Anterior genital trauma, incontinence link studied.(Obstetrics)

RANCHO MIRAGE, CALIF. -- Genital trauma during delivery was common but did not lead to postpartum urinary incontinence in a prospective study of 455 midwifery patients with low-risk pregnancies.

The findings of the study counter a common reason that is often cited for performing episiotomies: to prevent anterior genital trauma in hopes of avoiding future incontinence.

As episiotomy rates decreased from 55% of deliveries in 1991 to 29% in 2001, the rate of anterior lacerations increased, leading investigators in the current study to analyze whether the increase in lacerations was associated with urinary incontinence.

Only 20% of the 455 women had no lacerations after delivery. An additional 35% had anterior lacerations to the clitoral, labial, or periurethral tissues; 18% developed posterior (perineal) lacerations, and 25% had both anterior and posterior trauma, Rebecca Rogers, M.D., said at the annual meeting of the Society of Gynecologic Surgeons.

The remaining 2% of women were excluded from analysis because their vaginal lacerations did not extend to external genitalia. Only two of these nine patients required sutures.

Most of the trauma included in the analyses was minor. Only 1% of patients developed a posterior third- or fourth-degree laceration, according to Dr. Rogers of the University of New Mexico, Albuquerque.

Urinary incontinence was reported by 27% of women 6 weeks after delivery and by 29% 3 months after delivery. These women answered "yes" to the question, "Since the birth of your baby, have you leaked urine when you did not mean to?"