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Q. Urinary incontinence,the well known complications of forceps delivery

Answered by
Dr. Megha Tuli Gupta
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Dec 26, 2017 and last reviewed on: Oct 09, 2018

Hi doctor,

Nine months ago, my wife delivered a baby boy. It was a forceps delivery at the eleventh hour after observing for nearly 20 hours for normal delivery. The doctors did not inform us it will be a forceps delivery till last minute. Now, the baby is normal. But, my wife is facing urine inconsistency issues. Before and during pregnancy other than her sinusitis everything was normal. Initially as per the advice of urogynaecologist she had medication to check the progress. Later she was referred to an urologist and she was given Urivoid medicine. We have told the doctor that she is not able to take all antibiotics. Still she was insisted to take Urivoid (half in the morning and half at night) and after that she had suffered with all side effects like vomiting, drowsiness and fever. They had done urodynamics, uroflowmetry, abdominal scan, x-ray, etc., but unable to figure out the cause of the issue.

Later on we went to a well-known hospital for sudden chill and fever. After a week of observation she got discharged. Senior general physician had recommended us to check the issue with their doctors (gynaecologist and urologist) and they have suggested to undergo one observation test where in they will pass a liquid by giving anesthesia to her in an operation theater and observe her for an hour how the urine is passing through her body and is there any leak in her urinary system or not. Doctor advised us to come after 1-2 months once she becomes fit and normal. My doubts are can I go ahead and perform this test? Will this test will be really beneficial? Will it help to figure out the actual issue? Do we have any other method of evaluation or test to figure out the issue? I heard that there will be complication if a baby is born with forceps delivery. Can you please guide and help me on how to identify the future risk and how to overcome this.

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Hi,

Welcome to icliniq.com.

I went through your query. I totally understand the problem.

It is not a very frequent but a well known complication of forceps. I am really sorry to know your wife is suffering from urinary incontinence. I know it is an agonizing problem.

Urinary incontinence is of three types. From your history I have not been able to make out exactly which type of problem she has.

Does she leak urine continuously? Or not able to hold urine while coughing or laughing? The type of her problem will give me an idea as to the exact cause of her problem.

Also, I would like to inform you that decision of forceps delivery is usually made at the very end only. There is no way to predict exactly when and which patient will need it. So, do not think your doctor could have prevented this complication. It is a sorry event but there was no way of knowing that this is going to happen.

The medicine Urivoid (Bethanechol chloride) is a good medicine to treat the condition your wife has. Also the tests advised are a good way to detect the site of obstruction or leakage in the urinary system.

This test will differentiate if there is any abnormal communication in the urinary system also known as fistula in medical terms. This is what I was referring to as the different types of incontinence.

A fistula will show as a continuous and slow leakage of urine. Whereas episodic incontinence like while coughing or lifting heavy weights will show as abnormal uroflow studies which you say are normal. Only in the second type of problem the Urivoid will work.

Revert back with the answers for the above questions to an obstetrician and gynaecologist online --> https://www.icliniq.com/ask-a-doctor-online/obstetrician-and-gynaecologist

Hi doctor,

She is suffering from continuous leakage (fistula). It is leaking continuously and we are using carefree pads to manage. Can you explain the complications or issues in new born forceps baby? How to identify it? How can we plan precautions for minimizing the risks associated with the forceps delivery? Please help doctor.

#

Hi,

Welcome to icliniq.com.

Fistula problem is most dreaded complication of forceps. Other complications can be constant perineal pain, painful intercourse, bladder and bowel incontinence, weakening of the pelvic muscles which in long term can cause bladder or bowel prolapse through vagina.

The last one is again a very difficult and agonizing problem and would feel like a constant dragging sensation in the pelvis and eventually one will be able to see a mass (bladder) coming out through the vagina.

You can prevent this condition if you work on it from the beginning. There are pelvic muscle exercises known as Kegel exercise to help in this situation.

As for the fistula, it is very difficult to treat the condition. But I am sorry no medication will work for her if it is a fistula.

Your only mode of cure is a surgery, but let me warn you that depending on the site and size of the fistula the prognosis or success rate of the surgery shall depend.

  • In forceps delivery, the fistula usually will be present in the lower aspect of the urethra. But size of the fistula is very important. The larger the size, more likely the surgery is to fail.
  • I have personally consulted so many post forceps fistulas which have responded well to surgery but there are cases which recurrently fail even after two to three operations.
  • I am deeply concerned about your wife, as I can understand the agony she must be facing daily.
  • The tests advised for finding the site of leak is not very necessary in my opinion. Get them done if the site is not localized by examination alone. Visit a good specialist of urogynaecology and he/she should be able to find the site by examination alone or there are more simpler OPD (Outpatient department) tests available to find the site before you go for those expensive and extensive tests.

For further information consult an obstetrician and gynaecologist online --> https://www.icliniq.com/ask-a-doctor-online/obstetrician-and-gynaecologist


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