Background: Urinary incontinence (UI) represents a major long-term morbidity after childbirth, with significant psychosocial consequences. The relationship between mode of delivery vaginal or cesarean and subsequent urinary continence remains a matter of ongoing debate, particularly in low- and middle-income settings where long-term cohort data are limited.
Objective: To determine the association between mode of delivery and urinary continence two years postpartum, using data from a multicenter prospective cohort.
Methods: This is a hospital-based longitudinal cohort was established in 2023 across three tertiary centers in Mangalore. The principal investigator, is from the Department of urology, Father Muller Medical College, Mangalore, where the research design and primary source of the subjects were taken from. Women were followed for two years postpartum. Data on mode of delivery (vaginal, instrumental, elective cesarean, emergency cesarean), pelvic floor symptoms, and urinary leakage were collected using the validated International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Risk factors were analyzed using multivariate logistic regression controlling for parity, age, and BMI.
Results: Among 768 women completing follow-up, 33.7% of those with spontaneous vaginal delivery reported persistent stress UI at 2 years, compared with 14.2% of cesarean births (p<0.001). Instrumental deliveries carried the highest risk (adjusted OR 2.43, 95% CI 1.62-3.64). Protective factors included pelvic floor muscle training adherence and lower BMI (p=0.02).
Conclusion: Vaginal and especially instrumental deliveries were associated with a higher long-term risk of urinary incontinence compared to cesarean section. However, mode of delivery alone does not fully predict continence outcomes early postpartum rehabilitation remains critical.
International Journal of Clinical Obstetrics and Gynaecology
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