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clinmed/2000090001v1 (November 14, 2000)
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Antenatal screening for postpartum urinary incontinence in nulliparous women: results of a pilot study

Douglas G. Tincello, Elisabeth J. Adams, and David H. Richmond

Objectives: To examine the utility of joint mobility scoring as a screening test for predicting post-partum urinary incontinence. Design: Prospective observational cohort study. Setting: Antenatal clinics and urodynamic clinic of a large tertiary referral teaching hospital. Participants: 150 nulliparous Caucasian women. Women from different ethnic groups and those with a history of prolapse, incontinence surgery or connective tissue diseases were excluded. 103 women were followed up until at least 21 days after delivery. Main outcome measures: Joint mobility score at 20 weeks. Reported incidence of urinary incontinence at 32 and 38 weeks gestation and postnatally at the end of the study period (42 days). Maximum daily perineal pad use. Results: Antenatal incontinence occurred in 43.7% of subjects. Postpartum incontinence occurred in 12.6% with a prevalence of 2.9% at study end. Total joint mobility was normally distributed with no differences between continent and incontinent women. Elbow hyperextension (>180 ) was associated with postnatal incontinence at the end of the study (Odds ratio 12.2; 95%CI 1.3, 114.2). Conclusion: Elbow hyperextension carries an estimated relative risk of postnatal urinary incontinence of 12. The small size of the study necessitates caution in interpretation of this finding, but it appears to have potential value as a simple, independent screening tool for women at high -risk of postnatal incontinence. Confirmation of this finding in a large sample with longer follow up is important and will allow prospective randomised trials to evaluate the benefits of suggested antenatal interventions to be performed on high-risk women.