 1076/year at HC-FMB were performed. There was an increase of 2.5 times in the number of deliveries in low risk hospitals and, in high risk hospitals, that number was maintained. The number of deliveries in 2002 was similar for both Services. Caesarean rate decreased in both places, however, it was more accentuated in the low risk (HR-ABHS from 46.6% to 26.9%; ? < 0.0001) than in the high risk hospital (HC-FMB from 49.2% to 40.1%; ? < 0.0001). HMMC was lower at HR-ABHS (26.3 vs 128.7 / 100,000 liveborns; ? < 0.02). PPMR decreased in both Services, with more accentuated fall in the high risk hospital (HC-FMB from 60.8‰ to 26.2‰; ? < 0.00001) than in the low risk one (HR-ABHS from 9.7‰ to 6.7‰; ? < 0.04). Conclusions: The Delivery and Newborn Assistance Hierarchyzation Program improved the obstetric and perinatal assistance quality in the DIR XI – SP region: there was a decrease in Caesarean and perinatal mortality rates in both hospitals. Maternal mortality was higher in the high risk hospital, however, during two years, no death occurred in the tertiary hospital. There was no maternal mortality in the secondary hospital during six years. The importance of delivery and newborn hierarchyzation levels was proved by the decrease of Caesarean rates associated to diminished perinatal I mortality rate.Objetivo geral: avaliar a influência do Programa de Hierarquização da Assistência ao Parto e Recém-nascido no resultado materno e perinatal, na Região da DIR XI - SP, entre os anos de 1995 e 2002. Objetivos específicos: calcular o número de partos, taxas de cesárea, Razão de Mortalidade Materna hospitalar (RMMH) e taxas de Mortalidade Perinatal precoce (MPN I), nas maternidades de baixo (Hospital Regional - Associação Beneficente dos Hospitais Sorocabana – HR-ABHS) e alto risco (Hospital das Clínicas da Faculdade de Medicina de Botucatu – UNESP – HC-FMB). Metodologia: trabalho descritivo e prospectivo, da hierarquização no atendimento ao parto e ao recém-nascido, durante oito anos (1995-2002), em hospitais de baixo (HR-ABHS) e alto risco (HC-FMB), da região da DIR XI. Foram incluídas todas as pacientes atendidas nestes Serviços com registro diário de protocolo clínico padronizado com as seguintes informações: número de partos, cesáreas, mortes maternas, nativivos, natimortos e neomortos precoces (até 7 dias de vida). O teste do ?2 e o cálculo do coeficiente de correlação linear simples foram utilizados para avaliação dos resultados. Resultados: o total de partos assistidos no período foi de 17748, sendo que na implantação do programa eram realizados 410 partos / ano no HR-ABHS e 1076 partos / ano no HC-FMB. Houve aumento de 2,5 vezes no número de partos no hospital de baixo risco e manutenção do número de partos no alto risco. O número de partos em 2002 é semelhante nos dois Serviços. A taxa de cesárea declinou nos dois locais, porém, de forma mais acentuada no baixo risco (HR-ABHS de 46,6% para 26,9%; ? < 0,0001) que no alto risco (HC-FMB de 49,2% para 40,1%; ? < 0,0001). A RMMH foi menor no HR-ABHS (26,3 vs 128,7 / 100.000 nascidos vivos; ? < 0,02). A taxa de MPN I declinou nos dois serviços, com diminuição mais acentuada no alto risco (HC-FMB de 60,8‰ para 26,2‰; ? < 0,00001) do que no baixo risco (HR-ABHS de 9,7‰ para 6,7‰; ? < 0,04). Conclusões: o Programa de Hierarquização ao Parto e Recém-nascido melhorou a qualidade da assistência obstétrica e perinatal na região da DIR XI - SP: houve diminuição das taxas de cesárea e de mortalidade perinatal I nos dois hospitais. A morte materna foi mais freqüente no hospital de alto risco, mas durante dois anos não ocorreu nenhum óbito no hospital terciário. Não houve nenhum óbito materno no Hospital secundário durante seis anos. Comprovou-se a importância de níveis hierarquizados de assistência ao parto e recém-nascido, com a diminuição dos índices de cesárea associada à diminuição da taxa de mortalidade perinatal I

Níveis de substâncias tóxicas persistentes (PTS) em sangue de parturientes de sete áreas selecionadas do Estado de São Paulo - Brasil

OBJETIVO: Determinar substâncias tóxicas persistentes (PTS) no sangue de 160 parturientes em áreas do Estado de São Paulo-Brasil. SUJEITOS E MÉTODOS: Foram analisados os PCBs (99, 101, 118, 138, 153, 156, 163, 170, 180, 183, 187, 194) e pesticidas organoclorados ( -HCH, -HCH, -HCH, HCB, p,p'-DDE, p,p'-DDT, t-chlordane, cchlordane, oxy-chlordane, t-nonachlor and c-nonachlor) em sete áreas; duas rurais (Botucatu e Ribeirão Preto), uma industrial (Campinas), uma litorânea (Santos) e três urbanas em São Paulo (UNIFESP, Vila Nova Cachoeirinha e Leonor Mendes de Barros). Valores abaixo do limite de detecção (LOD) foram substituídos por 0.5XLOD. Teste de Kruskall Wallis e Dumm compararam as áreas com níveis de PTS acima do LOD. O projeto foi aprovado pelo CEP da FMB. RESULTADOS: Os valores das PTS (ng/g lipideo) foram baixos. PCBs 118, 138, 153, p-p’-DDE e pesticidas -HCH, - CH, HCB, oxy-chlordane e t-nonachlor tiveram níveis acima do LOD em mais de 70% das amostras. PCB 118 foi significativamente diferente nas áreas, com concentração maior na industrial (Campinas; 4.64). O organoclorado p-p’-DDE na zona rural de Ribeirão Preto; (123.05) foi maior que na urbana de Vila Nova Cachoeirinha. A mediana do ß-HCH para as áreas foi 6.31, significativamente maior na zona rural de Botucatu (18.20). A maior concentração de oxy-chlordane (3.59) e de t-nanochlor (1.17) foi na zona rural de Ribeirão Preto (p<0.05), diferentes também da área urbana (Leonor Mendes de Barros; p<0.05). CONCLUSAO: As concentrações das PTS foram baixas com diferenças entre as áreas; os maiores valores estavam nas parturientes da zona rural.Persistent organic pollutants (POPs) present in the living environment are thought to have detrimental health effects on the population, with pregnant women and the developing foetus being at highest risk. We report on the levels of selected POPs in maternal blood of 160 delivering women residing in different regions within the São Paulo State, Brazil. Overall levels of measured compounds were found to be low with only PCBs 118, 138, 153 congeners, p-p’-DDE metabolite, -HCH, -HCH, HCB, oxy-chlordane and t-nonachlor pesticides having levels above LOD in more than 70% of the samples, thus comparisons between sites were performed for those compounds only. Statistical differences between sites were only observed for PCB 118 congener, with the highest concentration measured in the industrial site – Campinas (4.7 ng/g lipids). The p,p’-DDE metabolite was detected in all participants, with the median for all sites being 58.2 ng/g lipids, and large regional differences were evident. The highest levels of p,p’-DDE were measured in the rural 2 site – Ribeirão Preto with a median of 123 ng/g lipids that was significantly higher if compared with the urban 2 site (São Paulo City). The median concentration of ß-HCH for all sites was 6.31 ng/g lipids with the significantly highest concentration found in the rural 1 site – Botucatu (18.20 ng/g lipids). Oxy-chlordane was detected in all samples, with the highest concentration measured in the rural 2 site - Ribeirão Preto (3.6 ng/g lipids)¸which was found to be significantly higher than in all other sites The t-nonachlor compound was detected in 99% of samples with the highest concentration being 1.17 ng/g lipids, also in the rural 2 site- Ribeirão Preto. The level found in the rural 2 site was significantly higher than the level measured in the urban 3 site (São Paulo City)... (Complete abstract click electronic access below)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

Desenvolvimento do inventário da resposta sexual na gestação - PSRI

Estimar a prevalência e a incidência de disfunção sexual feminina (DSF) é importante para entender seu impacto na qualidade de vida, identificando fatores de risco para adoção de medidas preventivas. OBJETIVO: Estudar a evolução histórica do conhecimento da função e da disfunção sexual, o estado atual da arte e os novos conceitos e classificações das DSF. MATERIAL E MÉTODOS: Os modelos lineares de Masters & Johnson e Kaplan (Desejo, Excitação, Orgasmo e Resolução) representaram avanço científico e facilitaram as pesquisas, porém o conceito focado no genital não tem sido útil na orientação das disfunções sexuais. O novo modelo descrito por Basson (2002) move o foco do início da RSF de desejo sexual espontâneo genital para um ciclo responsivo, onde a motivação sexual é baseada na intimidade, transformando o estímulo sexual em excitação e o prazer afetivo desta excitação. Esta experiência física satisfatório leva posteriormente ao desejo sexual. Se o resultado for emocional e fisicamente satisfatório aumentará a intimidade emocional do casal. A classificação diagnóstica das DSF varia entre os diferentes sistemas diagnósticos, CID-10 (OMS) e DSM-IV (Associação Americana de Psiquiatria) e Classificação de Paris (2nd International Consultation on Sexual Dysfunction), sendo a inclusão do critério de acentuado sofrimento pessoal o elemento essencial para o diagnóstico.CONCLUSÃO: Mais estudos sobre a fisiologia da RSF são necessários para identificar seus marcadores, entender melhor essa espiral ascendente e quando e porquê ela se modifica − estica, achata ou rompe.Accurate estimates of prevalence/ incidence of female sexual dysfunction (FSD) are important in understanding the true burden on quality of life, and in identifying risk factors for prevention. PURPOSE: To study the historical evolution of female sexual response, the state-of-the-art knowledge in women’s sexual response, and the revised definitions and classifications of FSD. MATERIAL AND METHODS: The Master & Johnson and Kaplan models (desire, arousal, orgasm and resolution) was a great scientific advance, facilitated clinical research, however the concept one linear sequence genitally focused events has not proven helpful in managing women’s sexual dysfunctions. A new view of women’s sexual response published by Basson (2002) moves the focus from spontaneous sexual drive to an inherently responsive cycles, that reflects intimacy-based sexual motivation, processing of sexual stimuli to arousal. Sexual desire to continue the physical experience is emotionally and physically satisfying, emotional intimacy with the partner is increased. Diagnostic classifications have varies among different diagnostic systems: ICD-10 (WHO), and DSM-IV (American Psychiatric Association) and Paris classification (2nd International Consultation on Sexual Dysfunction). An essential element of the new diagnostic system is the inclusion of personal distress criterion for most of the diagnostic categories. CONCLUSION: Further research is urgently need on female sexual response physiology, to identify their markers and to better understanding the feedback loops

The placenta as a barrier for toxic and essential elements in paired maternal and cord blood samples of South African delivering women

Environmental toxicants such as metals may be detrimental to foetus and infant development and health because of their physiological immaturity, opportunistic and differential exposures, and a longer lifetime over which disease, initiated during pregnancy and in early life, can develop. The placental mechanisms responsible for regulation of absorption and excretion of elements during pregnancy are not fully understood. The aim of this paper is to assess the correlation for selected toxic and essential elements in paired whole blood samples of delivering women and cord blood, as well as to evaluate the placental permeability for selected elements. Regression analyses used to assess this correlation in 62-paired samples of maternal and cord whole blood of delivering women show that the concentrations of mercury, lead, cobalt, arsenic and selenium in maternal and cord blood differed statistically. Lead, cobalt, arsenic and selenium appear to pass the placental barrier by a diffusion mechanism. It was also found that the mercury levels in cord blood were almost double those of the mother, suggesting that the foetus may act as a filter for the maternal mercury levels during pregnancy. Transplacental transfer for arsenic and cobalt was 80% and 45%, respectively, suggesting that the placenta modulates the rate of transfer for these elements. Cadmium, manganese, copper and zinc levels did not show statistically significant correlations between two compartments (maternal versus cord whole blood). The study confirms that most of the toxic metals measured have an ability to cross the placental barrier.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

Prevalência de incontinência urinária e disfunção muscular do assoalho pélvico em primíparas dois anos após parto cesárea: Estudo transversal

CONTEXT AND OBJECTIVE: There is uncertainty in the literature regarding the theory that obstetric events and pelvic floor injuries give rise to lower risk of subsequent urinary incontinence among women delivering via cesarean section than among women delivering vaginally. The objective of this study was to assess the two-year postpartum prevalence of urinary incontinence and pelvic floor muscle dysfunction and the factors responsible for them. DESIGN AND SETTING: Cross-sectional study, conducted in a public university. METHODS: 220 women who had undergone elective cesarean section or vaginal childbirth two years earlier were selected. Their urinary incontinence symptoms were investigated, and their pelvic floor muscle dysfunction was assessed using digital palpation and a perineometer. RESULTS: The two-year urinary incontinence prevalences following vaginal childbirth and cesarean section were 17% and 18.9%, respectively. The only risk factor for pelvic floor muscle dysfunction was weight gain during pregnancy. Body mass index less than 25 kg/m2 and normal pelvic floor muscle function protected against urinary incontinence. Gestational urinary incontinence increased the risk of two-year postpartum urinary incontinence. CONCLUSION: Gestational urinary incontinence was a crucial precursor of postpartum urinary incontinence. Weight gain during pregnancy increased the subsequent risk of pelvic floor muscle dysfunction, and elective cesarean section did not prevent urinary incontinence

Prevalence of urinary incontinence and pelvic floor muscle dysfunction in primiparae two years after cesarean section: cross-sectional study Prevalência de incontinência urinária e disfunção muscular do assoalho pélvico em primíparas dois anos após parto cesárea: estudo transversal

CONTEXT AND OBJECTIVE There is uncertainty in the literature regarding the theory that obstetric events and pelvic floor injuries give rise to lower risk of subsequent urinary incontinence among women delivering via cesarean section than among women delivering vaginally. The objective of this study was to assess the two-year postpartum prevalence of urinary incontinence and pelvic floor muscle dysfunction and the factors responsible for them. DESIGN AND SETTING Cross-sectional study, conducted in a public university. METHODS 220 women who had undergone elective cesarean section or vaginal childbirth two years earlier were selected. Their urinary incontinence symptoms were investigated, and their pelvic floor muscle dysfunction was assessed using digital palpation and a perineometer. RESULTS The two-year urinary incontinence prevalences following vaginal childbirth and cesarean section were 17% and 18.9%, respectively. The only risk factor for pelvic floor muscle dysfunction was weight gain during pregnancy. Body mass index less than 25 kg/m 2 and normal pelvic floor muscle function protected against urinary incontinence. Gestational urinary incontinence increased the risk of two-year postpartum urinary incontinence. CONCLUSION Gestational urinary incontinence was a crucial precursor of postpartum urinary incontinence. Weight gain during pregnancy increased the subsequent risk of pelvic floor muscle dysfunction, and elective cesarean section did not prevent urinary incontinence.<br> CONTEXTO E OBJETIVO &#201; ainda controversa na literatura a teoria de que eventos obst&#233;tricos e traumas no assoalho p&#233;lvico representariam menor risco para mulheres submetidas ao parto ces&#225;rea do que para aquelas submetidas a parto vaginal, no tocante a subsequente incontin&#234;ncia urin&#225;ria. O objetivo do estudo foi avaliar a preval&#234;ncia de incontin&#234;ncia urin&#225;ria e disfun&#231;&#227;o muscular do assoalho p&#233;lvico dois anos ap&#243;s o parto e os fatores respons&#225;veis por elas. TIPO DE ESTUDO E LOCAL Estudo transversal conduzido em universidade p&#250;blica. M&#201;TODOS Foram selecionadas 220 mulheres dois anos ap&#243;s parto ces&#225;reo eletivo ou parto vaginal. Foram avaliados sintomas de incontin&#234;ncia urin&#225;ria e disfun&#231;&#227;o muscular do assoalho p&#233;lvico por palpa&#231;&#227;o digital e perine&#244;metro. RESULTADOS A preval&#234;ncia de incontin&#234;ncia urin&#225;ria dois anos ap&#243;s parto vaginal e ces&#225;rea foi de 17% e 18,9% respectivamente. O &#250;nico fator de risco para disfun&#231;&#227;o muscular do assoalho p&#233;lvico foi o ganho de peso durante a gesta&#231;&#227;o. &#205;ndice de massa corporal inferior a 25 kg/m 2 e disfun&#231;&#227;o muscular do assoalho p&#233;lvico normal foram fatores de prote&#231;&#227;o contra incontin&#234;ncia urin&#225;ria. Incontin&#234;ncia urin&#225;ria na gesta&#231;&#227;o aumentou o risco de incontin&#234;ncia urin&#225;ria dois anos p&#243;s-parto. CONCLUS&#195;O Incontin&#234;ncia urin&#225;ria gestacional foi um precursor crucial de incontin&#234;ncia urin&#225;ria p&#243;s-parto. O ganho de peso durante a gesta&#231;&#227;o aumentou o risco posterior de disfun&#231;&#227;o muscular do assoalho p&#233;lvico e o parto ces&#225;rea eletivo n&#227;o foi uma a&#231;&#227;o de preven&#231;&#227;o para a incontin&#234;ncia urin&#225;ria

Prevalence of urinary incontinence and pelvic floor muscle dysfunction in primiparae two years after cesarean section: cross-sectional study

CONTEXT AND OBJECTIVE There is uncertainty in the literature regarding the theory that obstetric events and pelvic floor injuries give rise to lower risk of subsequent urinary incontinence among women delivering via cesarean section than among women delivering vaginally. The objective of this study was to assess the two-year postpartum prevalence of urinary incontinence and pelvic floor muscle dysfunction and the factors responsible for them. DESIGN AND SETTING Cross-sectional study, conducted in a public university. METHODS 220 women who had undergone elective cesarean section or vaginal childbirth two years earlier were selected. Their urinary incontinence symptoms were investigated, and their pelvic floor muscle dysfunction was assessed using digital palpation and a perineometer. RESULTS The two-year urinary incontinence prevalences following vaginal childbirth and cesarean section were 17% and 18.9%, respectively. The only risk factor for pelvic floor muscle dysfunction was weight gain during pregnancy. Body mass index less than 25 kg/m 2 and normal pelvic floor muscle function protected against urinary incontinence. Gestational urinary incontinence increased the risk of two-year postpartum urinary incontinence. CONCLUSION Gestational urinary incontinence was a crucial precursor of postpartum urinary incontinence. Weight gain during pregnancy increased the subsequent risk of pelvic floor muscle dysfunction, and elective cesarean section did not prevent urinary incontinence