Acceptable Postvoid Residual Urine Volume after Vaginal Delivery and Its Association with Various Obstetric Parameters

Incidence, risk factors and diagnostic accuracy of clinical palpation in picking up post-void residual urine in postnatal women

PURPOSE

To determine the incidence of covert and overt postpartum urinary retention after vaginal delivery and the associated risk factors for postpartum urinary retention. To determine how well clinical examination by abdominal palpation correlates with ultrasound findings of urinary retention.

METHODS

Patients after delivery were screened with ultrasound and examined clinically to check for retention of urine after voiding.

RESULTS

A total of 822 of women were recruited in the study of which 86 (10.5%) women had significant post-void residue of urine. 33 (38.4%) had overt retention, while 53 (61.6%) had covert retention. Duration of labour and an increased VAS score were found to be significantly higher among those with urinary retention. Using clinical examination to diagnose postpartum urinary retention had a sensitivity of 66.1%, specificity of 88.6%, positive predictive value of 76.5% and negative predictive value of 82.3%.

CONCLUSIONS

Clinical examination by abdominal palpation is not a very sensitive test in diagnosing PPUR.

The Effectiveness and Safety of Intrapartum or Postpartum Catheterization in the Prevention of Postpartum Urinary Retention: A Scoping Review

INTRODUCTION AND HYPOTHESIS

Catheterization is a common treatment for postpartum urinary retention (PUR); however, its application before diagnosis of PUR remains unclear. The aim was to give an overview of the existing literature on the effectiveness and safety of intrapartum or postpartum catheterization in the prevention of PUR.

METHODS

This scoping review followed a methodological framework. PubMed, the Cochrane Library, Embase, Web of Science, the China National Knowledge Infrastructure, WanFang, the China Science and Technology Journal Database, and the China Biomedical Literature Database were searched from the inception of each database to 21 May 2023.

RESULTS

The search revealed 16 studies examining three different catheterization methodologies, including 12 intrapartum studies. Ten studies concluded that intrapartum or postpartum catheterization prevented PUR, two of which were only for overt or covert PUR. In 4 out of 13 experimental studies, no significant difference was found: one for intrapartum catheterization versus routine nursing, the other for intrapartum or postpartum intermittent versus indwelling catheterization. However, one found that postpartum disposable catheterization after ineffective targeted care reduced the incidence of PUR compared with indwelling catheterization. One out of the 3 case-control studies concluded that prenatal catheterization ≥2 times was a risk factor for PUR.

CONCLUSIONS

Based on the findings in this scoping review, catheterization prior to the diagnosis of PUR appears to play a role in preventing PUR and is safe. Preliminary evidence is accumulating on the effectiveness of three types of catheterization methods in preventing PUR, but more comprehensive studies are needed to establish these findings.

Prolonged second stage of labor in delivery using epidural analgesia is a risk factor for postpartum urinary retention

AIM

To determine the postpartum urinary retention rate and risk factors after delivery using epidural analgesia.

METHODS

This single-center retrospective study targeted 341 women who gave birth after at least 37 weeks of gestation from April to August 2021; from this cohort, 208 patients were examined. The postpartum urinary retention rate was compared between the no epidural analgesia group (n = 107) and epidural analgesia group (n = 101). Subsequently, risk factors for postpartum urinary retention were investigated in the epidural analgesia group.

RESULTS

After adjustment by propensity score matching for age, body mass index, being primiparous, and labor induction as covariates, the analysis of the incidence of postpartum urinary retention revealed that the epidural analgesia group exhibited a significantly higher postpartum urinary retention rate than the no epidural analgesia group (30% vs. 11%, p = 0.02). The investigation results regarding risk factors for postpartum urinary retention in the epidural analgesia group obtained through a univariate analysis showed that being primiparous and having a prolonged second stage of labor were significantly correlated with postpartum urinary retention. Multivariate analysis indicated that a prolonged second stage of labor was an independent risk factor for postpartum urinary retention (p = 0.03; odds ratio: 3.18; 95% confidence interval: 1.08-9.77). All patients recovered from postpartum urinary retention by day 4.

CONCLUSIONS

The postpartum urinary retention rate after delivery using epidural analgesia was 25.7%. In the case of epidural analgesia deliveries, a prolonged second stage of labor was an independent risk factor for postpartum urinary retention.

Factors associated with urinary retention after vaginal delivery under intraspinal anesthesia: a path analysis model

INTRODUCTION AND HYPOTHESIS

Women who have intraspinal anesthesia for delivery are more likely to experience postpartum urinary retention (PUR), which, if not recognized and treated promptly, can result in long-term urinary dysfunction. Many factors influencing PUR have been proposed, but no study has been conducted to investigate the relationship between them. This study is aimed at determining the influencing factors of PUR and to explore the relationship between them.

METHODS

A prospective, cross-sectional survey using self-made questionnaires was conducted among 372 puerperae in a Grade A hospital in Guangzhou, China, from April to September 2022. SPSS25.0 and AMOS24.0 were used for data analysis, and a path analysis model was established to determine the relationship between the influencing factors.

RESULTS

The incidence of PUR was 49.85%. Residence, the level of postpartum pain, and the change of postnatal urination position had a direct effect on PUR. Episiotomy and analgesic duration have both direct and indirect effects on PUR. Forceps delivery, perineal edema and oxytocin had an indirect effect on PUR. Variables could influence the occurrence of PUR by mediating the analgesic duration, episiotomy, postpartum pain level, and postnatal urination position changes.

CONCLUSIONS

This study provides an empirical model to illustrate the relationship between PUR and related factors in women who delivered under intraspinal anesthesia. In future management, more attention should be paid to women who live in cities, have higher levels of postpartum pain, longer analgesic duration, higher grade of perineal edema, and received episiotomy, forceps delivery, and oxytocin during labor.

The Occurrence and Factors Associated with Overt Urinary Retention Among Postpartum Women After Vaginal Delivery with Labor Epidural Analgesia

Background

Early recognition and prompt intervention for overt postpartum urinary retention (PUR) takes on a critical significance when a woman chooses labor epidural analgesia for pain relief. However, there have been rare fewer reports on the incidence and factors influencing overt PUR in women after vaginal delivery with labor epidural analgesia in China. Therefore, this study aimed to investigate the incidence and factors correlated with overt urinary retention in postpartum women undergoing vaginal delivery with labor epidural analgesia.

Methods

In total, 462 Chinese postpartum women with labor epidural analgesia and vaginal delivery were recruited in one tertiary hospital in Beijing from Dec. 2020 to Nov. 2021. Factors associated with overt PUR for these women were identified through multivariate logistic regression analysis.

Results

The incidence of overt PUR was obtained as 10.2% among these women after vaginal delivery with labor epidural analgesia. As indicated by the result of univariate analysis, forceps-assisted delivery, lateral episiotomy, perineal pain, and fluid administration in the delivery room were correlated with PUR. The result of the multivariate logistic regression suggested that forceps-assisted delivery (odds ratio [OR]=2.46, 95% confidence interval [CI]: 1.14-5.32, P=0.022), lateral episiotomy (OR=4.55, 95% CI: 1.91-10.80, P=0.001), and perineal pain (OR=4.23, 95% CI: 2.05-8.73, P<0.001) were factors affecting overt PUR for these women.

Conclusion

Postpartum women undergoing vaginal delivery with labor epidural analgesia showed a high incidence of overt PUR, and health-care providers should pay more attention to their postpartum urination status in clinical practice. Effective and timely intervention is strongly recommended to reduce the occurrence of overt PUR for these kinds of postpartum women undergoing vaginal delivery with labor epidural analgesia, such as ones experienced forceps-assisted delivery, lateral episiotomy, and more severe perineal pain.

Prevalence of urinary retention after vaginal delivery: a systematic review and meta- analysis

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.

Predictive Value of Voiding Efficiency After Active Void Trial in Men Undergoing BPH Surgery

OBJECTIVES

To determine the predictive value of voiding efficiency on acute urinary retention after discharge from BPH surgery.

MATERIALS AND METHODS

We performed a prospective observational cohort study of three surgeons' practices from 2019 to present. All men included underwent trial of void on post-operative day one after transurethral resection of prostate or Holmium enucleation of prostate . Active filling void trials were performed on all patients and voiding efficiency (percent of bladder volume emptied) was calculated. Multivariable logistic regression was performed to determine predictors of developing acute urinary retention.

RESULTS

During the study period, 188 men met inclusion criteria. 110 (59%) men underwent Holmium enucleation of prostate , and 78 (41%) underwent transurethral resection of prostate. The median age of our cohort was 70 (IQR 65-75). The median prostate size was 100g (IQR 61-138g). Nineteen patients (10%) returned after discharge with acute urinary retention requiring catheterization. On post-operative day one, the median voiding efficiency was 75% (IQR 55%-94%). On multivariable analysis, patients with a voiding efficiency less than 50% were 3.8 times more likely (95% confidence interval 1.1-12.8) to develop subsequent retention compared to a voiding efficiency of greater than 75%. Increasing pre-operative prostate size was associated with lower risk of urinary retention after discharge (aOR 0.8, 95%CI 0.6-0.9).

CONCLUSIONS

Voiding efficiency after an active void trial helps stratify risk of urinary retention in patients undergoing benign prostate surgery. High-risk patients include those with voiding efficiencies less than 50% and smaller pre-operative prostate sizes (<80g).

Postpartum urinary retention: what are the sequelae? A long-term study and review of the literature

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.

The risk factors of postpartum urinary retention after vaginal delivery: A systematic review

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.

Levator ani muscle avulsion: a risk factor for persistent postpartum voiding dysfunction

INTRODUCTION AND HYPOTHESIS

Persistent postpartum voiding dysfunction (P-PPVD) is defined as the inability to empty the bladder properly 72 h after delivery despite the use of intermittent urinary catheterization. Our aim was to find predictive factors for P-PPVD and to compare its urogynecologic outcomes with transient dysfunctions.

MATERIALS AND METHODS

A case-control study was performed in a university hospital center between January 2018 and April 2019. The case group included women diagnosed with P-PPVD after vaginal delivery, and the control group included women with PPVD that resolved before 72 h. Patients were followed up at 12 weeks and 12 months postpartum, including an ultrasound assessment of the levator ani muscle (LAM).

RESULTS

Of 2308 deliveries, 1894 (81%) were vaginal, 75 (3.85%) presented PPVD, and 1 lasted > 72 h (0.69% P-PPVD). LAM avulsion (OR 6.3, 95% CI 1.24-32.01) was the only independent risk factor for P-PPVD found. No significant differences in urogynecologic symptoms between transient and persistent PPVD were found in the short and the long term, except that women with P-PPVD had a lower prevalence of urinary incontinence at 12 weeks postpartum.

CONCLUSIONS

PPVD is a common, self-limited event, but in 17.3% of cases persists > 3 days. Levator ani muscle avulsion acts as an independent risk factor for P-PPVD. Early diagnosis and appropriate treatment of P-PPVD can help minimize any clinical implications for long-term urogynecologic disorders.

Post Partum Urinary Retention and Related Risk Factors

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.