Aims of the study:

Stress urinary (SUI) in young women may be the result of injury to the pelvic floor during vaginal delivery. The present study was conducted to compare the prevalence of de novo SUI among young primiparae delivered vaginally by assisted breech versus spontaneous vertex delivery.

Methods:

The study population comprised 43 consecutive primiparae who delivered vaginally by assisted breech delivery and a matched control group of 43 consecutive primiparae delivered vaginally by spontaneous vertex delivery. Matching was made by maternal age, gestational age at delivery, length of 2^nd and active 2nd  (defined as phase of active pushing) stages of labor and birth weight. All women had epidural analgesia and psterolateral episiotomy and had an apparently atraumatic vaginal delivery. Obstetric data was collected from hospital records. One year postpartum, all women were interviewed regarding symptoms of de novo SUI. The symptom of SUI was defined as an involuntary leakage of urine with any physical effort regardless of the severity and frequency. Results were analyzed statistically by student t-test and c2 test. Value of p<0.05 was considered significant.

Results:

The two groups differed only by the fetal presentation at delivery (breech versus vertex). All other obstetric parameters were identical. Data are presented in the following table:

Mean ±SD	Vertex delivery N=43	Breech delivery N=43	P
Maternal age (years)	27.7±4.7	26.6±3.9	0.2
Gestational age (weeks)	39.0±1.8	38.6±2.3	0.4
2nd   stage (minutes)	76.3±62.7	79.5±70.3	0.8
Active 2nd stage (minutes)	33.8±23.1	25.3±18.6	0.07
Birth weight (grams)	28883.9±496.2	2886.4±506.3	0.98
Postpartum SUI	10(23.3%)	6(14%)	0.27

A clear trend of lower prevalence of de novo postpartum SUI was evident following assisted breech delivery than spontaneous vertex delivery (14% versus 23.3% respectively), although statistical significant was not reached (p=0.27).

Conclusion;

Breech presentation and assisted breech delivery were found to be associated with lower prevalence of de novo postpartum SUI than vertex delivery. This may be due to concealed damages caused by the firm fetal head during an apparently a traumatic labor. Further studies are needed to confirm this hypothesis.