OBSTETRIC ASPECTS OF IMPAIRED URINATION IN WOMEN

Objective. To study the rate of impaired urination during pregnancy, to determine the importance of risk factors, and to elaborate an optimal algorithm for examination and treatment. Subjects and methods. A detailed clinical and laboratory examination was made in 140 women with impaired urination at 20 and 32 weeks’ gestational age and 4 months after labor. Group 1 (a study group) comprised 70 patients who received complex behavioral therapy; Group 2 (a comparison group) included 70patients who dismissed behavioral therapy. A control group consisted of 30 healthy pregnant women matched for main parameters. The authors interviewed using a specially designed questionnaire (518 women), used a clinicoanamnestic method, assessed urination diaries, conducted an objective examination including serum relaxin measurements, uroflowmetry, ultrasonography estimating the urethral sphincter area and the urethrovesical angle (alpha angle), and applied statistical methods. Results. During pregnancy, the rate of impaired urination substantially increases; the risk factors are the preexisting disease before current pregnancy; patient age; a history of pregnancies and vaginal deliveries;previous deliveries of relatively higher birthweight neonates, and body mass index. The optimal method for correction of any type of impaired urination during pregnancy is behavioral therapy that reduces its symptoms during pregnancy and after labor by 3 and 1.9 times, respectively. Conclusion. Evaluation of impaired urination in pregnant women is extraordinarily important and allows high risk-group identification. The detailed clinical and laboratory examination of risk group patients makes it possible to reveal the type and degree of impaired urination and to determine its prognosis. Complex behavioral therapy is an optimal method to treat and prevent impaired urination during pregnancy.

pregnancy, impaired urination, risk factors, behavioral therapy