A 37-Year-Old Woman, Gravida 2 Para 1, at 28 Weeks

A 37-year-old woman, gravida 2 para 1, at 28 weeks gestation comes to the office due to leakage of urine.  The patient has had intermittent leakage with cough but no dysuria or hematuria.  She reports normal fetal movement and has had an uncomplicated pregnancy.  Four years ago, the patient had a spontaneous vaginal delivery of a 3500 g (7 lb 11 oz) neonate.  The patient has no chronic medical conditions or prior surgeries.  Vital signs are normal.  Prepregnancy BMI was 32 kg/m².  She has gained 15.8 kg (34.8 lb) during this pregnancy.  The abdomen is gravid, and there is no suprapubic tenderness.  Urinalysis is negative for blood, leukocyte esterase, and nitrite.  Which of the following is the most likely mechanism for this patient's urinary incontinence?

A) Bladder outlet obstruction
B) Detrusor muscle hyperactivity
C) Impaired detrusor contractility
D) Increased intraabdominal pressure
E) Sciatic nerve root compression
F) Ureteral compression

Correct Answer:

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