Pregnancy and delivery after mid-urethral sling operation

Sari A Tulokas,Tomi S Mikkola,Maarit J Mentula,Mika Gissler,Päivi Rahkola-Soisalo

doi:10.1007/s00192-020-04497-w

Abstract

Introduction and hypothesesThere is no consensus regarding pregnancy after mid-urethral sling (MUS) operation, and some clinicians recommend postponing the MUS operation if a woman considers further pregnancies or routinely suggest cesarean section as the delivery method after MUS operations. Our primary aim was to assess the risk for stress urinary incontinence (SUI) re-procedure after delivery in women with a MUS operation prior to pregnancy. We also analyzed SUI re-visits and MUS-related complications during pregnancy and postpartum.MethodsWe conducted a register-based case-control study of women with a MUS operation in Finland during 1996–2016. We identified 94 cases with a subsequent pregnancy and 330 controls without subsequent pregnancies matched by age, operation type and year.ResultsThe median follow-up time was 10.7 years (IQR 7.1–13.7). The number of SUI re-procedures did not differ between the cases (n = 3, 3.2%) and controls (n = 17, 5.2%; OR 0.6, 95% CI 0.2–2.1). There was no significant difference in re-visits for stress or mixed urinary incontinence between the cases (n = 23, 24.5%) and controls (n = 86, 26.1%; OR 0.9, 95% CI 0.5–1.6), but 35% of the re-visits in the case group occurred already before the delivery after MUS. The rate of vaginal delivery was lower after MUS operation (57%) than in deliveries before MUS (91%, P < 0.001).ConclusionsPregnancy after MUS did not increase the odds for SUI re-procedure or re-visit. Considering on our results, future pregnancy does not need to be viewed as an absolute contraindication for MUS operation.

Highlights

Introduction and hypothesesThere is no consensus regarding pregnancy after mid-urethral sling (MUS) operation, and some clinicians recommend postponing the MUS operation if a woman considers further pregnancies or routinely suggest cesarean section as the delivery method after MUS operations
We identified the sample by searching all visits with the Nordic Medico-Statistical Committee Classification of Surgical Procedures (NCSP) operation codes for MUS operation (LEG10 for retropubic MUS, LEG12 for outside-in transobturator MUS and LEG13 for inside-out transobturator MUS)
0 1–2 3 or more Index operation year, n (%) 1997–1999 2000–2004 2005–2009 2010–2014 2015–2016 BMI at start of last pregnancy before index MUS Median (IQR) Unknown, n (%) Follow-up time, median in years (IQR) Mode of deliveries before index operation, n (%) Only vaginal One or more cesarean sections Unknown Number of deliveries after index MUS 1 2 Mode of delivery after index operation, n (%) Vaginal Elective cesarean section Urgent or emergency cesarean section Difference compared with delivery mode before index operation Time to delivery after index MUS, median in years (IQR)