The diagnostic strength of the 24-h pad test for self-reported symptoms of urinary incontinence in pregnancy and after childbirth

Abstract

The clinical impact of incontinence in pregnancy and after childbirth is growing because some studies report the efficacy of physiotherapy in pregnancy and because obstetric choices are supposed to have significant impact on post-reproductive urinary function (Goldberg et al. in Am J Obstet Gynecol 188:1447-1450, 2003). Thus, the need for objective measurement of urinary incontinence in pregnancy is growing. Data on pad testing in pregnancy are lacking. We assessed the clinical relevance of the 24-h pad test during pregnancy and after childbirth, compared with data on self-reported symptoms of urinary incontinence and visual analogue score. According to the receiver operating characteristic curve, the diagnostic value of pad testing for measuring (severity of) self-reported incontinence during pregnancy is not of clinical relevance. However, for the purposes of research, pad tests, combined with subjective/qualitative considerations, play a critical role in allowing comparisons across studies, quantifying the amount of urine loss and establishing a measure of severity.

Fig. 1

Distribution of 24-h pad test results at 28 and 38 weeks of pregnancy

Fig. 2

ROC curve, the diagnostic value of the pad test at different cutoff levels (g/24 h) for measuring self reported incontinence at 28 (a) and 38 (b) weeks

Fig. 3

Distribution of 24-h pad test results at 6 weeks and 6 months post-partum

Fig. 4

ROC curve, the diagnostic value of the pad test at different cutoff levels (g/24 h) for measuring self-reported incontinence at 6 weeks (a) and 6 months post-partum (b)