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Симптомы нижних мочевых путей в динамике физиологически протекающей беременности в зависимости от паритета и метода родоразрешения
Симптомы нижних мочевых путей в динамике физиологически протекающей беременности в зависимости от паритета и метода родоразрешения
Осипова Н.А., Ниаури Д.А., Гзгзян А.М., Зиятдинова Г.М. Симптомы нижних мочевых путей в динамике физиологически протекающей беременности в зависимости от паритета и метода родоразрешения. Гинекология. 2015; 17 (3): 60–63.
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Аннотация
Цель настоящей работы – исследование частоты манифестации симптомов нижних мочевых путей (СНМП) у женщин в динамике физиологически протекающей беременности в зависимости от паритета и метода родоразрешения.
Всего были обследованы 270 пациенток с физиологическим течением беременности (83 – в I триместре, 78 – во II триместре и 109 – в III триместре) в возрасте от 18 до 44 лет, не имевших до настоящей беременности СНМП.
СНМП обнаружены у 81,9±2,3% беременных женщин. Среди СНМП превалируют симптомы накопления: недержание мочи, императивные позывы, учащенное мочеиспускание, ноктурия. Частота симптомов накопления, мочеиспускания и после опорожнения нарастает по мере прогрессирования беременности. Стрессовое недержание мочи чаще встречается у повторнородящих женщин, регулярность развития никтурии, императивных позывов и учащенного мочеиспускания одинакова у перво- и повторнородящих пациенток. Стрессовое недержание мочи чаще встречается у женщин, родоразрешенных через естественные родовые пути, в то время как частота развития никтурии, императивных позывов и учащенного мочеиспускания не зависит от метода родоразрешения.
Ключевые слова: симптомы нижних мочевых путей, беременность.
In total 270 women with the physiological pregnancy (83 – in the I trimester, 78 – in the II trimester and 109 – in the III trimester) aged from 18 till
44 years with no LUTS before the current pregnancy were examined. LUTS are revealed at 81.9±2.3% of pregnant women. The most common LUTS during pregnancy were: urine incontience, urgency, frequency and nocturia. There was a significantly higher prevalence of storage, voiding and post micturition symptoms with gestational age. Stress urinary incontinence is more often in the multiparous women; nocturia, urgency and frequency are identical in nulliparous and multiparous women. Stress urinary incontinence is more common after vaginal delivery but prevalence rates of nocturia, urgency and frequency do not depend on delivery method.
Key words: lower urinary tract symptoms, pregnancy.
Всего были обследованы 270 пациенток с физиологическим течением беременности (83 – в I триместре, 78 – во II триместре и 109 – в III триместре) в возрасте от 18 до 44 лет, не имевших до настоящей беременности СНМП.
СНМП обнаружены у 81,9±2,3% беременных женщин. Среди СНМП превалируют симптомы накопления: недержание мочи, императивные позывы, учащенное мочеиспускание, ноктурия. Частота симптомов накопления, мочеиспускания и после опорожнения нарастает по мере прогрессирования беременности. Стрессовое недержание мочи чаще встречается у повторнородящих женщин, регулярность развития никтурии, императивных позывов и учащенного мочеиспускания одинакова у перво- и повторнородящих пациенток. Стрессовое недержание мочи чаще встречается у женщин, родоразрешенных через естественные родовые пути, в то время как частота развития никтурии, императивных позывов и учащенного мочеиспускания не зависит от метода родоразрешения.
Ключевые слова: симптомы нижних мочевых путей, беременность.
________________________________________________
In total 270 women with the physiological pregnancy (83 – in the I trimester, 78 – in the II trimester and 109 – in the III trimester) aged from 18 till
44 years with no LUTS before the current pregnancy were examined. LUTS are revealed at 81.9±2.3% of pregnant women. The most common LUTS during pregnancy were: urine incontience, urgency, frequency and nocturia. There was a significantly higher prevalence of storage, voiding and post micturition symptoms with gestational age. Stress urinary incontinence is more often in the multiparous women; nocturia, urgency and frequency are identical in nulliparous and multiparous women. Stress urinary incontinence is more common after vaginal delivery but prevalence rates of nocturia, urgency and frequency do not depend on delivery method.
Key words: lower urinary tract symptoms, pregnancy.
Полный текст
Список литературы
1. Abrams P, Cardozo L, Fall M et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Am J Obstet Gynecol 2002; 187 (1): 116–26.
2. Adaji SE, Shittu OS, Bature SB et al. Bothersome lower urinary symptoms during pregnancy: a preliminary study using the International Consultation on Incontinence Questionnaire. Afr Health Sci 2011; 11 (Suppl. 1): S46 52.
3. Lin KL, Shen CJ, Wu MP et al. Comparison of low urinary tract symptoms during pregnancy between primiparous and multiparous women. Biomed Res Int 2014; 2014: 303697.
4. Wanichsetakul P, Lekskulchai O. Effect of pregnancy on urinary functions in Thai nulliparous pregnant women. J Med Assoc Thai 2014; 97 (Suppl. 8): S164–70.
5. Martínez FE, Parés D, Lorente Colomé N et al. Urinary incontinence during pregnancy. Is there a difference between first and third trimester? Eur J Obstet Gynecol Reprod Biol 2014; 182: 86–90.
6. Van Brummen HJ, Bruinse HW, Van de Pol G et al. Bothersome lower urinary tract symptoms 1 year after first delivery: prevalence and the effect of childbirth. BJU Int 2006; 98 (1): 89–95.
7. Glazener CM, Herbison GP, MacArthur C et al. New postnatal urinary incontinence: obstetric and other risk factors in primiparae. BJOG 2006; 113 (2): 208–17.
8. Ebbesen MH, Hunskaar S, Rortveit G, Hannestad YS. Prevalence, incidence and remission of urinary incontinence in women: longitudinal data from the Norwegian HUNT study (EPINCONT). BMC Urol 2013; 13: 27.
9. Hannestad YS, Rortveit G, Hunskaar S. Help-seeking and associated factors in female urinary incontinence. The Norwegian EPINCONT Study. Epidemiology of Incontinence in the County of Nord-Trøndelag. Scand J Prim Health Care 2002; 20 (2): 102–7.
10. Rortveit G, Daltveit AK, Hannestad YS, Hunskaar S. Vaginal delivery parameters and urinary incontinence: the Norwegian EPINCONT study. Am J Obstet Gynecol 2003; 189 (5): 1268–74.
11. Kristiansson P, Samuelsson E, Schoults BV, Srardsudd K. Reproductive hormones and stress urinary incontinence in pregnancy. Acta Obstet Gynecol Scand 2001; 80 (12): 1125–30.
12. Petros P. Urinary incontinence during pregnancy: a function of collagen depolymerisation by relaxin? Eur J Obstet Gynecol Reprod Biol 2015; 186: 111–2.
13. Sayed RF, Morsy MM, Abdel-Azim MS. Anatomy of the urethral supporting ligaments defined by dissection, histology, and MRI of female cadavers and MRI of healthy nulliparous women. AJR Am J Roentgenol 2007; 189: 1145–57.
14. Chaliha C, Bland JM, Monga A et al. Pregnancy and delivery: a urodynamic viewpoint. BJOG 2000; 107: 1354–9.
15. Sibui B, Newton E. The urinary tract in pregnancy. Urogynecol Reconstr Pelvic Surg 2007; 472–90.
16. Harvey MA, Johnston SL, Davies GA. Mid-trimester serum relaxin concentrations and post-partum pelvic floor dysfunction. Acta Obstet Gynecol Scand 2008; 87 (12): 1315–21.
17. Lin G, Ning H, Wang G et al. Effects of birth trauma and estrogen on urethral elastic fibers and elastin expression. Urology 2010; 76 (4): 1018.
18. Jundt K, Scheer I, Schiessl B et al. Incontinence, bladder neck mobility, and sphincter ruptures in primiparous women. Eur J Med Res 2010; 15 (6): 246–52.
19. Van Veelen A, Schweitzer K, Van der Vaart H. Ultrasound assessment of urethral support in women with stress urinary incontinence during and after first pregnancy. Obstet Gynecol 2014; 124 (2 Pt. 1): 249–56.
20. Panayi DC, Khullar V. Urogynaecological problems in pregnancy and postpartum sequelae. Curr Opin Obstet Gynecol 2009; 21 (1): 97–100.
21. Nygaard I, Cruikshank DP. Should all women be offered elective cesarean delivery? Obstet Gynecol 2003; 102 (2): 217–9.
22. Tanawattanacharoen S, Thongtawee S. Prevalence of urinary incontinence during the late third trimester and three months postpartum period in King Chulalongkorn Memorial Hospital. J Med Assoc Thai 2013; 96 (2): 144–9.
23. Rortveit G, Hunskaar S. Urinary incontinence and age at the first and last delivery: the Norwegian HUNT/EPINCONT study. Am J Obstet Gynecol 2006; 195 (2): 433–8.
2. Adaji SE, Shittu OS, Bature SB et al. Bothersome lower urinary symptoms during pregnancy: a preliminary study using the International Consultation on Incontinence Questionnaire. Afr Health Sci 2011; 11 (Suppl. 1): S46 52.
3. Lin KL, Shen CJ, Wu MP et al. Comparison of low urinary tract symptoms during pregnancy between primiparous and multiparous women. Biomed Res Int 2014; 2014: 303697.
4. Wanichsetakul P, Lekskulchai O. Effect of pregnancy on urinary functions in Thai nulliparous pregnant women. J Med Assoc Thai 2014; 97 (Suppl. 8): S164–70.
5. Martínez FE, Parés D, Lorente Colomé N et al. Urinary incontinence during pregnancy. Is there a difference between first and third trimester? Eur J Obstet Gynecol Reprod Biol 2014; 182: 86–90.
6. Van Brummen HJ, Bruinse HW, Van de Pol G et al. Bothersome lower urinary tract symptoms 1 year after first delivery: prevalence and the effect of childbirth. BJU Int 2006; 98 (1): 89–95.
7. Glazener CM, Herbison GP, MacArthur C et al. New postnatal urinary incontinence: obstetric and other risk factors in primiparae. BJOG 2006; 113 (2): 208–17.
8. Ebbesen MH, Hunskaar S, Rortveit G, Hannestad YS. Prevalence, incidence and remission of urinary incontinence in women: longitudinal data from the Norwegian HUNT study (EPINCONT). BMC Urol 2013; 13: 27.
9. Hannestad YS, Rortveit G, Hunskaar S. Help-seeking and associated factors in female urinary incontinence. The Norwegian EPINCONT Study. Epidemiology of Incontinence in the County of Nord-Trøndelag. Scand J Prim Health Care 2002; 20 (2): 102–7.
10. Rortveit G, Daltveit AK, Hannestad YS, Hunskaar S. Vaginal delivery parameters and urinary incontinence: the Norwegian EPINCONT study. Am J Obstet Gynecol 2003; 189 (5): 1268–74.
11. Kristiansson P, Samuelsson E, Schoults BV, Srardsudd K. Reproductive hormones and stress urinary incontinence in pregnancy. Acta Obstet Gynecol Scand 2001; 80 (12): 1125–30.
12. Petros P. Urinary incontinence during pregnancy: a function of collagen depolymerisation by relaxin? Eur J Obstet Gynecol Reprod Biol 2015; 186: 111–2.
13. Sayed RF, Morsy MM, Abdel-Azim MS. Anatomy of the urethral supporting ligaments defined by dissection, histology, and MRI of female cadavers and MRI of healthy nulliparous women. AJR Am J Roentgenol 2007; 189: 1145–57.
14. Chaliha C, Bland JM, Monga A et al. Pregnancy and delivery: a urodynamic viewpoint. BJOG 2000; 107: 1354–9.
15. Sibui B, Newton E. The urinary tract in pregnancy. Urogynecol Reconstr Pelvic Surg 2007; 472–90.
16. Harvey MA, Johnston SL, Davies GA. Mid-trimester serum relaxin concentrations and post-partum pelvic floor dysfunction. Acta Obstet Gynecol Scand 2008; 87 (12): 1315–21.
17. Lin G, Ning H, Wang G et al. Effects of birth trauma and estrogen on urethral elastic fibers and elastin expression. Urology 2010; 76 (4): 1018.
18. Jundt K, Scheer I, Schiessl B et al. Incontinence, bladder neck mobility, and sphincter ruptures in primiparous women. Eur J Med Res 2010; 15 (6): 246–52.
19. Van Veelen A, Schweitzer K, Van der Vaart H. Ultrasound assessment of urethral support in women with stress urinary incontinence during and after first pregnancy. Obstet Gynecol 2014; 124 (2 Pt. 1): 249–56.
20. Panayi DC, Khullar V. Urogynaecological problems in pregnancy and postpartum sequelae. Curr Opin Obstet Gynecol 2009; 21 (1): 97–100.
21. Nygaard I, Cruikshank DP. Should all women be offered elective cesarean delivery? Obstet Gynecol 2003; 102 (2): 217–9.
22. Tanawattanacharoen S, Thongtawee S. Prevalence of urinary incontinence during the late third trimester and three months postpartum period in King Chulalongkorn Memorial Hospital. J Med Assoc Thai 2013; 96 (2): 144–9.
23. Rortveit G, Hunskaar S. Urinary incontinence and age at the first and last delivery: the Norwegian HUNT/EPINCONT study. Am J Obstet Gynecol 2006; 195 (2): 433–8.
2. Adaji SE, Shittu OS, Bature SB et al. Bothersome lower urinary symptoms during pregnancy: a preliminary study using the International Consultation on Incontinence Questionnaire. Afr Health Sci 2011; 11 (Suppl. 1): S46 52.
3. Lin KL, Shen CJ, Wu MP et al. Comparison of low urinary tract symptoms during pregnancy between primiparous and multiparous women. Biomed Res Int 2014; 2014: 303697.
4. Wanichsetakul P, Lekskulchai O. Effect of pregnancy on urinary functions in Thai nulliparous pregnant women. J Med Assoc Thai 2014; 97 (Suppl. 8): S164–70.
5. Martínez FE, Parés D, Lorente Colomé N et al. Urinary incontinence during pregnancy. Is there a difference between first and third trimester? Eur J Obstet Gynecol Reprod Biol 2014; 182: 86–90.
6. Van Brummen HJ, Bruinse HW, Van de Pol G et al. Bothersome lower urinary tract symptoms 1 year after first delivery: prevalence and the effect of childbirth. BJU Int 2006; 98 (1): 89–95.
7. Glazener CM, Herbison GP, MacArthur C et al. New postnatal urinary incontinence: obstetric and other risk factors in primiparae. BJOG 2006; 113 (2): 208–17.
8. Ebbesen MH, Hunskaar S, Rortveit G, Hannestad YS. Prevalence, incidence and remission of urinary incontinence in women: longitudinal data from the Norwegian HUNT study (EPINCONT). BMC Urol 2013; 13: 27.
9. Hannestad YS, Rortveit G, Hunskaar S. Help-seeking and associated factors in female urinary incontinence. The Norwegian EPINCONT Study. Epidemiology of Incontinence in the County of Nord-Trøndelag. Scand J Prim Health Care 2002; 20 (2): 102–7.
10. Rortveit G, Daltveit AK, Hannestad YS, Hunskaar S. Vaginal delivery parameters and urinary incontinence: the Norwegian EPINCONT study. Am J Obstet Gynecol 2003; 189 (5): 1268–74.
11. Kristiansson P, Samuelsson E, Schoults BV, Srardsudd K. Reproductive hormones and stress urinary incontinence in pregnancy. Acta Obstet Gynecol Scand 2001; 80 (12): 1125–30.
12. Petros P. Urinary incontinence during pregnancy: a function of collagen depolymerisation by relaxin? Eur J Obstet Gynecol Reprod Biol 2015; 186: 111–2.
13. Sayed RF, Morsy MM, Abdel-Azim MS. Anatomy of the urethral supporting ligaments defined by dissection, histology, and MRI of female cadavers and MRI of healthy nulliparous women. AJR Am J Roentgenol 2007; 189: 1145–57.
14. Chaliha C, Bland JM, Monga A et al. Pregnancy and delivery: a urodynamic viewpoint. BJOG 2000; 107: 1354–9.
15. Sibui B, Newton E. The urinary tract in pregnancy. Urogynecol Reconstr Pelvic Surg 2007; 472–90.
16. Harvey MA, Johnston SL, Davies GA. Mid-trimester serum relaxin concentrations and post-partum pelvic floor dysfunction. Acta Obstet Gynecol Scand 2008; 87 (12): 1315–21.
17. Lin G, Ning H, Wang G et al. Effects of birth trauma and estrogen on urethral elastic fibers and elastin expression. Urology 2010; 76 (4): 1018.
18. Jundt K, Scheer I, Schiessl B et al. Incontinence, bladder neck mobility, and sphincter ruptures in primiparous women. Eur J Med Res 2010; 15 (6): 246–52.
19. Van Veelen A, Schweitzer K, Van der Vaart H. Ultrasound assessment of urethral support in women with stress urinary incontinence during and after first pregnancy. Obstet Gynecol 2014; 124 (2 Pt. 1): 249–56.
20. Panayi DC, Khullar V. Urogynaecological problems in pregnancy and postpartum sequelae. Curr Opin Obstet Gynecol 2009; 21 (1): 97–100.
21. Nygaard I, Cruikshank DP. Should all women be offered elective cesarean delivery? Obstet Gynecol 2003; 102 (2): 217–9.
22. Tanawattanacharoen S, Thongtawee S. Prevalence of urinary incontinence during the late third trimester and three months postpartum period in King Chulalongkorn Memorial Hospital. J Med Assoc Thai 2013; 96 (2): 144–9.
23. Rortveit G, Hunskaar S. Urinary incontinence and age at the first and last delivery: the Norwegian HUNT/EPINCONT study. Am J Obstet Gynecol 2006; 195 (2): 433–8.
________________________________________________
2. Adaji SE, Shittu OS, Bature SB et al. Bothersome lower urinary symptoms during pregnancy: a preliminary study using the International Consultation on Incontinence Questionnaire. Afr Health Sci 2011; 11 (Suppl. 1): S46 52.
3. Lin KL, Shen CJ, Wu MP et al. Comparison of low urinary tract symptoms during pregnancy between primiparous and multiparous women. Biomed Res Int 2014; 2014: 303697.
4. Wanichsetakul P, Lekskulchai O. Effect of pregnancy on urinary functions in Thai nulliparous pregnant women. J Med Assoc Thai 2014; 97 (Suppl. 8): S164–70.
5. Martínez FE, Parés D, Lorente Colomé N et al. Urinary incontinence during pregnancy. Is there a difference between first and third trimester? Eur J Obstet Gynecol Reprod Biol 2014; 182: 86–90.
6. Van Brummen HJ, Bruinse HW, Van de Pol G et al. Bothersome lower urinary tract symptoms 1 year after first delivery: prevalence and the effect of childbirth. BJU Int 2006; 98 (1): 89–95.
7. Glazener CM, Herbison GP, MacArthur C et al. New postnatal urinary incontinence: obstetric and other risk factors in primiparae. BJOG 2006; 113 (2): 208–17.
8. Ebbesen MH, Hunskaar S, Rortveit G, Hannestad YS. Prevalence, incidence and remission of urinary incontinence in women: longitudinal data from the Norwegian HUNT study (EPINCONT). BMC Urol 2013; 13: 27.
9. Hannestad YS, Rortveit G, Hunskaar S. Help-seeking and associated factors in female urinary incontinence. The Norwegian EPINCONT Study. Epidemiology of Incontinence in the County of Nord-Trøndelag. Scand J Prim Health Care 2002; 20 (2): 102–7.
10. Rortveit G, Daltveit AK, Hannestad YS, Hunskaar S. Vaginal delivery parameters and urinary incontinence: the Norwegian EPINCONT study. Am J Obstet Gynecol 2003; 189 (5): 1268–74.
11. Kristiansson P, Samuelsson E, Schoults BV, Srardsudd K. Reproductive hormones and stress urinary incontinence in pregnancy. Acta Obstet Gynecol Scand 2001; 80 (12): 1125–30.
12. Petros P. Urinary incontinence during pregnancy: a function of collagen depolymerisation by relaxin? Eur J Obstet Gynecol Reprod Biol 2015; 186: 111–2.
13. Sayed RF, Morsy MM, Abdel-Azim MS. Anatomy of the urethral supporting ligaments defined by dissection, histology, and MRI of female cadavers and MRI of healthy nulliparous women. AJR Am J Roentgenol 2007; 189: 1145–57.
14. Chaliha C, Bland JM, Monga A et al. Pregnancy and delivery: a urodynamic viewpoint. BJOG 2000; 107: 1354–9.
15. Sibui B, Newton E. The urinary tract in pregnancy. Urogynecol Reconstr Pelvic Surg 2007; 472–90.
16. Harvey MA, Johnston SL, Davies GA. Mid-trimester serum relaxin concentrations and post-partum pelvic floor dysfunction. Acta Obstet Gynecol Scand 2008; 87 (12): 1315–21.
17. Lin G, Ning H, Wang G et al. Effects of birth trauma and estrogen on urethral elastic fibers and elastin expression. Urology 2010; 76 (4): 1018.
18. Jundt K, Scheer I, Schiessl B et al. Incontinence, bladder neck mobility, and sphincter ruptures in primiparous women. Eur J Med Res 2010; 15 (6): 246–52.
19. Van Veelen A, Schweitzer K, Van der Vaart H. Ultrasound assessment of urethral support in women with stress urinary incontinence during and after first pregnancy. Obstet Gynecol 2014; 124 (2 Pt. 1): 249–56.
20. Panayi DC, Khullar V. Urogynaecological problems in pregnancy and postpartum sequelae. Curr Opin Obstet Gynecol 2009; 21 (1): 97–100.
21. Nygaard I, Cruikshank DP. Should all women be offered elective cesarean delivery? Obstet Gynecol 2003; 102 (2): 217–9.
22. Tanawattanacharoen S, Thongtawee S. Prevalence of urinary incontinence during the late third trimester and three months postpartum period in King Chulalongkorn Memorial Hospital. J Med Assoc Thai 2013; 96 (2): 144–9.
23. Rortveit G, Hunskaar S. Urinary incontinence and age at the first and last delivery: the Norwegian HUNT/EPINCONT study. Am J Obstet Gynecol 2006; 195 (2): 433–8.
Авторы
Н.А.Осипова*1, 2, Д.А.Ниаури2, А.М.Гзгзян2, Г.М.Зиятдинова3
1. ФГБУ Северо-Западный федеральный медицинский исследовательский центр Минздрава России. 197341, Россия, Санкт-Петербург, ул. Аккуратова, д. 2;
2. ФГБОУ ВПО Санкт-Петербургский государственный университет. 199034, Россия, Санкт-Петербург, Университетская наб. д. 7/9;
3. СПб ГУЗ Родильный дом №1. 199178, Россия, Санкт-Петербург, В.О., Большой пр., д. 49/51
*naosipova@mail.ru
1. Northwestern federal medical research center of the Ministry of Health of the Russian Federation.
197341, Russian Federation, Saint Petersburg, ul. Akkuratova, d. 2;
2. Saint Petersburg State University. 199034, Russian Federation, Saint Petersburg, Universitetskaia nab., d. 7/9;
3. Saint Petersburg Maternity Hospital No.1, 199178, Russian Federation, Saint Petersburg, V.O., Bolshoi pr., d. 49/51
*naosipova@mail.ru
1. ФГБУ Северо-Западный федеральный медицинский исследовательский центр Минздрава России. 197341, Россия, Санкт-Петербург, ул. Аккуратова, д. 2;
2. ФГБОУ ВПО Санкт-Петербургский государственный университет. 199034, Россия, Санкт-Петербург, Университетская наб. д. 7/9;
3. СПб ГУЗ Родильный дом №1. 199178, Россия, Санкт-Петербург, В.О., Большой пр., д. 49/51
*naosipova@mail.ru
________________________________________________
1. Northwestern federal medical research center of the Ministry of Health of the Russian Federation.
197341, Russian Federation, Saint Petersburg, ul. Akkuratova, d. 2;
2. Saint Petersburg State University. 199034, Russian Federation, Saint Petersburg, Universitetskaia nab., d. 7/9;
3. Saint Petersburg Maternity Hospital No.1, 199178, Russian Federation, Saint Petersburg, V.O., Bolshoi pr., d. 49/51
*naosipova@mail.ru
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