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Li L, Chen Q, Li H, Yi S. Risk factors for postpartum urinary retention: An updated systematic review and meta-analysis. Int J Gynaecol Obstet 2024. [PMID: 39049607 DOI: 10.1002/ijgo.15802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 06/14/2024] [Accepted: 07/06/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND There are conflicting reports on the factors that increase the likelihood of postpartum urinary retention (PUR). OBJECTIVES We completed an updated systematic review and meta-analysis to identify the risk factors for PUR. SEARCH STRATEGY An exhaustive search of the literature was undertaken using multiple databases, including PubMed, Web of Science, the Cochrane Library, and Embase to identify pertinent studies published up until November 4, 2023. SELECTION CRITERIA Observational studies that provided outcomes to calculate the risk factors for PUR were included. DATA COLLECTION AND ANALYSIS Two investigators separately performed the extraction of pertinent data from the articles. The risk factors for PUR were identified by pooling adjusted and unadjusted odds ratios (ORs) and 95% confidence intervals (CIs). Heterogeneity test, sensitivity analysis, and publication bias assessment were performed. MAIN RESULTS This meta-analysis included 21 studies with a total of 36 951 participants. Meta-analysis was performed for 14 risk factors, and eight of these were statistically significant. The risk factors that were identified in this review included instrumental delivery (OR, 2.96 [95% CI, 1.82-4.80]; 95% prediction interval [PI], 0.67-12.98), relatively long duration of labor (OR, 1.04 [95% CI, 1.02-1.06]; 95% PI, 1.00-1.08), episiotomy (OR, 1.56 [95% CI, 1.19-2.06] 95% PI, 0.64-3.83), nulliparity (OR, 1.55 [95% CI, 1.30-1.84]; 95% PI, 0.94-2.77), epidural analgesia (OR, 2.99 [95% CI, 1.78-5.03]; 95% PI, 0.53-16.76), labor augmentation (OR, 2.21 [95% CI, 1.49-3.28]; 95% PI, 0.12-39.26), labor induction (OR, 1.73 [95% CI, 1.12-2.66]; 95% PI, 0.40-7.39), and perineal injury (OR, 2.75 [95% CI, 1.95-3.89]; 95% PI, 1.10-6.92). CONCLUSION Instrumental delivery, extended labor duration, episiotomy, nulliparity, epidural analgesia, labor augmentation/induction, and perineal injury are significant risk factors for PUR. The findings could help physicians identify patients at risk in the postpartum setting.
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Affiliation(s)
- Li Li
- Department of Gynecology and Obstetrics, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Qin Chen
- Department of Gynecology and Obstetrics, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Hongyu Li
- Department of Gynecology and Obstetrics, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Shuhua Yi
- Department of Gynecology and Obstetrics, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
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Hosakoppal S, Brown O, Peaceman A. Postpartum urinary retention after the institution of a universal voiding protocol. J Matern Fetal Neonatal Med 2022; 35:10199-10205. [PMID: 36093850 PMCID: PMC9691574 DOI: 10.1080/14767058.2022.2122800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/23/2022] [Accepted: 07/29/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Postpartum urinary retention is a frequently occurring condition for which screening is not typically a standardized part of postpartum care. The aim of this study was to determine the incidence of and risk factors for postpartum urinary retention after the introduction of a universal postpartum voiding protocol. METHODS This was a single-center retrospective case-control study of women delivering in a 12-month period. Women with a documented diagnosis of postpartum urinary retention per the institution's voiding protocol were classified as cases, and a matched sample of those without urinary retention were controls. Demographic and obstetric characteristics were compared between both groups using univariate and multivariate analyses as a means to identify risk factors for postpartum urinary retention. RESULTS 8992 women were studied during the time period examined; 195 (2.2%) were identified to have postpartum urinary retention. On multivariate logistic regression analysis, operative vaginal delivery (aOR 2.98 95% CI 1.32-6.70) and second-degree or greater perineal laceration (aOR 2.83 CI 1.59-5.04) were significantly associated with postpartum urinary retention. CONCLUSIONS The incidence of postpartum urinary retention with a postpartum voiding protocol in place was low. Risk factors identified for urinary retention included operative vaginal delivery and second degree or greater perineal laceration. Awareness of these risk factors and implementation of standardized voiding protocols may aid with the early identification and prevention of postpartum urinary retention.
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Affiliation(s)
- Shweta Hosakoppal
- Northwestern University Feinberg School of Medicine. Chicago, Illinois, USA
| | - Oluwateniola Brown
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University. Chicago, Illinois, USA
| | - Alan Peaceman
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Northwestern University. Chicago, Illinois, USA
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Yoshida A, Yoshida M, Kawajiri M, Takeishi Y, Nakamura Y, Yoshizawa T. Prevalence of urinary retention after vaginal delivery: a systematic review and meta- analysis. Int Urogynecol J 2022; 33:3307-3323. [PMID: 35689691 DOI: 10.1007/s00192-022-05256-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/24/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Postpartum urinary retention requires timely detection and intervention as late detection can lead to long-term voiding dysfunction; however, trends in the prevalence of urinary retention during the postpartum period remain unclear. This systematic review and meta-analysis aimed to estimate the pooled overall prevalence of overt and covert urinary retention in women after vaginal delivery and the difference in prevalence within 4 days after delivery. METHODS MEDLINE, CINAHL, Ichu-shi web, and J-stage databases were searched up until October 2020. Two researchers screened and included observational studies reporting the prevalence of urinary retention up to 4 days postpartum based on inclusion criteria. The overall prevalence of overt and covert urinary retention was calculated. RESULTS From 24 studies, the overall overt and covert urinary retention prevalence rates were estimated to be 1% and 13%, respectively. The prevalence of overt urinary retention over time was 2% at 6 h postpartum, 1% at 6-12 h, and 3% from postpartum to 24 h postpartum. The prevalence of covert urinary retention over time was 19% (6 h postpartum), 15% (24 h postpartum), 11% (1 day postpartum), 7% (2 days postpartum), 8% (3 days postpartum), and 0.1% (4 days postpartum). CONCLUSIONS By postpartum day 4 after vaginal delivery, 14% of women were found to have experienced urinary retention. The highest prevalence was observed at 6 h postpartum, suggesting that urinary retention could be identified at 6 h postpartum.
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Affiliation(s)
- Akari Yoshida
- Department of Women's Health Nursing & Midwifery, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 9808575, Japan
| | - Mikako Yoshida
- Department of Women's Health Nursing & Midwifery, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 9808575, Japan.
| | - Maiko Kawajiri
- Department of Women's Health Nursing & Midwifery, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 9808575, Japan
| | - Yoko Takeishi
- Department of Women's Health Nursing & Midwifery, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 9808575, Japan
| | - Yasuka Nakamura
- Department of Women's Health Nursing & Midwifery, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 9808575, Japan
| | - Toyoko Yoshizawa
- Department of Women's Health Nursing & Midwifery, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 9808575, Japan
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Stairs J, Rolnik DL, Pascali D, Clancy A. Association between obstetrical anal sphincter injury and postpartum urinary retention: a contemporary nationwide cohort study. Int Urogynecol J 2022; 33:3473-3479. [PMID: 36098789 DOI: 10.1007/s00192-022-05346-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 08/12/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Identification and prompt management of postpartum urinary retention after vaginal birth is essential to minimize long-term morbidity. Obstetrical anal sphincter injuries (OASIS) have been identified as a possible risk factor for urinary retention. The objective of this study was to estimate the association between OASIS and postpartum urinary retention and compare the length of hospital stay and cost of admission between postpartum patients who experienced urinary retention and those who did not. METHODS We conducted a population-based, retrospective cohort study of pregnant individuals delivering singleton fetuses via vaginal birth in the United States using the National Inpatient Sample (NIS) database. Multivariate logistic regression models were used to estimate the odds ratio (OR) for the association between OASIS and postpartum urinary retention. Simple linear regression was used to compare means. RESULTS A total of 2,013,052 delivery admissions were included, which was representative of a population size of 10,065,253 utilizing the complex sampling design of the NIS database. 47,192 (2.34%) admissions sustained OASIS and 5,339 (0.27%) admissions experienced overt urinary retention. After adjusting for potential confounders, vaginal deliveries where OASIS occurred had 3.60 times the odds of postpartum urinary retention compared with vaginal deliveries where OASIS was not sustained (95% CI 3.26-3.97). Postpartum urinary retention was associated with an increased mean length of stay (2.94 vs 2.28 days, p<0.001) and 1.37 times the mean total cost of admission (US$22,946.38 vs US$16,758.85, p<0.001). CONCLUSIONS Obstetrical anal sphincter injuries are associated with increased odds of postpartum urinary retention compared with vaginal deliveries where OASIS did not occur.
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Affiliation(s)
- Jocelyn Stairs
- Department of Obstetrics and Gynecology, Dalhousie University, 5850/5980 University Avenue, P.O. Box 9700, Halifax, NS, B3K 6R8, Canada. .,Division of Urogynaecology, Department of Obstetrics and Gynaecology, The Ottawa Hospital, Ottawa, ON, Canada.
| | - Daniel L Rolnik
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - Dante Pascali
- Division of Urogynaecology, Department of Obstetrics and Gynaecology, The Ottawa Hospital, Ottawa, ON, Canada
| | - Aisling Clancy
- Division of Urogynaecology, Department of Obstetrics and Gynaecology, The Ottawa Hospital, Ottawa, ON, Canada
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Kamarudin M, Chong WK, Hamdan M, Adlan AS, Saaid R, Tan PC. Micturition in the toilet compared with bedpan in laboring Nulliparas: a randomized controlled trial. BMC Pregnancy Childbirth 2022; 22:812. [PMCID: PMC9635173 DOI: 10.1186/s12884-022-05162-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
Abstract
Background
Bladder overdistension in labor may lead to prolonged postpartum urinary retention. We hypothesized that nulliparas mobilizing to toilet is more likely to achieve satisfactory micturition.
Methods
One hundred sixteen (58 in each arm) term nulliparas in labor with filled bladders were randomized to mobilizing to the toilet or using bedpan to micturate. Primary outcome was satisfactory micturition defined as ultrasound derived post-void bladder volume < 150 ml. Following unsatisfactory micturition, participants crossover to the opposed intervention. Participants were catheterized if after crossover, residual bladder volume was ≥250 ml.
Results
Satisfactory micturition rates were 55/58 (95%) vs. 43/58 (74%) RR 1.28 95%CI 1.08–1.51 NNTb 4.8 95%CI 3.0–12.4 P = 0.008, failure to micturate 1/58 (2%) vs. 8/58 (14%) RR 0.13 95%CI 0.02–0.97 NNTb 8.3 95%CI 4.6–38.7 P = 0.047. After cross over following unsatisfactory bladder voiding, satisfactory micturition rates were 0/3 (0%) vs 13/15 (87%) P = 0.024, bladder catheterization rates were 3/58 (5%) vs. 2/58 (4%) RR 95%CI 1.5 (0.26–8.65) P = 0.648, maternal satisfaction with allocated intervention 55/58 (95%) vs. 9/58 (16%) RR 95%CI 6.1 (3.3–11.2) NNTb 95%CI 1.3 (1.1–1.5) P < 0.0001 and preference for mobilizing to the toilet if micturition was needed again during labor 55/58 (95%) vs. 53/58 (92%) for mobilizing to the toilet compared to bedpan use arms respectively. Labor and neonatal outcomes were similar.
Conclusion
Satisfactory micturition was more frequently achieved with mobilization to the toilet than bedpan use. Women in both arms overwhelmingly prefer to mobilize to the toilet to urinate.
Trial registration
This study was registered with ISRCTN on 17/07/2019 with trial identification number: ISRCTN17787339. First participant was recruited on 31/07/2019. The last patient was recruited on 18/12/2019.
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Divakova O, Panayi D, Khan Z, Doumouchtsis SK. A rapid systematic review of postpartum bladder care guidelines and recommendations in the context of the COVID-19 pandemic. J OBSTET GYNAECOL 2022; 42:2634-2642. [PMID: 36222025 DOI: 10.1080/01443615.2022.2126751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
New pathways for the management of postpartum voiding dysfunction and postpartum urinary retention should be considered to shorten hospital stays and promote early discharge during the COVID-19 pandemic. This rapid systematic review aimed to identify relevant national and international guidelines, and summarise available recommendations on postpartum bladder care that are relevant to women's care and management at the time of the pandemic. We searched Medline, Embase and Cochrane from inception till September 2021. Hand-searching of national and international specialist societies' websites was performed. We identified one international technical consultation, one international society's report of recommendations and two national guidelines. Guidelines stated that postnatal women should not be left more than 6 hours without voiding and assessed for postpartum urinary retention. As the cut-off of 150 ml for the diagnosis of significant postvoid residual volume is commonly used with no reported adverse outcomes, it could be beneficial to adopt this instead of 100 ml as further unnecessary interventions can be avoided. Such changes can reduce the number of women staying in the hospital. Clean intermittent self-catheterisation for the management of postpartum urinary retention could be considered as an option during the COVID-19 pandemic aiming to shorten hospital stays and avoid further attendances. Optimised bladder care has become more relevant during the coronavirus pandemic by striving towards self-care, community-based and remote care. We propose consideration of intermittent self-catheterisation in cases of postpartum urinary retention enabling self-care and avoidance of hospital visits.
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Affiliation(s)
- Olga Divakova
- Epsom and St Helier University Hospital NHS Trust, St Helier Hospital, Department of Obstetrics and Gynecology, Carshalton, UK
| | - Demetri Panayi
- Epsom and St Helier University Hospital NHS Trust, St Helier Hospital, Department of Obstetrics and Gynecology, Carshalton, UK
| | - Zainab Khan
- Epsom and St Helier University Hospital NHS Trust, St Helier Hospital, Department of Obstetrics and Gynecology, Carshalton, UK
| | - Stergios K Doumouchtsis
- Department of Obstetrics and Gynaecology, Epsom and St Helier University Hospitals NHS Trust, Epsom, UK
- St Helier Hospital, Department of Obstetrics and Gynecology, Carshalton, UK
- Laboratory of Experimental Surgery and Surgical Research N. S. Christeas, National and Kapodistrian University of Athens, Medical School, Athens, Greece
- St George's University of London, London, UK
- School of Medicine, American University of the Caribbean, Pembroke Pines, Florida, USA
- School of Medicine, Ross University, Miramar, FL, USA
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Covert postpartum urinary retention: causes and consequences (PAREZ study). Int Urogynecol J 2022; 33:2307-2314. [PMID: 35716199 PMCID: PMC9206215 DOI: 10.1007/s00192-022-05278-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/03/2022] [Indexed: 11/17/2022]
Abstract
Introduction and hypothesis Increased post-voiding residual volume (PVRV), known as covert postpartum urinary retention (PUR), is an asymptomatic condition with unknown long-term adverse effects. The objectives were to determine the frequency of this phenomenon 3 days after delivery and to examine the associated risk factors and consequences of the increased residuum on women´s health 6 weeks postpartum. Methods We carried out a prospective observational study including a total of 926 primiparous women, giving birth to singletons. All participants underwent ultrasound determination of PVRV on day 3 postpartum. Then, risk factors were determined using logistic regression analysis. After 6 weeks, participants were invited to return for PVRV determination and to complete urogynecological and general health questionnaires. Using these data, the consequences of increased PVRV were determined. Results A total of n=90 women were diagnosed with abnormal PVRV. Mean age in the studied population was 30.4 years, BMI prior to delivery 27.8, weight of the newborn 3,420 g, and percentage of cesarean sections 15.9%. Gestational week (p=0.043), vaginal tear (p=0.032), and induction of labor (p=0.003) were risk factors for covert PUR. Puerperal incidence of urinary tract infection was 1.1% (6 out of 526) and of urinary incontinence 29.2% (155 out of 530), with no differences between the groups. In the second examination, covert PUR was no longer present, and the values of residual urine decreased for all patients in the case group. No statistically significant differences were observed in questionnaire scores in general health and wellbeing perceptions between the groups. Conclusions We have found a few significant obstetrical–pediatric risk factors for abnormal PVRVs. Data from the follow-up suggest that covert PUR has no impact on morbidity and quality of life 6 weeks postpartum. Therefore, abnormal PVRV is a self-limited phenomenon with a tendency toward self-correction. Our findings support those of previous studies that advocate against screening for asymptomatic retention in the postpartum period, despite some similar previous recommendations.
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Yetişkin G, Dinç Kaya H. The effect of pelvic floor muscle exercises applied during pregnancy on genito-pelvic pain level in postpartum period. Int Urogynecol J 2022; 33:2791-2799. [PMID: 35678835 DOI: 10.1007/s00192-022-05225-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 04/25/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The goal of the study is to determine the effect of pelvic floor muscle exercises on genito-pelvic pain levels during the postpartum period. METHODS The data of the study, which was carried out in a randomized controlled experimental design, were collected in the antenatal policlinic of a public hospital from June-December 2019. There were 60 pregnant women in the experimental and control groups. Pelvic floor muscle exercises were applied to the pregnant women in the experimental group from the 30th week of gestation to the 6th week postpartum. The control group was not given pelvic floor muscle exercise training, and only data collection forms were filled in. During the study, the Descriptive Form, Verbal Category Scale, Pelvic Floor Distress Inventory-20, and Labour and Postpartum Information Form were given to the pregnant women in both groups. RESULTS After pregnant women in the experimental group performed pelvic floor muscle exercises, pain levels were significantly lower than in the control group (p < 0.01). Pelvic Floor Distress Inventory-20 total score and sub-dimension scores of the experimental group were statistically significantly lower than in the control group (p < 0.01). In addition, a statistically significant difference was found (p < 0.01) in the postpartum 72 h findings of the experimental group in which pelvic floor muscle exercises were applied compared to the control group. CONCLUSIONS According to the result of the study, as the gestational weeks progress, the genito-pelvic pain increases. Pelvic floor muscle exercises applied during pregnancy prevent the development and progression of pelvic floor disorders in both the antenatal and postnatal periods. TRIAL REGISTRATION NCT05343520.
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Affiliation(s)
| | - Hüsniye Dinç Kaya
- Faculty of Health Sciences Department of Midwifery, Istanbul University-Cerrahpasa, Istanbul, Turkey.
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Postpartum urinary retention: what are the sequelae? A long-term study and review of the literature. Int Urogynecol J 2022; 33:1601-1608. [PMID: 35129645 PMCID: PMC9206615 DOI: 10.1007/s00192-021-05074-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/18/2021] [Indexed: 10/31/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Postpartum urinary retention (PUR) may cause long-term urogenital tract morbidity. The incidence ranges from 0.18 to 14.6%, but the importance of prompt diagnosis and appropriate management is often underappreciated. The paucity of data on long-term outcome after PUR contributes to these drawbacks. The aim of this study was to assess long-term persistence of elevated PVR (post-void residual urine) volume after PUR. Pathophysiology, risk factors and management of PUR are reviewed. METHODS In our tertiary referral urogynecology unit in the University Women's Hospital of Bern, Switzerland, all patients who were referred for PUR were asked to participate in this study. PVR was measured sonographically every 2 days until day 15, then after 6, 12, 24 and 36 months and, if increased, the patients were instructed to perform clean intermittent self-catheterization. If retention persisted longer than the lactation period, multichannel urodynamics was performed. RESULTS Sixty-two patients were included. The median PVR normalized at day 7. Long-term voiding disorders were found in 8.2%, 6.7%, and 4.9% after 1, 2, and 3 years respectively. Multichannel urodynamics confirmed in all patients with persisting retention an acontractile detrusor and de novo stress urinary incontinence in 4 cases. Quantile regression did not reveal any factor contributing to earlier recovery. Eighty-nine percent of the patients with PUR had operative vaginal deliveries, emphasizing the importance of this risk factor for PUR. CONCLUSIONS In most cases PUR resolves early, but voiding difficulties persist more often than previously thought, and for these patients the consequences are devastating. Obstetric awareness, early active management, and developing management strategies in the postpartum period might preclude lower urinary tract morbidity.
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Cao D, Rao L, Yuan J, Zhang D, Lu B. Prevalence and risk factors of overt postpartum urinary retention among primiparous women after vaginal delivery: a case-control study. BMC Pregnancy Childbirth 2022; 22:26. [PMID: 35016631 PMCID: PMC8751131 DOI: 10.1186/s12884-021-04369-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 12/27/2021] [Indexed: 11/10/2022] Open
Abstract
Background Postpartum urinary retention (PUR) may lead to bladder neuromuscular damage and subsequently voiding dysfunction. However, the literature regarding the incidence of and risk factors for PUR remains unclear. Moreover, previously reported studies are limited to small sample sizes. Thus, this study aimed to assess the incidence of and risk factors for overt PUR after vaginal delivery. Methods This retrospective case-control study included all primiparas who delivered vaginally between July 1, 2017, and June 30, 2019, at our institution. The case group comprised 677 women diagnosed with overt PUR who required catheterisation after delivery. The control group comprised 677 women without overt PUR randomly selected in a 1:1 ratio matched for date of delivery and who delivered immediately after each woman with overt PUR to minimise the impact of variations over time in obstetric practice. Univariate and multivariate logistic regression analyses were performed to investigate the factors associated with overt PUR. Results Of the 12,609 women included in our study, 677 were diagnosed with overt PUR (incidence 5.37%). Univariate analysis identified epidural analgesia, episiotomy, perineal tears, instrument-assisted delivery, duration of labour stage, intrauterine operation, and vulvar oedema as risk factors for PUR. Multivariate logistic regression identified epidural analgesia (odds ratio [OR] = 1.41, 95% confidence interval [CI]: 1.11–1.79, P = 0.005), vulvar oedema (OR = 6.92, 95% CI: 4.65–10.31, P < 0.001), forceps delivery (OR = 8.42, 95% CI: 2.22–31.91, P = 0.002), episiotomy (OR = 1.37, 95% CI: 1.02–1.84, P = 0.035), and second-degree perineal tear (OR = 3.42, 95% CI: 2.37–4.94, P < 0.001) as significant independent risk factors for PUR. Conclusions PUR was highly associated with epidural analgesia, forceps delivery, vulvar oedema, episiotomy, and second-degree perineal tears. More attention should be paid to women at high risk to reduce the incidence of PUR.
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Paola DR, Noemi G, Valeria B, Lorena C, Manara DF, Giulia V. Risk factors and management of postpartum urinary retention: A scoping review. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2022. [DOI: 10.1111/ijun.12309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- De Rosa Paola
- Nursing and Midwifery Sciences University of Parma Parma Italy
| | | | | | | | - Duilio Fiorenzo Manara
- Center for Nursing Research and Innovation Vita‐Salute San Raffaele University Milan Italy
| | - Villa Giulia
- Center for Nursing Research and Innovation Vita‐Salute San Raffaele University Milan Italy
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HE H, ZHANG SK, GAO WB, LIU Y, SHEN WJ, TAN ZD. Electroacupuncture for postpartum urinary retention: A randomized controlled study. WORLD JOURNAL OF ACUPUNCTURE-MOXIBUSTION 2021. [DOI: 10.1016/j.wjam.2021.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Napoe GS, Adjei NN, Cooper AC, Raker CA, Korbly NB. Postpartum urinary retention: a survey of obstetrics and gynaecology residents in the United States. J OBSTET GYNAECOL 2020; 40:1118-1121. [PMID: 32068448 DOI: 10.1080/01443615.2019.1706159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Postpartum urinary retention (PUR) is a common and potentially morbid condition if not recognised and managed promptly. We surveyed obstetrics and gynaecology (OBGYN) residents to determine residents' knowledge of the management of PUR. A total of 168 OBGYN residents in ACGME accredited programmes in the United States completed the survey. A percentage of 30.3 reported having a PUR prevention protocol at their institution, 43.3% reported not having a protocol and 26.7% did not know whether a protocol existed. About 89.3% of participants reported having previously taken care of a patient with PUR and 17.1% reported prior formal teaching on the management of PUR. Those who reported having a protocol were more likely to report feeling comfortable managing PUR. Overall, knowledge was low for management of PUR. Given the potential morbidity associated with inadequate management of PUR, formal education and standardisation through national guidelines may help improve care of patients with PUR.Impact statementWhat is already known on this subject? PUR is a common condition and if left untreated may lead to long-term impacts on patients' health. Early recognition of the condition and appropriate management can prevent these complications. Protocols have been shown to improve patient outcomes. Thus, it has been postulated that the implementation of protocols could improve recognition of the condition.What do the results of this study add? No previous studies have looked at the impact of PUR management protocols on physicians in training. Because physicians in training are often the first-in-line to manage patients at academic institutions, we sought to determine the proportion of obstetrics and gynaecology residents in the United States who report having a PUR management protocol at their institution and how this impacts their reported comfort at caring for patients with PUR, knowledge on PUR risk factors and recognition of scenarios concerning for PUR. While awareness of a PUR protocol did not lead to increased knowledge of risk factors or increased recognition of scenarios concerning for PUR, it did increase resident comfort with managing PUR patients. We also found that overall PUR knowledge was low.What are the implications of these findings for clinical practice and/or further research? Based on our findings, OBGYN residents would benefit from having protocols at their institutions since it increased their comfort at managing patients with PUR. Further, formal education on PUR is likely needed to improve knowledge of risk factors and recognition of scenarios concerning for PUR.
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Affiliation(s)
- Gnankang Sarah Napoe
- Department of Obstetrics and Gynecology, Division of Urogynecology and Reconstructive Pelvic Surgery, Women and Infants Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Naomi N Adjei
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale New Haven Hospital, New Haven, CT, USA
| | - Anne C Cooper
- Department of Obstetrics and Gynecology, Division of Urogynecology and Reconstructive Pelvic Surgery, Women and Infants Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Christine A Raker
- Department of Obstetrics and Gynecology, Division of Research, Women and Infants Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Nicole B Korbly
- Department of Obstetrics and Gynecology, Division of Urogynecology and Reconstructive Pelvic Surgery, Women and Infants Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
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Barba M, Frigerio M, Manodoro S, Bernasconi DP, Cola A, Palmieri S, Fumagalli S, Vergani P. Postpartum urinary retention: Absolute risk prediction model. Low Urin Tract Symptoms 2020; 13:257-263. [PMID: 33118328 DOI: 10.1111/luts.12362] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/08/2020] [Accepted: 10/12/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the incidence and assess clinical factors that can predict the occurrence of postpartum urinary retention (PPUR). PPUR is a puerperal condition defined as the inability to void over 6 hours after birth or after catheter removal in case of cesarean section, requiring catheterization. Lack of prompt diagnosis of this condition may lead to severe sequelae, including infection, chronic voiding difficulties, and renal failure. METHODS This retrospective cohort study analyzed all deliveries from January 2011 to December 2017 in a single Italian university hospital. We used multivariate logistic regression to develop a predictive score for PPUR. RESULTS By multivariate logistic regression, our analysis shows as minor (odds ratio [OR] < 2) risk factors for PPUR: non-Caucasian ethnicity (OR = 1.46, CI = 1.05-2.03), nulliparity (OR = 1.47, CI = 1.01-2.14), body mass index (BMI) at the end of the pregnancy <30 kg/m2 (OR = 1.54, CI = 1.10-2.17). On the other hand, epidural analgesia (OR = 3.93, CI = 2.96-5.22), meconium-stained amniotic fluid (OR = 2.07, CI = 1.54-2.77), nonoperative vaginal birth vs cesarean section (OR = 6.25, CI = 2.16-18.13), vacuum extraction vs cesarean section (OR = 8.80, CI = 2.86-27.01), pushing stage ≥60 minutes (OR = 3.00,CI = 2.26-3.97), and perineal tear (OR = 2.87, CI = 1.86-4.43) proved to be major (OR > 2) risk factors for PPUR. Using our final model (area under curve = 0.84), we created a nomogram for PPUR absolute risk calculation. Specifically, a 116-point cutoff might be used to identify high-risk patients who deserve more intensive micturition monitoring. CONCLUSIONS Our study identified non-Caucasian ethnicity, nulliparity, and a BMI <30 kg/m2 at the end of the pregnancy as minor and epidural analgesia, meconium-stained amniotic fluid, vaginal nonoperative birth, vacuum extraction, pushing stage ≥60 minutes, and perineal tear as major independent risk factors for PPUR.
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Affiliation(s)
- Marta Barba
- University of Milano-Bicocca, ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Matteo Frigerio
- University of Milano-Bicocca, ASST Monza, San Gerardo Hospital, Monza, Italy
| | | | | | - Alice Cola
- University of Milano-Bicocca, ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Stefania Palmieri
- University of Milano-Bicocca, ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Simona Fumagalli
- University Milano-Bicocca, Monza and Brianza Mother and Child Foundation, San Gerardo Hospital, Monza, Italy
| | - Patrizia Vergani
- University Milano-Bicocca, Monza and Brianza Mother and Child Foundation, San Gerardo Hospital, Monza, Italy
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Li Q, Zhu S, Xiao X. The risk factors of postpartum urinary retention after vaginal delivery: A systematic review. Int J Nurs Sci 2020; 7:484-492. [PMID: 33195762 PMCID: PMC7644563 DOI: 10.1016/j.ijnss.2020.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 07/24/2020] [Accepted: 09/01/2020] [Indexed: 12/02/2022] Open
Abstract
Objectives This review aimed to explore the independent risk factors of postpartum urinary retention (PUR) after a vaginal delivery. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was followed and relevant studies were retrieved from eleven databases. The quality of the included articles was assessed using Critical Appraisal Skills Programme tools or the Appraisal tool for Cross-Sectional Studies. The data analysis was performed using Review Manager version 5.3. Results A total of nine articles were included and five risk factors were identified, namely, episiotomy (OR = 2.99, 95%CI = 1.31–6.79, P = 0.009), epidural analgesia (OR = 2.48, 95%CI = 1.09–5.68, P = 0.03), primiparity (OR = 2.17, 95%CI = 1.06–4.46, P = 0.03), instrumental delivery (OR = 4.01, 95%CI = 1.97–8.18, P < 0.001), and the duration of the second stage of labor (MD = 15.24, 95%CI = 11.20–19.28, P < 0.001). However, fetal birth weights of more than 3800 g were not identified as an independent risk factor (MD = 64.41, 95%CI = −12.59 to 141.41, P = 0.10). Conclusion This systematic review indicated that the independent risk factors for PUR were found to include episiotomy, epidural analgesia, instrumental delivery, primiparity, and a longer second stage of labor. In clinical practice, healthcare providers could pay more attention to women with these factors and prevent postpartum urinary retention.
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Affiliation(s)
- Qiaomeng Li
- Obstetric Department, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong, China
| | - Shening Zhu
- Nursing Department, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong, China
| | - Xiao Xiao
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Outpatient Department Shenzhen, Guandong, China
- Corresponding author.
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EDITORIAL COMMENT. Urology 2020; 143:101-102. [PMID: 32862940 DOI: 10.1016/j.urology.2020.03.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 03/24/2020] [Indexed: 11/21/2022]
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Gupta A, Pampapati V, Khare C, Murugesan R, Nayak D, Keepanasseril A. Postpartum urinary retention in women undergoing instrumental delivery: A cross-sectional analytical study. Acta Obstet Gynecol Scand 2020; 100:41-47. [PMID: 32652531 DOI: 10.1111/aogs.13954] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/30/2020] [Accepted: 07/04/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Women undergoing instrumental delivery are known to be at higher risk of urinary retention, which can lead to long-term complications such as voiding dysfunction. Nulliparous women undergo a pronounced and sudden change in the perineum due to stretching during delivery, which may add to the perineal trauma from an episiotomy, increasing the risk of urinary retention. We aim to study the incidence and risk factors associated with postpartum urinary retention in women undergoing instrumental delivery. MATERIAL AND METHODS Pregnant women who had an instrumental delivery after 37 weeks of gestation at JIPMER, Puducherry, India, between January 2017 and June 2017 were included in the study. Postpartum urinary retention was defined as the inability to void spontaneously or ultrasonographic documentation of post-void residual volume of >150 mL, 6 hours after delivery. Demographic factors, clinical profile and follow-up of these patients were noted. Multivariate logistic regression analysis was performed to assess the risk factors associated with urinary retention and was presented as adjusted odds ratios (OR) with 95% confidence intervals (CI). RESULTS Postpartum urinary retention was noted in 124 (20.6%) women undergoing instrumental delivery. Overt and covert urinary retention occurred in 2.3% and 18.3%, respectively. After adjusting for other risk factors, nulliparity (adjusted OR = 4.05, 95% CI 2.02-8.12 compared with multiparity) and prolonged second stage (OR = 3.96, 95% CI 1.53-10.25) compared with suspected fetal compromise as an indication for instrumental delivery was associated with increased risk of postpartum urinary retention. Interaction was noted between parity and episiotomy on the occurrence of postpartum urinary retention (P = .010). Among nulliparous women, those with episiotomy (adjusted OR = 6.10, 95% CI 2.65-14.04) have higher odds of developing postpartum urinary retention compared with those without episiotomy. CONCLUSIONS Approximately one of five (20.6%) women undergoing instrumental delivery developed postpartum urinary retention. Among women undergoing instrumental delivery, episiotomy increased the chances of developing postpartum retention in nulliparous but not multiparous women. Prolonged second stage as an indication for instrumental delivery also increased the chances of retention. Future studies are needed to define the cutoff for diagnosis and to evaluate the long-term effects of covert postpartum urinary retention, as well to study the effect of episiotomy on development of postpartum urinary retention in women undergoing instrumental delivery.
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Affiliation(s)
- Avantika Gupta
- Department of Obstetrics & Gynecology, Jawaharlal Institute of Medical Education & Research, Puducherry, India
| | - Veena Pampapati
- Department of Obstetrics & Gynecology, Jawaharlal Institute of Medical Education & Research, Puducherry, India
| | - Chetan Khare
- Department of Neonatology, All India Institute of Medical Sciences, Bhopal, India
| | - Rajeswari Murugesan
- Department of Biostatistics, Jawaharlal Institute of Medical Education & Research, Puducherry, India
| | - Deepthi Nayak
- Department of Obstetrics & Gynecology, Jawaharlal Institute of Medical Education & Research, Puducherry, India
| | - Anish Keepanasseril
- Department of Obstetrics & Gynecology, Jawaharlal Institute of Medical Education & Research, Puducherry, India
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Ain QU, Shetty N, K S. Postpartum urinary retention and its associated obstetric risk factors among women undergoing vaginal delivery in tertiary care hospital. J Gynecol Obstet Hum Reprod 2020; 50:101837. [PMID: 32590112 DOI: 10.1016/j.jogoh.2020.101837] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 06/06/2020] [Accepted: 06/14/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Postpartum urinary retention (PUR) is not an uncommon consequence of bladder dysfunction after vaginal delivery. Despite its ubiquity, morbidity and discomfort brought to the postpartum women, it's a poorly discussed condition. Patients with Overt PUR are unable to void spontaneously within 6h of vaginal delivery and those with Covert PUR are able to void spontaneously but have a post void residual bladder volume (PVRV) of >150mL. Reported incidences of PUR vary widely ranging from 1.7 %-17.9 %. AIM AND OBJECTIVES To identify the prevalence and obstetric risk factors for PUR after vaginal delivery in order to identify women with increased risk of PUR. MATERIALS AND METHODS The PVRV of women who delivered vaginally was measured after the first spontaneous micturition by ultrasonography. PVRV of more than 150mL was considered as covert PUR. Patient data including age, obstetric history, mode of delivery, duration of labor, PVRV were compared between women with and those without PUR. RESULTS Of 878 included women, the overall prevalence of PUR after vaginal delivery was 12.9 %, the prevalence of overt and covert PUR were 1.8 % and 11.04 % respectively. Parturient who were primigravidae, had perineal injury, instrumental delivery, birth weight >3.5kg and a longer duration of second stage of labor were risk factors for developing PUR. CONCLUSION Any misdiagnosis or delay in diagnosis of PUR can cause bladder over distension leading to irreversible detrusor damage. Hence vigilant monitoring and early detection of PUR helps in facilitating timely interventions and prevention of immediate and long term sequelae.
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Affiliation(s)
- Qurrat Ul Ain
- Department of Obstetrics and Gynaecology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India.
| | - Nikil Shetty
- Department of Obstetrics and Gynaecology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India.
| | - Supriya K
- Department of Obstetrics and Gynaecology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India.
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Perú Biurrun G, Gonzalez-Díaz E, Fernández Fernández C, Fernández Corona A. Post Partum Urinary Retention and Related Risk Factors. Urology 2020; 143:97-102. [PMID: 32439549 DOI: 10.1016/j.urology.2020.03.061] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/09/2020] [Accepted: 03/24/2020] [Indexed: 10/24/2022]
Abstract
OBJETIVE To investigate the prevalence and potential risk factors for postpartum voiding dysfunction (PPVD). METHODS A retrospective observational study was performed in a university hospital center between January 2018 and April 2019. Women with PPVD criteria postpartum were diagnosed and treated. Gestational, delivery, and puerperium characteristics were compared between women with and without PPVD. RESULTS A total of 1894 out of 2308 deliveries (81%) were vaginal, 73 (9.85%) had PPVD and 13.7% were severe. Epidural analgesia (odds ratio [OR] 7.72, 95% confidence interval [CI],1.02-58.37), operative vaginal delivery (OR 2.23, 95% CI,1.01-4.93), birthweight >4000g (OR 3.7, 95%CI,1.4-9.73), and previous cesarean delivery (OR 6.54, 95% CI, 2.2-19.2) were independent risk factors for PPVD. CONCLUSION PPVD is a relatively common finding that complicates around 10% of vaginal deliveries. Epidural analgesia, birthweight, operative vaginal birth, and having a previous cesarean delivery are independent risk factors for PPVD. In order to prevent PPVD, more research on PPVD risk factors is needed.
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Affiliation(s)
- Gema Perú Biurrun
- Department of Obstetrics and Gynecology, Complejo Asistencial Universitario de León (CAULE), Spain
| | - Enrique Gonzalez-Díaz
- Pelvic Floor Unit, Department of Obstetrics and Gynecology, Complejo Asistencial Universitario de León (CAULE), Spain.
| | | | - Alfonso Fernández Corona
- Department of Obstetrics and Gynecology, Complejo Asistencial Universitario de León (CAULE), Spain
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20
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Identification of risk factors for postpartum urinary retention following vaginal deliveries: A retrospective case-control study. Eur J Obstet Gynecol Reprod Biol 2019; 243:7-11. [DOI: 10.1016/j.ejogrb.2019.10.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 10/01/2019] [Accepted: 10/03/2019] [Indexed: 11/21/2022]
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21
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Sudhakaran P. Urinary Retention in Pregnancy and Puerperium: Acupuncture Treatment. Med Acupunct 2019; 31:269-273. [PMID: 31624525 DOI: 10.1089/acu.2019.1363] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Urinary retention (UR) during pregnancy and postpartum is a common obstetric complication. The accepted method of treatment is catheterization; this is invasive and associated with morbidity and sequelae. There are few uniform protocols for the management of this condition, and most hospitals have implemented their own guidelines. Acupuncture is a widely accepted modality of treatment in Chinese hospitals. It is quite effective and safe. It has not been well accepted globally for treating UR, and this is due to a lack of robust studies involving a large number of patients. Methods: Various studies are reviewed and a case from the author's practice is presented. Conclusions: Acupuncture is an effective and safe alternative to catheterization in for UR associated with pregnancy and postpartum.
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Kawasoe I, Kataoka Y. Prevalence and risk factors for postpartum urinary retention after vaginal delivery in Japan: A case-control study. Jpn J Nurs Sci 2019; 17:e12293. [PMID: 31465155 DOI: 10.1111/jjns.12293] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 06/24/2019] [Accepted: 07/15/2019] [Indexed: 11/29/2022]
Abstract
AIM This study aimed to clarify the prevalence and risk factors of postpartum urinary retention after vaginal delivery. It also described the healing process of women who had postpartum urinary retention. METHODS In this case-control study, 77 women who had postpartum urinary retention were matched by age and parity with 385 women as controls. Data were analyzed by conditional logistic regression analysis. Data were collected from the women in the case group regarding their healing process and conditions for urinary retention (overt or covert urinary retention). RESULTS The prevalence of postpartum urinary retention was 1.2%. The adjusted odds ratio and the 95% confidence intervals for risk factors were as follows: epidural analgesia 4.72, 95% CI 2.38, 9.39; episiotomy 2.68, 95% CI 1.40, 5.13; length of second stage of labor 1.85, 95% CI 0.98, 3.49; labor augmentation 1.78, 95% CI 0.90, 3.51; instrument delivery 0.96, 95% CI 0.43, 2.17; and Kristeller maneuver 0.93, 95% CI 0.37, 2.37. Among 59 women with overt urinary retention, 29 (49.2%) transitioned to covert urinary retention within 10 days after delivery. More than half of the women were normal within 72 hr, but there were five women whose urinary retention did not resolve 11 days following delivery. CONCLUSIONS The statistically significant risk factors for postpartum urinary retention were epidural analgesia and episiotomy. Initiatives for the prevention and management of postpartum urinary retention are necessary.
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Affiliation(s)
- Izumi Kawasoe
- Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan.,Department of Nursing, Aiiku Hospital, Tokyo, Japan
| | - Yaeko Kataoka
- Women's Health/Midwifery, St. Luke's International University, Tokyo, Japan
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Distension vésicale secondaire à une rétention urinaire postpartum. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1071-1072. [DOI: 10.1016/j.jogc.2018.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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24
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Clancy AA, Pascali D. Bladder Distension Injury Secondary to Postpartum Urinary Retention. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1069-1070. [PMID: 30770328 DOI: 10.1016/j.jogc.2018.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 04/25/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Aisling A Clancy
- Division of Urogynecology, Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON
| | - Dante Pascali
- Division of Urogynecology, Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON
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25
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Beaumont T. Prevalence and outcome of postpartum urinary retention at an Australian hospital. Midwifery 2019; 70:92-99. [PMID: 30605821 DOI: 10.1016/j.midw.2018.12.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 11/22/2018] [Accepted: 12/21/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Postpartum urinary retention is thought to be a potentially significant complication of childbirth. A universal postpartum void review process has been in place since 2008 at this tertiary obstetric hospital to screen for voiding dysfunction. Procedure compliance audits were undertaken on implementation but local prevalence and clinical outcomes of both acute and persistent postpartum urinary retention had not been documented for our cohort to date. DESIGN A clinical audit was undertaken to review the medical files for all women who birthed between January 1st 2016-March 31st 2016 (n = 1108 cases) to determine the prevalence of acute postpartum urinary retention. Medical files of persistent postpartum urinary retention cases occurring in 2016 requiring follow up were individually reviewed. MEASUREMENT AND FINDINGS An overall 3.8% baseline prevalence of acute postpartum urinary retention was observed retrospectively (n = 42/1108) in a 3 month period, with 28.6% of these experiencing significant bladder over distension (n = 12/42). Following urinary catheterisation, and often a period of bladder rest, 100% of women who failed their first void review were able to successfully void on catheter removal. There were 3 cases of persistent postpartum urinary retention over 12 months, representing an overall prevalence of 0.07% (n = 3/4353). KEY CONCLUSIONS The existing postpartum void review process appears to be a reliable framework for the early detection and management of postpartum urinary retention, but could be further enhanced by objectively confirming effective bladder emptying and function. IMPLICATIONS FOR PRACTICE In spite of a universal void review framework for postnatal void review, urinary retention and bladder overdistension still occurs. Staff education to encourage compliance with the framework and to facilitate timely clinical reasoning and decision making may improve prevalence rates.
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Affiliation(s)
- Tara Beaumont
- Women's and Children's Hospital, 72 King William Road, North Adelaide, SA 5006, Australia..
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26
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Acceptable Postvoid Residual Urine Volume after Vaginal Delivery and Its Association with Various Obstetric Parameters. Obstet Gynecol Int 2018; 2018:5971795. [PMID: 30158981 PMCID: PMC6109527 DOI: 10.1155/2018/5971795] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 06/07/2018] [Accepted: 07/12/2018] [Indexed: 11/17/2022] Open
Abstract
Background Urinary retention and voiding dysfunction is a distressing event and relatively common in immediate postpartum period. This study aims at investigating the range of postvoid residual urine volume after vaginal delivery and its association with various obstetric parameters. Methods This was a prospective observational study of women who delivered vaginally in Universiti Kebangsaan Malaysia Medical Centre from March 2017 to September 2017. Those who were able to void within 6 hours after delivery, the voided volume measurements were taken at their second void followed by measurement of residual urine using a transabdominal ultrasound scan. For those unable to void at 6 hours postpartum, the bladder volume was measured. If the bladder volume was 500 ml or more, an indwelling catheter would be inserted and kept for 24 hours. Results A total of 155 patients who fulfilled the inclusion were recruited. There were 143 (92.3%) patients who had residual urine volume of less than 150 ml at second void. Out of these 143 patients, 138 (96.5%) had residual urine volume of less than 100 ml, and among the 138 patients, 119 (86.2%) had residual urine volume of less than 50 ml. The median residual urine volume was 10 ml (2, 42). The overall rate of postpartum urinary retention (PPUR) was 7.7%; 6 (3.85%) had overt retention and 6 (3.85%) had covert retention. Primiparity, duration of active phase of labour, duration of second stage of labour, epidural analgesia, episiotomy, instrumental delivery, and perineal pain score were independent risk factors associated with postpartum urinary retention. Conclusion Postpartum urinary retention complicates approximately 7.7% of vaginal deliveries. Majority (86.2%) of them had residual urine volume less than 50 ml. Obstetrics factors independently associated with PPUR include primiparity, duration of active phase of labour, duration of second stage of labour, epidural analgesia, episiotomy, instrumental delivery, and degree of perineal pain.
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Mulder FEM, van der Velde S, Pol F, Bos M, van Leeuwen JS, Dietz V, Hakvoort RA, Roovers JPWR. Accuracy of postvoid residual volumes after vaginal delivery: a prospective equivalence study to compare an automatic scanning device with transurethral catheterization. Int Urogynecol J 2018; 30:773-778. [PMID: 29951911 PMCID: PMC6491401 DOI: 10.1007/s00192-018-3700-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 06/12/2018] [Indexed: 11/28/2022]
Abstract
Introduction and hypothesis Abnormal postvoid residual volumes (PVRV) after delivery are common in daily clinical practice. By using an automatic scanning device, unnecessary catheterizations can be prevented. The aim of this study was to determine the accuracy of PVRV after vaginal delivery measured by an automatic scanning device through a comparison with transurethral catheterization. Materials and methods This prospective observational equivalence study was performed in patients who delivered vaginally between June 2012 and May 2017 in three teaching hospitals in The Netherlands. After the first spontaneous void after delivery, postvoid residual volume (PVRV) was measured with a portable automatic scanning device (BladderScan® BVI 9400). Directly afterward, it was measured by catheterization. Correlation between measurements was calculated using Spearman’s correlation coefficient and agreement plot. The primary outcome was to validate the correlation between the BladderScan® compared with the gold standard of transurethral catheterization. Results Data of 407 patients was used for final analysis. Median PVRV as measured by BladderScan® was 380 ml (± 261–0–999 ml) and by catheterization was 375 ml (± 315–1800 ml). Mean difference between measurements was −12.9 ml (± 178 ml). There was a very good correlation between methods (Spearman’s rho = 0.82, p < 0.001). Using a cut-ff value of >500 ml, specificity and sensitivity were 85.4 and 85.6%, respectively. Conclusions The BladderScan® (BVI 9400) measures PVRV precisely and reliably after vaginal delivery and should be preferred over catheterization.
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Affiliation(s)
- Femke E M Mulder
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Meibergdreef 9 - room H4.240, 1105 AZ, Amsterdam, The Netherlands.
| | - Sytske van der Velde
- Department of Obstetrics and Gynaecology, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Fraukje Pol
- Department of Obstetrics and Gynaecology, Catharina Ziekenhuis, Eindhoven, The Netherlands
| | - Marjolein Bos
- Department of Obstetrics and Gynaecology, Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | | | - Viviane Dietz
- Department of Obstetrics and Gynaecology, Catharina Ziekenhuis, Eindhoven, The Netherlands
| | - Robert A Hakvoort
- Department of Obstetrics and Gynaecology, Martini Hospital, Groningen, The Netherlands
| | - Jan-Paul W R Roovers
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Meibergdreef 9 - room H4.240, 1105 AZ, Amsterdam, The Netherlands
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Polat M, Şentürk MB, Pulatoğlu Ç, Doğan O, Kılıççı Ç, Budak MŞ. Postpartum urinary retention: Evaluation of risk factors. Turk J Obstet Gynecol 2018; 15:70-74. [PMID: 29971181 PMCID: PMC6022424 DOI: 10.4274/tjod.43931] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 03/18/2018] [Indexed: 12/01/2022] Open
Abstract
Objective Postpartum urinary retention means the absence of spontaneous micturition more than 6 hours after birth or when residual volume after urination is less than 150 cc. If neglected, postpartum urinary retention may result in bladder denervation and detrusor muscle weakness requiring intermittent catheterization or permanent micturition dysfunction. Our goal was to identify the possible risk factors for postpartum urinary retention. Materials and Methods Five hundred sixty female subjects were included in this retrospective study. All data obtained including variables such as age, parity, body mass index, duration of labor, prepartum bladder catheterization were compared between female subjects with and without postpartum urinary retention. Results Among the 560 patients recruited to our study, 124 (22.1%) had postpartum urinary retention. Third stage duration, time from birth to the first void, and number of peripartum micturitions were found to be potential risk factors for postpartum urinary retention. Different than other studies, our study revealed a correlation between peripartum catheterization and postpartum urinary retention. There were no statistically significant differences between patients with and without postpartum urinary retention in terms of other variables. Conclusion In this study, a correlation between peripartum catheterization and postpartum urinary retention was found. There are studies that reported the possible risk factors related to the occurrence of postpartum urinary retention. More studies should be conducted to investigate long-term results with larger populations.
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Affiliation(s)
- Mesut Polat
- İstanbul Medeniyet University Faculty of Medicine, Departments of Obstetrics and Gynecology, İstanbul, Turkey
| | - Mehmet Baki Şentürk
- İstanbul Medeniyet University Faculty of Medicine, Departments of Obstetrics and Gynecology, İstanbul, Turkey
| | - Çiğdem Pulatoğlu
- Bayburt State Hospital, Clinic of Obstetrics and Gynecology, Bayburt, Turkey
| | - Ozan Doğan
- University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Çetin Kılıççı
- İstanbul Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Mehmet Şükrü Budak
- University of Health Sciences, Diyarbakır Gazi Yaşargil Training and Research Hospital, Clinic of Obstetrics and Gynecology, Diyarbakır Turkey
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Mulder FEM, Hakvoort RA, de Bruin JP, Janszen EW, van der Post JAM, Roovers JPWR. Long-term micturition problems of asymptomatic postpartum urinary retention: a prospective case-control study. Int Urogynecol J 2018; 29:481-488. [PMID: 28871388 PMCID: PMC5876278 DOI: 10.1007/s00192-017-3457-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 08/10/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Covert (asymptomatic) postpartum urinary retention (PUR) is defined as post-void residual volume (PVRV) ≥150 mL. Although often supposed to be a common and harmless phenomenon, no data are available on the potential long-term micturition problems of increased PVRV after vaginal delivery. METHODS After the first spontaneous void post-vaginal delivery, PVRV was measured using a portable scanning device. Micturition symptoms were compared using validated questionnaires between women with PVRV < 150 mL and those with PVRV ≥150 mL until 1 year after delivery. Women with PVRV ≥ 150 mL were followed until complete bladder emptying was achieved. RESULTS Data of 105 patients with PVRV < 150 mL and 119 with PVRV ≥ 150 mL were available for analysis. 75% of all patients included had PVRV ≥ 250 mL. More primiparous patients had PVRV ≥ 150 mL (p < 0.02). 92% of women with PVRV ≥ 150 mL after delivery were able to adequately empty their bladder within 4 days. One year after delivery, no statistically significant differences were found. CONCLUSIONS Covert PUR according to the definition of PVRV ≥ 150 mL, is a common and transient phenomenon that does not result in more lower urinary tract symptoms 1 year after delivery. Although the current definition is not useful in identifying postpartum women with a pathological condition, we suggest that the definition of covert PUR should be change to: "PVRV≥500 mL after the first spontaneous void after (vaginal) delivery." This cut-off value is the value at which some women do need more time to normalise emptying of the bladder. The exact clinical implications of covert PUR need to be further studied in this subcategory of women.
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Affiliation(s)
- Femke E M Mulder
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Meibergdreef 9-room H4.240, 1105 AZ, Amsterdam, The Netherlands.
| | - Robert A Hakvoort
- Department of Obstetrics and Gynaecology, Martini Hospital, Groningen, The Netherlands
| | - Jan-Peter de Bruin
- Department of Obstetrics and Gynaecology, Jeroen Bosch Ziekenhuis, 's Hertogenbosch, The Netherlands
| | - Erica W Janszen
- Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Joris A M van der Post
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Meibergdreef 9-room H4.240, 1105 AZ, Amsterdam, The Netherlands
| | - Jan-Paul W R Roovers
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Meibergdreef 9-room H4.240, 1105 AZ, Amsterdam, The Netherlands
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Impact of systematic urinary catheterization protocol in delivery room on covert postpartum urinary retention: a before-after study. Sci Rep 2017; 7:17720. [PMID: 29255204 PMCID: PMC5735096 DOI: 10.1038/s41598-017-18065-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 12/05/2017] [Indexed: 11/24/2022] Open
Abstract
We investigated whether implementation of a routine catheterization procedure in labor improves covert postpartum urinary retention (cPUR) rates. We conducted a prospective before-after study. 121 women admitted to delivery room in the observational group, and 82 in the intervention group, in a tertiary university hospital in Southern France were included. All patients in the intervention group were systematically catheterized 2 hours after delivery. cPUR was screened for in both groups. The primary end-point was cPUR (post-void residual bladder volume >150 ml when voided volume is >150 mL). The rate of cPUR decreased from 50% (60 out of 121 patients) in the observational group to 17% (14/82) in the intervention group (OR = 0.21; 95% Confidence Interval [0.13;0.58]; p < 0.001). Similarly, in the subgroup of patients who underwent instrumental delivery, the rate of cPUR was lower in the intervention group (18%, 2/11) than in the observational group (65%, 15/23) (p = 0.02). Systematic intermittent bladder catheterization immediately postpartum could decrease cPUR. Further studies are necessary to assess the long-term outcomes and improve understanding of postpartum voiding dysfunction.
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Costa JND, Botelho ML, Duran ECM, Carmona EV, Oliveira-Kumakura ARDS, Lopes MHBDM. Conceptual and Operational Definitions for the Nursing Diagnosis "Urinary Retention". Int J Nurs Knowl 2017; 30:49-54. [PMID: 29214730 DOI: 10.1111/2047-3095.12196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To develop conceptual and operational definitions for defining characteristics and related factors for nursing diagnosis of urinary retention, as contained in Taxonomy II of NANDA-I. DATA SOURCES Integrative literature review and elaboration of terms related to urinary retention. DATA SYNTHESIS It includes operational and conceptual definitions of the nursing diagnosis urinary retention. CONCLUSIONS It is necessary to review the definition of this nursing diagnosis and most of its defining characteristics and related factors. IMPLICATIONS FOR NURSING PRACTICE The use of internationally known terms for various disciplines in areas of common knowledge helps to standardize the language used by professionals.
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Affiliation(s)
- Juliana Neves da Costa
- Doctoral Student at Faculty of Nursing (FENF), University of Campinas (UNICAMP), Campinas, SP, Brazil
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Ren Y, Zhu Y, Liu L, Yu T, Dong X. Ultrasound induces contraction of the bladder smooth muscle. Int Urol Nephrol 2016; 48:1229-1236. [PMID: 27262850 DOI: 10.1007/s11255-016-1298-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 04/18/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE To investigate whether the treatment of overt postpartum urinary retention (PUR) with low-intensity pulsed ultrasound (LIPUS) was clinically effective and whether LIPUS could accelerate bladder smooth muscle (BSM) contraction by opening the L-type calcium channels and activating the Ca(2+) signaling pathway. METHODS Records of 136 patients undergoing PUR were retrospectively reviewed in two different groups for LIPUS and neostigmine between from 2014 to July 2015. The rats BSM strips in vitro were irradiated by LIPUS. The contraction frequency and amplitude were recorded with BL-410F biological experimental system. The BSM cells were constructed and identified by α-actin-specific antibody staining, and the intracellular Ca(2+) concentration was analyzed by flow cytometry. RESULTS The clinical trial indicated that LIPUS had potential therapeutic effect on PUR (80.6 vs. 64.1 %, p < 0.05), and the BSM strip contractility was increased by LIPUS (p < 0.001), and the concentration of Ca(2+) was markedly enhanced by about twofold than that without LIPUS exposure (p < 0.01). Besides, nimodipine could suppress the contraction of BSM and the concentration of intracellular Ca(2+) which was caused by ultrasound. CONCLUSIONS The results suggested LIPUS had potential therapeutic effect on PUR and the Ca(2+) signaling pathway was involved in the mechanism. The ultrasound irradiation may provide a new method for PUR therapy.
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Affiliation(s)
- Yan Ren
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital, Chongqing Medical University, 74 Linjiang Road, Yuzhong District, Chongqing, 400010, China
| | - Yi Zhu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital, Chongqing Medical University, 74 Linjiang Road, Yuzhong District, Chongqing, 400010, China
| | - Li Liu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital, Chongqing Medical University, 74 Linjiang Road, Yuzhong District, Chongqing, 400010, China
| | - Tinghe Yu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital, Chongqing Medical University, 74 Linjiang Road, Yuzhong District, Chongqing, 400010, China
| | - Xiaojing Dong
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital, Chongqing Medical University, 74 Linjiang Road, Yuzhong District, Chongqing, 400010, China.
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Abstract
Introduction and hypothesis Postpartum urinary retention (PUR) is a common consequence of bladder dysfunction after vaginal delivery. Patients with covert PUR are able to void spontaneously but have a postvoid residual bladder volume (PVRV) of ≥150 mL. Incomplete bladder emptying may predispose to bladder dysfunction at a later stage of life. The aim of this cross-sectional study was to identify independent delivery-related risk factors for covert PUR after vaginal delivery in order to identify women with an increased risk of covert PUR. Methods The PVRV of women who delivered vaginally was measured after the first spontaneous micturition with a portable bladder-scanning device. A PVRV of 150 mL or more was defined as covert PUR. Independent risk factors for covert PUR were identified in multivariate regression analysis. Results Of 745 included women, 347 (47 %) were diagnosed with covert PUR (PVRV ≥150 mL), of whom 197 (26 %) had a PVRV ≥250 mL (75th percentile) and 50 (7 %) a PVRV ≥500 mL (95th percentile). In multivariate regression analysis, episiotomy (OR 1.7, 95 % CI 1.02 – 2.71), epidural analgesia (OR 2.08, 95 % CI 1.36 – 3.19) and birth weight (OR 1.03, 95 % CI 1.01 – 1.06) were independent risk factors for covert PUR. Opioid analgesia during labour (OR 3.19, 95 % CI 1.46 – 6.98), epidural analgesia (OR 3.54, 95 % CI 1.64 – 7.64) and episiotomy (OR 3.72, 95 % CI 1.71 – 8.08) were risk factors for PVRV ≥500 mL. Conclusions Episiotomy, epidural analgesia and birth weight are risk factors for covert PUR. We suggest that the current cut-off values for covert PUR should be reevaluated when data on the clinical consequences of abnormal PVRV become available.
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Marie B, Roland B, Lennart C, Peter B. Systematic bladder scanning identifies more women with postpartum urinary retention than diagnosis by clinical signs and symptoms. ACTA ACUST UNITED AC 2015. [DOI: 10.5897/ijnm2015.0164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Mulder FEM, Hakvoort RA, Schoffelmeer MA, Limpens J, Van der Post JAM, Roovers JPWR. Postpartum urinary retention: a systematic review of adverse effects and management. Int Urogynecol J 2014; 25:1605-12. [DOI: 10.1007/s00192-014-2418-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 04/22/2014] [Indexed: 10/25/2022]
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