Monopolisering og monopolløn? Effekten af legal autorisation

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Persistent urinary incontinence and delivery mode history: a six-year longitudinal study.

Objective: To investigate the prevalence of persistent and long term postpartum urinary incontinence and associations with mode of first and subsequent delivery. Setting: Maternity units in Aberdeen (Scotland), Birmingham (England) and Dunedin (New Zealand). Design: Longitudinal study Population: 4214 women who returned postal questionnaires 3 months and 6 years after the index birth. Methods: Symptom data were obtained from both questionnaires and obstetric data from case-notes for the index birth and the second questionnaire for subsequent births. Logistic regression investigated the independent effects of mode of first delivery and delivery mode history. Main outcome measures: Urinary incontinence – persistent (at 3 months and 6 years after index birth) and long-term (at 6 years after index birth). Results: The prevalence of persistent urinary incontinence was 24%. Delivering exclusively by Caesarean section was associated with both less persistent (OR= 0.46, 95% CI 0.32 to 0.68) and long term urinary incontinence (OR=0.50, 95% CI 0.40 to 0.63). Caesarean section birth in addition to vaginal delivery however was not associated with significantly less persistent incontinence (OR 0.93, 95%CI 0.67 to 1.29). There were no significant associations between persistent or long-term urinary incontinence and forceps or vacuum extraction delivery. Other significantly associated factors were increasing number of births and older maternal age. Conclusions: The risk of persistent and long term urinary incontinence is significantly lower following Caesarean section deliveries but not if there is another vaginal birth. Even when delivering exclusively by Caesarean section, the prevalence of persistent symptoms (14%) is still high

The effect of urinary incontinence status during pregnancy and delivery mode on incontinence postpartum. A cohort study*

Objective: The objectives of this study were to investigate prevalence of urinary incontinence at 6 months postpartum and to study how continence status during pregnancy and mode of delivery influence urinary incontinence at 6 months postpartum in primiparous women. Design: Cohort study. Setting: Pregnant women attending routine ultrasound examination were recruited to the Norwegian Mother and Child Cohort Study (MoBa). Population A total of 12 679 primigravidas who were continent before pregnancy. Methods: Data are from MoBa, conducted by the Norwegian Institute of Public Health. Data are based on questionnaires answered at week 15 and 30 of pregnancy and 6 months postpartum. Main outcome measures Urinary incontinence 6 months postpartum is presented as proportions, odds ratios and relative risks (RRs). Results Urinary incontinence was reported by 31% of the women 6 months after delivery. Compared with women who were continent during pregnancy, incontinence was more prevalent 6 months after delivery among women who experienced incontinence during pregnancy (adjusted RR 2.3, 95% CI 2.2–2.4). Adjusted RR for incontinence after spontaneous vaginal delivery compared with elective caesarean section was 3.2 (95% CI 2.2–4.7) among women who were continent and 2.9 (95% CI 2.3–3.4) among women who were incontinent in pregnancy. Conclusion Urinary incontinence was prevalent 6 months postpartum. The association between incontinence postpartum and mode of delivery was not substantially influenced by incontinence status in pregnancy. Prediction of a group with high risk of incontinence according to mode of delivery cannot be based on continence status in pregnancy

Prevalence of urinary incontinence in Andorra: impact on women's health.

BACKGROUND: Urinary incontinence (UI) is a frequent public health problem with negative social consequences, particularly for women. Female susceptibility is the result of anatomical, social, economic and cultural factors. The main objectives of this study are to evaluate the prevalence of UI in the female population of Andorra over the age of 15 and, specifically, to determine the influence of socio-demographic factors. A secondary aim of the study is to measure the degree of concern associated with UI and whether the involved subjects have asked for medical assistance, or not. METHODS: Women aged 15 and over, answered a self-administered questionnaire while attending professional health units in Andorra during the period November 1998 to January 2000. A preliminary study was carried out to ensure that the questionnaire was both understandable and simple. RESULTS: 863 completed questionnaires were obtained during a one year period. The breakdown of the places where the questionnaires were obtained and filled out is as follows: 32.4% – medical specialists' offices; 31.5% – outpatient centres served exclusively by nurses; 24% – primary care doctors' offices; 12% from other sources. Of the women who answered the questionnaire, 37% manifested urine losses. Of those,45.3% presented regular urinary incontinence (RUI) and 55.7% presented sporadic urinary incontinence (SporadicUI). In those women aged between 45 and 64, UI was present in 56% of the subjects. UI was more frequent among parous than non-parous women. UI was perceived as a far more bothersome and disabling condition by working, middle-class women than in other socio-economic groups. Women in this particular group are more limited by UI, less likely to seek medical advice but more likely to follow a course of treatment. From a general point of view, however, less than 50% of women suffering from UI sought medical advice. CONCLUSION: The prevalence of UI in the female population of Andorra stands at about 37%, a statistic which should encourage both health professionals and women to a far greater awareness of this condition