Pregnancy and delivery by a patient with tension-free vaginal tape – case report and literature review
Authors:
K. Sedláková; M. Huser; I. A. Belkov; Petr Janků
Authors place of work:
Gynekologicko-porodnická klinika, LF MU a FN Brno
Published in the journal:
Prakt Gyn 2011; 15(1): 42-46
Category:
Case Report
Summary
Objective:
We present a case report and available medical data and standards for the management of pregnant women with a history of stress urinary incontinence (SUI) treated by tension-free vaginal tape (TVT) insertion. If SUI is treated surgically by TVT and the patient becomes pregnant, it is necessary to individually consider possible ways of delivery. During pregnancy and vaginal delivery in particular, a change in the position of the tape could theoretically occur, causing deterioration of continence; the options for the management of such incontinence are then very limited. Therefore, selection of the appropriate mode of delivery way is important. Literature on the risk of SUI recurrence during pregnancy and delivery after TVT insertion is very scarce. This paper presents a case of 29-year-old woman with TVT, who delivered vaginally without SUI recurrence. This paper further presents available data on this issue and suggestions on how to manage these cases.
Case report:
We describe a case of a young woman with a history of SUI and after the TVT procedure. The patient was monitored in our clinic from her 37th week of pregnancy. She wanted to deliver vaginally. In the 38th week of her pregnancy urological and gynaecological examination was performed and there was no evidence of SUI. Subsequently, considering her wish and after she was informed on the possibility of SUI recurrence, vaginal delivery was agreed upon. The patient later delivered spontaneously without complications. No perineal or vaginal injury was found during delivery and the patient was discharged on day 3 postpartum without any symptoms of SUI. Follow up urological and gynaecological examination 6 weeks after delivery confirmed full urinary continence.
Conclusion:
There is no clear consensus on the mode of delivery after TVT insertion. Elective caesarean section in not absolutely indicated, but it is preferred in the majority of these cases. There is no evidence of protective effects of elective caesarean section on the SUI recurrence risk reduction. Pregnancy is considered a risk factor for SUI recurrence. According to the available literature, vaginal delivery compared to elective caesarean section probably does not increase the risk of SUI recurrence. If there are no symptoms of SUI during pregnancy, vaginal delivery is possible, although most gynaecologists are more likely to prefer caesarean section.
Key words:
stress urinary incontinence – tension-free vaginal tape – caesarean section – pregnancy – delivery
Zdroje
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Štítky
Paediatric gynaecology Gynaecology and obstetrics Reproduction medicineČlánok vyšiel v časopise
Practical Gynecology
2011 Číslo 1
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