Prediction models for postpartum urinary and fecal incontinence in primiparous women.
Abstract
OBJECTIVES: This study aimed to develop and internally validate a nomogram that facilitates
decision making between patient and physician by predicting a woman's individual probability
of developing urinary (UI) or fecal incontinence (FI) after her first delivery. METHODS:
This study used Childbirth and Pelvic Symptoms Study data, which estimated the prevalence
of postpartum UI and FI in primiparous women after vaginal or cesarean delivery. Two
models were developed using antepartum variables, and 2 models were developed using
antepartum plus labor and delivery variables. Urinary incontinence was defined by
a response of leaking urine "sometimes" or "often" using the Medical, Epidemiological,
and Social Aspects of Aging Questionnaire. Fecal incontinence was defined as any involuntary
leakage of mucus, liquid, or solid stool using the Fecal Incontinence Severity Index.
Logistic regression models allowing nonlinear effects were used and displayed as nomograms.
Overall performance was assessed using the Brier score (zero equals perfect model)
and concordance index (c-statistic). RESULTS: A total of 921 women enrolled in the
Childbirth and Pelvic Symptoms Study, and 759 (82%) were interviewed by telephone
6 months postpartum. Two antepartum models were generated, which discriminated between
women who will and will not develop UI (Brier score = 0.19, c-statistic = 0.69) and
FI (Brier score = 0.10, c-statistic = 0.67) at 6 months and 2 models were generated
(Brier score = 0.18, c-statistic= 0.68 and Brier score = 0.09, c-statistic = 0.68)
for predicting UI and FI, respectively, for use after labor and delivery. CONCLUSIONS:
These models yielded 4 nomograms that are accurate for generating individualized prognostic
estimates of postpartum UI and FI and may facilitate decision making in the prevention
of incontinence.
Type
Journal articleSubject
HumansFecal Incontinence
Urinary Incontinence
Puerperal Disorders
Nomograms
Prospective Studies
Decision Making
Parity
Pregnancy
Adult
Female
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https://hdl.handle.net/10161/19762Published Version (Please cite this version)
10.1097/spv.0b013e31828508f0Publication Info
Jelovsek, J Eric; Piccorelli, Annalisa; Barber, Matthew D; Tunitsky-Bitton, Elena;
& Kattan, Michael W (2013). Prediction models for postpartum urinary and fecal incontinence in primiparous women.
Female pelvic medicine & reconstructive surgery, 19(2). pp. 110-118. 10.1097/spv.0b013e31828508f0. Retrieved from https://hdl.handle.net/10161/19762.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Matthew Don Barber
W. Allen Addison, M.D. Distinguished Professor of Obstetrics and Gynecology
John E Jelovsek
F. Bayard Carter Distinguished Professor of Obstetrics and Gynecology
Dr. Jelovsek is the F. Bayard Carter Distinguished Professor of OBGYN at Duke University
and serves as Director of Data Science for Women’s Health. He is Board Certified in
OBGYN by the American Board of OBGYN and in Female Pelvic Medicine & Reconstructive
Surgery by the American Board of OBGYN and American Board of Urology. He has an active
surgical practice in urogynecology based out of Duke Raleigh. He has expertise as
a clinician-scientist in developing and evaluating clini
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