Forceps delivery in nulliparous patients and urinary incontinence.

Title
Risk factors for forceps delivery in nulliparous ( a woman who has not given birth to a living infant ) patients.
Source
Acta Obstetricia et Gynecologica Scandinavica. 85(3):298-301, 2006.

"CONCLUSION: Age over 35 years and induction of labor are risk factors for forceps delivery at admission. Epidural use, fetal head in occiput posterior position, and birth weight >4000 g are strong intrapartum risk factors for instrumental delivery in nulliparous women. "

Transvaginal sonographic measurement of cervical length is a good predictor of a successful labor induction at term in nulliparas.

The prevalence of urinary incontinence was 29%. New incontinence first beginning after delivery was associated with older maternal age and method of delivery. There were no significant associations with forceps delivery or vacuum delivery.

Incontinence first occurring during pregnancy and still present at 3 months was associated with higher maternal body mass index (BMI>25) and heavier babies. In these women, caesarean section was associated with less incontinence but incontinence was not associated with age.

Women have less urinary incontinence after a first delivery by caesarean section whether or not that first starts during pregnancy. Older maternal age was associated with new postnatal incontinence, and higher BMI and heavier babies with incontinence first starting during pregnancy.

Caesarean section in a first pregnancy appears to protect against pelvic floor surgery in later life.

The risk of persistent faecal incontinence is significantly higher after a first delivery by forceps. We found no evidence of a lower risk of subsequent faecal incontinence for exclusive caesarean section deliveries.

Nulliparous : A woman who has not given birth to a living infant.

intrapartum : Occurring during labor and delivery.

Our results suggest that stress urinary incontinence after pregnancy arises from a multifactorial condition. The main risk factors are: age, previous incontinence (before or during the first pregnancy), prolonged labor and vaginal delivery.

When stress urinary incontinence arises during the first pregnancy, the risk of stress incontinence occurring 15 years later is doubled. Although pelvic floor reinnervation progressed after the postnatal period, the absence of an adequate marker for pelvic floor denervation makes it of uncertain clinical significance.