不同产科因素对尿失禁发生的影响
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摘要
目的:探讨妊娠、分娩方式以及其它相关的产科因素对女性压力性尿失禁发生的影响。
方法:采用国际尿控协会(International Continence Society,ICS)推荐的国际尿失禁标准问卷,对180名在我院分娩并进行产后复查的初产妇进行问卷调查,了解其孕期及产后42天尿失禁的发病情况。分析妊娠和分娩方式与尿失禁的关系,探讨与尿失禁发生率有关的产科因素。
结果:①161例产妇中有56人(34.78%)在孕期发生了尿失禁症状,有37人(22.98%)在产后4—8周内出现了尿失禁症状;产后尿失禁的发生与分娩方式、新生儿体重和产后恢复轻体力劳动的时间相关;②剖宫产、阴道顺产的尿失禁发生率分别为50%(24/48)、11.5%(13/113),两组之间有极显著性差异(P＜0.001);③阴道分娩组中与产后尿失禁有明显关系的因素有第二产程时间,而与孕周、年龄、孕期发生尿失禁、新生儿体重、会阴切开或裂伤、产后哺乳均无明显相关性。
结论:①剖宫产与阴道顺产相比具有明显的保护作用,可以显著降低产后早期尿失禁的发生率:②新生儿体重增加可使产后压力性尿失禁发生的风险增加;③孕期及产后尿失禁均以轻度为主,加强孕期和产后盆底肌肉训练可以预防和治疗产后尿失禁。
OBJECTIVE:To investigate the impact of pregnancy,different delivery modes and the other factors of delivery on stress urinary incontinence.
METHODS:180 pnmipara,who had chuild delivery in our hospitai and were followed up 42 days after delivery,were recruited and their symptoms of stress urinary incontinence during and after pregnancy were investigated.The information of delivery was also recorded.The questionnaire was designed according to International Continence Society.As many as 161 questionnaires were valid and their data were analyzed in order to evaluate the risk factors of stress urinary incontinence.
RESULTS:①56 of 161(34.78%)women complained of urinary leakage at least once during pregnancy,and 37 of 161(22.98%)women complained of urinary leakage at least once after delivery.The three factors that associated with postpartum urinary incontinence were the weight of newborn,the rest time after delivery,and the mode of delivery,but not the occurrence of urinary incontinence during pregnancy and the age.②The incidence of postpartum urinary incontinence in spontaneous vaginal delivery,and cesarean section Was 50%(24/48)and 11.5%(13/113)respectively. The incidence of urinary incontinence in spontaneous vaginal delivery Was obviously higher than that of the cesarean section(P＜0.001).③The risk factors to postpartum urinary incontinence in vaginal delivery was the duration of the second period of delive.But the outher events,such as gestational weeks,age,fetal weight,pudendal tears,episiotomy,lactation and the occurrence of urinary incontinence during. pregnant,were not correlated.
CONCLUSION:①Cesarean section is obviously protective to postpartum stress urinary incontinence than vaginal delivery.②Heavy fetal weight increases the risk of postpartum stress urinary incontinence.③The symptoms of the most women with postpartum stress urinary incontinence are mild.Pelvic floor exercise during pregnancy and after delivery is valid to prevent postpartum urinary incontinence.
方法:采用国际尿控协会(International Continence Society,ICS)推荐的国际尿失禁标准问卷,对180名在我院分娩并进行产后复查的初产妇进行问卷调查,了解其孕期及产后42天尿失禁的发病情况。分析妊娠和分娩方式与尿失禁的关系,探讨与尿失禁发生率有关的产科因素。
结果:①161例产妇中有56人(34.78%)在孕期发生了尿失禁症状,有37人(22.98%)在产后4—8周内出现了尿失禁症状;产后尿失禁的发生与分娩方式、新生儿体重和产后恢复轻体力劳动的时间相关;②剖宫产、阴道顺产的尿失禁发生率分别为50%(24/48)、11.5%(13/113),两组之间有极显著性差异(P＜0.001);③阴道分娩组中与产后尿失禁有明显关系的因素有第二产程时间,而与孕周、年龄、孕期发生尿失禁、新生儿体重、会阴切开或裂伤、产后哺乳均无明显相关性。
结论:①剖宫产与阴道顺产相比具有明显的保护作用,可以显著降低产后早期尿失禁的发生率:②新生儿体重增加可使产后压力性尿失禁发生的风险增加;③孕期及产后尿失禁均以轻度为主,加强孕期和产后盆底肌肉训练可以预防和治疗产后尿失禁。
OBJECTIVE:To investigate the impact of pregnancy,different delivery modes and the other factors of delivery on stress urinary incontinence.
METHODS:180 pnmipara,who had chuild delivery in our hospitai and were followed up 42 days after delivery,were recruited and their symptoms of stress urinary incontinence during and after pregnancy were investigated.The information of delivery was also recorded.The questionnaire was designed according to International Continence Society.As many as 161 questionnaires were valid and their data were analyzed in order to evaluate the risk factors of stress urinary incontinence.
RESULTS:①56 of 161(34.78%)women complained of urinary leakage at least once during pregnancy,and 37 of 161(22.98%)women complained of urinary leakage at least once after delivery.The three factors that associated with postpartum urinary incontinence were the weight of newborn,the rest time after delivery,and the mode of delivery,but not the occurrence of urinary incontinence during pregnancy and the age.②The incidence of postpartum urinary incontinence in spontaneous vaginal delivery,and cesarean section Was 50%(24/48)and 11.5%(13/113)respectively. The incidence of urinary incontinence in spontaneous vaginal delivery Was obviously higher than that of the cesarean section(P＜0.001).③The risk factors to postpartum urinary incontinence in vaginal delivery was the duration of the second period of delive.But the outher events,such as gestational weeks,age,fetal weight,pudendal tears,episiotomy,lactation and the occurrence of urinary incontinence during. pregnant,were not correlated.
CONCLUSION:①Cesarean section is obviously protective to postpartum stress urinary incontinence than vaginal delivery.②Heavy fetal weight increases the risk of postpartum stress urinary incontinence.③The symptoms of the most women with postpartum stress urinary incontinence are mild.Pelvic floor exercise during pregnancy and after delivery is valid to prevent postpartum urinary incontinence.
引文
[1]Wilson PD,Herbison RM,Herbison GP.Obstetric practice and the prevalence of urinary incontinence three months afte rdelivery.Br J Obstet Gynaeenl,1996,103(2):154-161.
[2]Hampel C,Artibani W,Espuna Pons M,et al.Understanding the burden of stress urinary incontinence in Europe:a qualitative review of the literature.Eur Urol.2004,46(1):15-27.
[3]宋岩峰主编.女性尿失禁诊断与治疗.人民军医出版社,2003,2-4.
[4]Thorn DH,van den Eeden SK,Ragins AI,et al.Differences in prevalence of urinary incontinence by race/ethnicity.J Urol,2006,175(1):259-264.
[5]杨欣,郑红,廖秦平等.分娩方式对尿失禁发生的影响.中华妇产科杂志,2004,39(10):662-665.
[6]Gaudenz R.A questionnaire with a new urge-score and stress-score for the evaluation of female urinary incontinence.Geburtshilfe Frauenheilkd,1979,39(9):784-792.
[7]Ishiko O,Hirai K,Sumi T,et al.The urinary incontinence score in the diagnosis of female urinary incontinence.Int J Gynecol Obste,2000,68(2):131-137.
[8]王宏,朱兰,郎景和等.压力性尿失禁问卷评分对女性压力性尿失禁诊断的价值.实用妇产科杂志,2006,22(6):363-365.
[9]Foldspang A,Mommsen S,Lam GW,et al.Parity as a correlate of adult female urinary incontinence prevalence.J Epidemiol Community Health,1992,46(6):595-600.
[10]Hojberg KE,Salvig JD,Winslow NA,et al.Urinary incontinence:prevalence and risk factors at 16 weeks of gestation.Br J Ohstet Gynaecol,1999,106(8):842-850.
[11]Mason L,Glenn S,Walton I,et al.The instruction in pelvic floor exercises provided to women during pregnancy or following delivery.Midwifery,2001,17(1):55-64.
[12]Wijma J,Weis Potters AE,de Wolf BT,et al.Anatomical and functional changes in the lower urinary tract during pregnancy.BJOG,2001,108(7):726-732.
[13]Kristiansson P,Samuelsson E,von Schoultz B,et al.Reproductive hormones and stress urinary incontinence in pregnancy.Acta Obstet Gyneeol Stand,2001,80(12):1125-1130.
[14]Chen B,Wen Y,Wang H,et al.Difference in estrogen modulation of tissue inhibitou of matrix metalloproteinase-1 and matrix metalloproteinase-1expression in cultured fibroblasts from continent and incontinent women.Am J Obstet Gynecol,2003,189(1):59-65.
[15]Vikrup L,Lose G.Epidural anesthesia during labour and stress incontinence after delivery.Obstet Gynecol,1993,82(6):984-986.
[16]Parazzini F,Chiaffarino F,Lavezzari M,et al.Risk factors for stress,urge or mixed urillary incontinence in Italy.BJOG,2003,110(10):927-933.
[17]古力米热,夏昊,杨勇等.新疆地区维吾尔族人群尿失禁发病率调查.中华泌尿外科杂志,2002,23(7):422-423.
[18]Burgio KL,Zyczynski H,Locher J L,et al.Urinary incontinence in the 12-month postpartum period.Obstet Gynecol,2003,102(6):1291-1298.
[19]Sultan AH,Kamm MA,Hudson CN.Pudendal nerve damage during labour:Prospective study before and after childbirth.Br J Obstet Gynaecol,1994,101(1):22-28.
[20]Benassi L,Bocchialini E,Bertelli M,et al.Risk of genital prolapse and urinary incontinence due to pregnancy and delivery:A prospective study.Minerva Ginecol,2002,54(4):317-324.
[21]Dolan LM,Hosker GL,Mallett VT,et al.Stress incontinence and pelvic floor neurophysiology 15 years after the first delivery.BJOG,2003,110(12):1107-1114.
[22]Sartori JP,Sartori MG,Baracat EC,et al.Bladder neck mobility and functional evaluation of the pelvic floor in primiparae according to the type of delivery.Clin Exp Obstet Gynecol,2004,31(2):120-122.
[23]Fener DE,Genberg B,Bralllllapetal.Fecal and urinary incontinence after Vaginal delivery with anal sphincter disruption in an obstetrics unit in theUnited States. Am J Obstet Gynecol. 2003,189(6): 1543-1549.
[24] Persson J, Wolner-Hanssen P, Rydhstroem H.Obstetric risk factors for stress urinary incontinences population—based study. Obstet Gynecol 2000, 96(3): 440-445.
[25] Pregazzi R, Sartore A, Troiano L, et al. Postpartum urinary symptoms: prevalence and risk factors. Eur J Obstet Gynecol Reprod Biol, 2002, 103(2): 179-182.
[26] Farrell SA, Allen VM, Baskett TF. Parturition and urinary incontinence in primiparas. Obstet Gynecol, 2001, 97(3): 350-356.
[27] Hannah ME, Hannah WJ, Hodnett ED, et al. Outcomes at 3 months after planned cesarean vs planned vaginal delivery for breech presentation at term: the international randomized Term Breech Trial. JAMA, 2002,287(14): 1822-1831.
[28] Hvidman L, Foldspang A, Mommsen S, et al. Postpartum urinary incontinence. Acta Obstet Gynecol Scand, 2003, 82(6): 556-563.
[29] Chiarelli P, Cockburn J. Promoting urinary continence in women after delivery: randomised controlled trial. BMJ, 2002, 324(7348): 1241.
[30] Morkved S, Kari B, Schei B, et al. Pelvic floor muscle training during pregnancy to prevent urinary incontinence: a single-blind randomized controlled trial. Obstet Gynecol, 2003,101(2): 313-319.
[1] Viktrup L, Lose G, Rolff M, et al. The symptom of stress incontinence caused by pregnancy or delivery in primiparas. Obsted Gynecol, 1992, 79: 945-949.
[2] Viktrup L. The risk of lower urinary tract symptoms five years after the first delivery [J]. Neurourol Urodyn, 2002,21(1): 2-29.
[3] Pregazzi R, Sartore A, Troiano L,et al. Postpartum urinary symptoms: prevalence and risk factors [J]. Eur J Obstet Gynecol Reprod Biol, 2002,103(2): 179-182.
[4] Anne D, Walling. Exercise to treat postpartum urinary incontinence [J]. Am Fam Physician, 2002, 65(7): 1457-1458.
[5] Klauser A, Frauscher F, Strasser H, et al. Age-related rhabdosphincter function in female urinary stress incontinence: assessment of intraurethral sonography. J Ultrasound Med, 2004,23(5): 631-637.
[6] Jacobus W, Annemarie E, Potters W, et al. Anatomical and functional changes in the lower urinary tract during pregnancy. British Journal of Obstetrics and Gynaecology, 2001,108: 726-732.
[7] Goldberg RP, Kwon C, Gandhi S, et al. Urinary incontinence among mothers of multiples: the protective effect of cesarean delivery. Am J Obstet Gynecol, 2003, 188(6): 1447-1453.
[8] Chen B, Wen Y, Zhang ZM, et al. Difference in estrogen modulation of tissue inhibitou of matrix metalloproteinase-1 and matrix metalloproteinase-1 expression in cultured fibroblasts from continent and incontinent women. Am J Obstet Gynecol, 2003,189(1): 59-65.
[9] Chen B, Wen Y, Zhang ZM, et al. Menstrual phase-dependent gene expression difference in periurethral vaginal tissue from women with stress incontinence. Am J Obstet Gynecol, 2003,189(1): 89-97.
[10] Foldspang A, Mommsen S, Lam GW, et al. Parity as a correlate of adult female urinary incontinence prevalence. J Epidemiol Community Health, 1992, 46: 595-600.
[11]Hojberg KE,Salvig JD,Winslow NA,et al.Urinary incontinence:prevalence and risk factors at 16 weeks of gestation.Br J Ohstet Gynaecol,1999,106:842-850.
[12]Diez HP,Bennettet MJ.The Effect of childbieth on pelvic organ mobility.Obstet Gynecol Surv,2003,58(11):722-723.
[13]Clark MH,Scott M,Vogt V,et al.Monitoring pudendal never function during labor.Obstet Gynecol,2001,97(1):637-639
[14]宋岩峰主编.女性尿失禁诊断与治疗.人民军医出版社,2003:113-151.
[15]Wilson PD,Herbison RM,Herbison GP.Obstetric practice and the prevalence of urinary incontinence three months after delivery[J].Br J Obslet Gynaeenl,1996,103(2):154-161.
[16]Sultan AH,Kamm MA,Hudson CN.Pudendal nerve damage during labour:prospective study before and after childbirth.Br J Obstet Gynaecol,1994,101:22-28.
[17]Burgio KL,Zyczynski H,Locher JL,et al.Urinary incontinence in the 12-month postpartum period[J].Obstet Gynecol,2003,102(6):1291-1298.
[18]Lara C,Nacey J.Ethnic diferences between Maori,Pacific Island and European New Zealand women in prevalence and attitudes to urinary incontinence.N Z Med J,1994;107:374-376.
[19]Hvidman L,Foldspang A,Mommsen S,et al.Postpartum urinary incontinence [J].Acta Obstet Gynaecol Stand,2003,82(6):556-563.
[20]MacArthur C,Glazener CM,Wilson PD,et al.Persistent urinary incontinence and delivery mode history:a six-year longitudinal study.BJOG,2006,113(2):218-224.
[21]Chiarelli P,Cockburn J.Promoting urinary continence in women after delivery:randomised controlled trial.BMJ,2002,324(7348):1241.
[22]Morkved,Kari B,Berit S,et al.Pelvic floor muscle training during pregnancy to prevent urinary incontinence:a single-blind randomized controlled trial.Obstet Gynecol,2003,101:313-319.
[23] PregazziR, Sartore A, Troiano L, et al. Postpartum urinary symptoms: prevalence and risk factors. Eur J Obstet Gynecol Reprod Biol, 2002,103: 179.
[2]Hampel C,Artibani W,Espuna Pons M,et al.Understanding the burden of stress urinary incontinence in Europe:a qualitative review of the literature.Eur Urol.2004,46(1):15-27.
[3]宋岩峰主编.女性尿失禁诊断与治疗.人民军医出版社,2003,2-4.
[4]Thorn DH,van den Eeden SK,Ragins AI,et al.Differences in prevalence of urinary incontinence by race/ethnicity.J Urol,2006,175(1):259-264.
[5]杨欣,郑红,廖秦平等.分娩方式对尿失禁发生的影响.中华妇产科杂志,2004,39(10):662-665.
[6]Gaudenz R.A questionnaire with a new urge-score and stress-score for the evaluation of female urinary incontinence.Geburtshilfe Frauenheilkd,1979,39(9):784-792.
[7]Ishiko O,Hirai K,Sumi T,et al.The urinary incontinence score in the diagnosis of female urinary incontinence.Int J Gynecol Obste,2000,68(2):131-137.
[8]王宏,朱兰,郎景和等.压力性尿失禁问卷评分对女性压力性尿失禁诊断的价值.实用妇产科杂志,2006,22(6):363-365.
[9]Foldspang A,Mommsen S,Lam GW,et al.Parity as a correlate of adult female urinary incontinence prevalence.J Epidemiol Community Health,1992,46(6):595-600.
[10]Hojberg KE,Salvig JD,Winslow NA,et al.Urinary incontinence:prevalence and risk factors at 16 weeks of gestation.Br J Ohstet Gynaecol,1999,106(8):842-850.
[11]Mason L,Glenn S,Walton I,et al.The instruction in pelvic floor exercises provided to women during pregnancy or following delivery.Midwifery,2001,17(1):55-64.
[12]Wijma J,Weis Potters AE,de Wolf BT,et al.Anatomical and functional changes in the lower urinary tract during pregnancy.BJOG,2001,108(7):726-732.
[13]Kristiansson P,Samuelsson E,von Schoultz B,et al.Reproductive hormones and stress urinary incontinence in pregnancy.Acta Obstet Gyneeol Stand,2001,80(12):1125-1130.
[14]Chen B,Wen Y,Wang H,et al.Difference in estrogen modulation of tissue inhibitou of matrix metalloproteinase-1 and matrix metalloproteinase-1expression in cultured fibroblasts from continent and incontinent women.Am J Obstet Gynecol,2003,189(1):59-65.
[15]Vikrup L,Lose G.Epidural anesthesia during labour and stress incontinence after delivery.Obstet Gynecol,1993,82(6):984-986.
[16]Parazzini F,Chiaffarino F,Lavezzari M,et al.Risk factors for stress,urge or mixed urillary incontinence in Italy.BJOG,2003,110(10):927-933.
[17]古力米热,夏昊,杨勇等.新疆地区维吾尔族人群尿失禁发病率调查.中华泌尿外科杂志,2002,23(7):422-423.
[18]Burgio KL,Zyczynski H,Locher J L,et al.Urinary incontinence in the 12-month postpartum period.Obstet Gynecol,2003,102(6):1291-1298.
[19]Sultan AH,Kamm MA,Hudson CN.Pudendal nerve damage during labour:Prospective study before and after childbirth.Br J Obstet Gynaecol,1994,101(1):22-28.
[20]Benassi L,Bocchialini E,Bertelli M,et al.Risk of genital prolapse and urinary incontinence due to pregnancy and delivery:A prospective study.Minerva Ginecol,2002,54(4):317-324.
[21]Dolan LM,Hosker GL,Mallett VT,et al.Stress incontinence and pelvic floor neurophysiology 15 years after the first delivery.BJOG,2003,110(12):1107-1114.
[22]Sartori JP,Sartori MG,Baracat EC,et al.Bladder neck mobility and functional evaluation of the pelvic floor in primiparae according to the type of delivery.Clin Exp Obstet Gynecol,2004,31(2):120-122.
[23]Fener DE,Genberg B,Bralllllapetal.Fecal and urinary incontinence after Vaginal delivery with anal sphincter disruption in an obstetrics unit in theUnited States. Am J Obstet Gynecol. 2003,189(6): 1543-1549.
[24] Persson J, Wolner-Hanssen P, Rydhstroem H.Obstetric risk factors for stress urinary incontinences population—based study. Obstet Gynecol 2000, 96(3): 440-445.
[25] Pregazzi R, Sartore A, Troiano L, et al. Postpartum urinary symptoms: prevalence and risk factors. Eur J Obstet Gynecol Reprod Biol, 2002, 103(2): 179-182.
[26] Farrell SA, Allen VM, Baskett TF. Parturition and urinary incontinence in primiparas. Obstet Gynecol, 2001, 97(3): 350-356.
[27] Hannah ME, Hannah WJ, Hodnett ED, et al. Outcomes at 3 months after planned cesarean vs planned vaginal delivery for breech presentation at term: the international randomized Term Breech Trial. JAMA, 2002,287(14): 1822-1831.
[28] Hvidman L, Foldspang A, Mommsen S, et al. Postpartum urinary incontinence. Acta Obstet Gynecol Scand, 2003, 82(6): 556-563.
[29] Chiarelli P, Cockburn J. Promoting urinary continence in women after delivery: randomised controlled trial. BMJ, 2002, 324(7348): 1241.
[30] Morkved S, Kari B, Schei B, et al. Pelvic floor muscle training during pregnancy to prevent urinary incontinence: a single-blind randomized controlled trial. Obstet Gynecol, 2003,101(2): 313-319.
[1] Viktrup L, Lose G, Rolff M, et al. The symptom of stress incontinence caused by pregnancy or delivery in primiparas. Obsted Gynecol, 1992, 79: 945-949.
[2] Viktrup L. The risk of lower urinary tract symptoms five years after the first delivery [J]. Neurourol Urodyn, 2002,21(1): 2-29.
[3] Pregazzi R, Sartore A, Troiano L,et al. Postpartum urinary symptoms: prevalence and risk factors [J]. Eur J Obstet Gynecol Reprod Biol, 2002,103(2): 179-182.
[4] Anne D, Walling. Exercise to treat postpartum urinary incontinence [J]. Am Fam Physician, 2002, 65(7): 1457-1458.
[5] Klauser A, Frauscher F, Strasser H, et al. Age-related rhabdosphincter function in female urinary stress incontinence: assessment of intraurethral sonography. J Ultrasound Med, 2004,23(5): 631-637.
[6] Jacobus W, Annemarie E, Potters W, et al. Anatomical and functional changes in the lower urinary tract during pregnancy. British Journal of Obstetrics and Gynaecology, 2001,108: 726-732.
[7] Goldberg RP, Kwon C, Gandhi S, et al. Urinary incontinence among mothers of multiples: the protective effect of cesarean delivery. Am J Obstet Gynecol, 2003, 188(6): 1447-1453.
[8] Chen B, Wen Y, Zhang ZM, et al. Difference in estrogen modulation of tissue inhibitou of matrix metalloproteinase-1 and matrix metalloproteinase-1 expression in cultured fibroblasts from continent and incontinent women. Am J Obstet Gynecol, 2003,189(1): 59-65.
[9] Chen B, Wen Y, Zhang ZM, et al. Menstrual phase-dependent gene expression difference in periurethral vaginal tissue from women with stress incontinence. Am J Obstet Gynecol, 2003,189(1): 89-97.
[10] Foldspang A, Mommsen S, Lam GW, et al. Parity as a correlate of adult female urinary incontinence prevalence. J Epidemiol Community Health, 1992, 46: 595-600.
[11]Hojberg KE,Salvig JD,Winslow NA,et al.Urinary incontinence:prevalence and risk factors at 16 weeks of gestation.Br J Ohstet Gynaecol,1999,106:842-850.
[12]Diez HP,Bennettet MJ.The Effect of childbieth on pelvic organ mobility.Obstet Gynecol Surv,2003,58(11):722-723.
[13]Clark MH,Scott M,Vogt V,et al.Monitoring pudendal never function during labor.Obstet Gynecol,2001,97(1):637-639
[14]宋岩峰主编.女性尿失禁诊断与治疗.人民军医出版社,2003:113-151.
[15]Wilson PD,Herbison RM,Herbison GP.Obstetric practice and the prevalence of urinary incontinence three months after delivery[J].Br J Obslet Gynaeenl,1996,103(2):154-161.
[16]Sultan AH,Kamm MA,Hudson CN.Pudendal nerve damage during labour:prospective study before and after childbirth.Br J Obstet Gynaecol,1994,101:22-28.
[17]Burgio KL,Zyczynski H,Locher JL,et al.Urinary incontinence in the 12-month postpartum period[J].Obstet Gynecol,2003,102(6):1291-1298.
[18]Lara C,Nacey J.Ethnic diferences between Maori,Pacific Island and European New Zealand women in prevalence and attitudes to urinary incontinence.N Z Med J,1994;107:374-376.
[19]Hvidman L,Foldspang A,Mommsen S,et al.Postpartum urinary incontinence [J].Acta Obstet Gynaecol Stand,2003,82(6):556-563.
[20]MacArthur C,Glazener CM,Wilson PD,et al.Persistent urinary incontinence and delivery mode history:a six-year longitudinal study.BJOG,2006,113(2):218-224.
[21]Chiarelli P,Cockburn J.Promoting urinary continence in women after delivery:randomised controlled trial.BMJ,2002,324(7348):1241.
[22]Morkved,Kari B,Berit S,et al.Pelvic floor muscle training during pregnancy to prevent urinary incontinence:a single-blind randomized controlled trial.Obstet Gynecol,2003,101:313-319.
[23] PregazziR, Sartore A, Troiano L, et al. Postpartum urinary symptoms: prevalence and risk factors. Eur J Obstet Gynecol Reprod Biol, 2002,103: 179.