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Birth may be associated with maternal pelvic floor damage. It is unclear whether planned cesarean section as compared with planned vaginal birth lowers the risk of problematic urinary, fecal or flatal incontinence. The principal maternal outcome and secondary outcome of the Twin Birth Study was problematic urinary or fecal or flatal incontinence 2 years after birth.
Women between 320/7 and 386/7 weeks gestation with twin pregnancy were randomized to one of two strategies: planned cesarean section (n=1398) or planned vaginal birth, with cesarean only if indicated (n=1406). Using a structured, self-administered questionnaire women were asked if, in the past 7 days, they had lost or leaked urine when they coughed, laughed or sneezed (urinary incontinence) if they had lost or leaked feces, stool, fluid or mucus unexpectedly from bowels (fecal incontinence) and if they had passed gas or wind unexpectedly (flatal incontinence). Incontinence was considered problematic if women indicated the incontinence caused them a little or a big problem.
The follow up rate at 2 years was 82.2% (1155 women in the planned cesarean and 1150 in the planned vaginal birth groups). The rate of cesarean was 90.2% in the planned cesarean group and 42.9% in the planned vaginal birth group. Women in the planned cesarean group had a lower rate of problematic urinary incontinence compared with the planned vaginal birth group (93/1147 [8.1%] vs 140/1143 [12.25%], odds ratio with planned cesarean, 0.63; 95% confidence interval, 0.48 to 0.83; p=0.001). There were no significant differences in rates of fecal or flatal incontinence or any other maternal outcome.
Planned cesarean as a birth strategy for twins reduces the risk of problematic urinary incontinence at 2 years after the birth compared with planned vaginal birth. This information may be useful to women in making an informed decision about method of birth.