Efficacy of a self-heating Chinese medicine hot pack for postpartum urinary retention.

Reported rates of postpartum urinary retention (PUR) following vaginal delivery range as high as 18%, but the risk of PUR associated with cesarean delivery is difficult to determine because of the effects of surgery and anesthesia on postpartum bladder function and also because there is no consensus on what constitutes PUR. In this study, PUR was diagnosed when ultrasonography demonstrated a postvoid residual bladder volume (PVRBV) of 150 mL or greater. Participating in this prospective study were 605 pregnant women having cesarean section. The PVRBV was estimated ultrasonically after first micturition. The overall incidence of PUR following cesarean delivery was 24.1%. The incidence of overt PUR, when no spontaneous micturition took place 6 hours after removal of the catheter and patients developed symptoms of obstructed voiding such as incomplete emptying, straining, and difficulty voiding, was 7.4%. Covert PR, with no associated urinary symptoms despite an elevated PVRBV, was more than twice as frequent (16.7%). Factors significantly associated with PUR included postoperative epidural morphine administration, multiple pregnancy, and a low body mass index at the time of delivery. After 3 months of follow-up, 5% of patients had obstructive voiding symptoms and 9.1% had irritative voiding symptoms. Differences in the frequency of voiding problems between the PUR and normal groups were not statistically significant. Nearly one-fourth of these patients developed PUR following cesarean delivery. The chief contributing factor was the use of morphine for postoperative analgesia. When transient and diagnosed at an early stage, PUR did not compromise urinary function and was not associated with subsequent voiding problems.

Liang, C.C.; Chang, S.D.; Chang, Y.L.; Chen, S.H.; Chueh, H.Y.; Cheng, P.J. Author Information

Postpartum urinary retention after cesarean delivery

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

Background: Epidural analgesia is a widely employed method in obstetric care for labor pain management. Postpartum urinary retention is a common complication that can arise during the postnatal period. This study aimed to evaluate the current status and influencing factors of postpartum urinary retention in parturients who received epidural anesthesia. Methods: We retrospectively included parturients who underwent vaginal delivery at our institution from June 2022 to October 2024. The characteristics of parturients with and without postpartum urinary retention were analyzed and compared. Logistic regression analyses were conducted to evaluate the influencing factors of postpartum urinary retention. Results: This study enrolled a cohort consisting of 520 parturients who underwent epidural anesthesia, resulting in a total of 520 instances of childbirth. Among this population, 56 parturients were identified as experiencing postpartum urinary retention. The incidence of postpartum urinary retention in parturients with epidural anesthesia was 10.77%. Correlation analysis results showed that the parity (r = 0.582), duration of analgesia (r = 0.554), degree of perineal laceration (r = 0.656) and use of oxytocin (r = 0.580) were correlated with the occurrence of postpartum urinary retention among parturients with epidural anesthesia (all p < .05). Logistic regression analysis indicated that parity (OR = 2.587, 95% CI: 1.890∼3.225), duration of analgesia (OR = 2.778, 95% CI: 2.104∼3.467), degree of perineal laceration (OR = 3.265, 95% CI: 2.620∼3.815) and use of oxytocin (OR = 2.436, 95% CI: 1.909∼3.875) were the independent influencing factors of postpartum urinary retention (all p < .05). Conclusion: It is imperative that clinical healthcare providers implement targeted preventative and management strategies to reduce postpartum urinary retention.

To determine the incidence of postpartum urinary retention (PUR) after vaginal delivery and associated risk factors. A total of 250 women were recruited following vaginal delivery at the UCH, Ibadan. Sociodemographic and obstetrical data were collected using a pro forma. Transabdominal ultrasound scan of the urinary bladder was performed 6hours after delivery to estimate the post-void residual bladder volume (PVRBV) of participants. PVRBV was compared with obstetrical characteristics and labor events. Data collected were analyzed using SPSS 17.0. The level of statistical significance was set at P value less than 0.05. The incidence of PUR was 17.6%. Women with PUR, had longer duration of first stage (591 versus 501minutes; P=0.001), and second stage (50 versus 32minute; P<0.001) of labor compared with those without PUR. There was evidence that augmentation of labor (P<0.01), catheterization during labor (P<0.01), perineal injury (P<0.01), and episiotomy (P<0.01) were associated with developing PUR. Also, women with PUR were more likely to experience storage and obstructive urinary symptoms than those without PUR. Resolution of PUR occurred within 24hours. This study showed that postpartum urinary retention is relatively common following vaginal delivery. Awareness of risk factors will increase index of suspicion especially in women with storage and obstructive symptoms.

Postpartum urinary retention is a common complication following caesarean section, with significant implications for patient comfort and recovery. Combined spinal and epidural anaesthesia is frequently employed for caesarean section, but postpartum urinary retention remains a clinical concern despite its benefits. This study aimed to investigate the effectiveness of hydromorphone hydrochloride combined with bupivacaine for combined spinal and epidural anaesthesia in reducing postpartum urinary retention. A retrospective analysis was conducted on patients who received combined spinal and epidural anaesthesia for caesarean section. The control group received bupivacaine, whereas the hydromorphone hydrochloride combined with bupivacaine spinal-epidural anaesthesia (HB) group received hydromorphone hydrochloride combined with bupivacaine. Data on demographics, anaesthesia, operative characteristics, postoperative urinary retention and adverse events were collected and analysed. The study enrolled 105 patients, with a control group (n = 51) receiving bupivacaine spinal-epidural anaesthesia and an observation group (n = 54) receiving hydromorphone hydrochloride combined with bupivacaine spinal-epidural anaesthesia. The incidence of postoperative urinary retention was significantly lower in the HB group than in the control group (3.70% vs. 17.65%, p = 0.044). Furthermore, the HB group exhibited a shorter time to first voiding after anaesthesia (5.72 ± 1.26 h vs. 6.28 ± 1.35 h, p = 0.029), lower peak postvoid residual volume (168.57 ± 25.09 mL vs. 180.43 ± 30.21 mL, p = 0.032), decreased need for postoperative catheterisation (5.56% vs. 21.57%, p = 0.034) and shorter duration of urinary catheterisation (10.92 ± 2.61 h vs. 12.04 ± 2.87 h, p = 0.039) than the control group. Correlation analysis supported a negative correlation between hydromorphone supplementation and parameters related to postoperative urinary retention. Multivariate regression analysis demonstrated a significant association between the duration of urinary catheterisation and the use of hydromorphone with the occurrence of postoperative urinary retention, providing further insights into the multifactorial nature of this postoperative complication. The addition of hydromorphone hydrochloride to bupivacaine for combined spinal and epidural anaesthesia was associated with a reduced incidence of postpartum urinary retention and improved postoperative voiding parameters, without significantly increasing the risk of adverse events.

Background: The overall risk of postpartum urinary retention (PUR) is between 0.05% and 37%. Being Asian increases the risk, while other factors include epidural analgesia, prolonged first and second stage of labour and previous history of PUR.&#x0D; Subjects and Methods: This is a cohort study conducted at a tertiary hospital in Pahang State of Malaysia over one year duration. All postpartum women were included. The post void residual volume (PVRV) was measured after minimum 6 hours postpartum or when the subject complained of inability to pass urine. The PVRV of more than 150ml was considered as PUR. Data analysis was performed using SPSS version 20.&#x0D; Results: Of 1000 included women, mean age was 28.44(5.68), parity of 2.0 and 75.8% had vaginal delivery. PUR was diagnosed in 42 (4.2%) women, of whom 4 (9.5%) were diagnosed with overt and 38 (90.5%) had covert PUR. Parity and perineal tear were significantly associated with PUR. Second degree perineal tear (including episiotomy) were independent risk factors associated with PUR (adjusted OR 3.19, CI 1.23 - 8.30).&#x0D; Conclusion: Incidence of PUR in our population is low compared with others. Second degree perineal tear (including episiotomy) is a risk factor for PUR. PUR screening is not needed in our population.

Acupoint hot compress during the early postpartum period may benefit patients after a vaginal delivery, but the evidence of this effect is limited. To assess whether acupoint hot compress involving the abdominal, lumbosacral, and plantar regions could reduce the incidence of postpartum urinary retention, relieve postpartum uterine contraction pain, prevent emotional disorders, and promote lactation. This multicenter randomized clinical trial was conducted at 12 hospitals in China. Pregnant patients were screened for eligibility (n = 13 949) and enrolled after vaginal delivery (n = 1200) between January 17 and August 15, 2021; data collection was completed on August 18, 2021. After vaginal delivery, these participants were randomized 1:1 to either the intervention group or control group. Statistical analysis was based on per-protocol population. Participants in the control group received routine postpartum care. Participants in the intervention group received routine postpartum care plus 3 sessions of a 4-hour acupoint hot compress involving the abdominal, lumbosacral, and plantar regions within 30 minutes, 24 hours, and 48 hours after delivery. The primary outcome was the incidence of postpartum urinary retention, defined as the first urination occurring more than 6.5 hours after delivery and/or use of an indwelling catheter within 72 hours after delivery. The secondary outcomes were postpartum uterine contraction pain intensity (assessed with the visual analog scale [VAS]), depressive symptoms (assessed with the Edinburgh Postnatal Depression Scale), and lactation conditions (including lactation initiation time, breastfeeding milk volume, feeding mood and times, and newborn weight). Of the 1200 participants randomized, 1085 completed the study (537 in the intervention group and 548 in the control group, with a median [IQR] age of 26.0 [24.0-29.0] years). Participants in the intervention group compared with the control group had significantly decreased incidence of postpartum urinary retention (relative risk [RR], 0.58; 95% CI, 0.35-0.98; P = .03); improved postpartum uterine contraction pain when measured at 6.5 hours (median [IQR] VAS score, 1 [1-2] vs 2 [1-2]; P < .001), 28.5 hours (median [IQR] VAS score, 1 [0-1] vs 1 [1-2]; P < .001), 52.5 hours (median [IQR] VAS score, 1 [0-1] vs 1 [0-1]; P < .001), and 76.5 hours (median [IQR] VAS score, 0 [0-1] vs 0 [0-1]; P = .01) after delivery; reduced depressive symptoms (RR, 0.73; 95% CI, 0.54-0.98; P = .01); and increased breastfeeding milk volume measured at 28.5, 52.5, and 76.5 hours after delivery. No adverse events occurred in either of the 2 groups. Results of this trial showed that acupoint hot compress after vaginal delivery decreased postpartum urinary retention, uterine contraction pain, and depressive symptoms and increased breastfeeding milk volume. Acupoint hot compress may be considered as an adjunctive intervention in postnatal care that meets patient self-care needs. Chinese Clinical Trial Registry Identifier: ChiCTR2000038417.

Objective To investigate the main reasons for post-partum urinary retention and treatment measures.Methods 2008 January-December 46 cases of urinary retention in patients with post-natal date were retrospectively analyzed.Results The main reason for post-partum urinary retention mainly uterine atony and psychological factors;the adoption of traditional Chinese and western medicine treatment,46 cases of patients with the exception of two cases of fever,increased WBC,severe urinaryt tract infections in conjunction with other treatment,the rest are government more.Conclusion In view of the reasons for the occurrence of postpartum urinary retention,targeted to the maternal treatment can reduce the incidence of postpartum urinary retention. Key words: Postpartum urinary retention; Reason; Treatment

Objective: This study was designed to assess the effects of preventive nursing care combined with auricular acupressure on the incidence of postpartum urinary retention in women with vaginal delivery. Methods: A total of 260 women who delivered vaginally in Shijiazhuang Fourth Hospital from March 2019 to March 2020 were enrolled into the observation group and the control group, with 130 cases in each group. Both groups were given preventive nursing, and the observation group was given additional auricular acupressure. The incidence of urinary retention, duration of voiding, residual urine volume, and indwelling urinary catheter were analyzed, and the treatment efficiency and satisfaction towards nursing care were compared. Results: The observation group showed a significantly lower incidence of urinary retention and experienced a significantly earlier time to first urination than the control group (both P&lt;0.001). The amount of residual urine at 6h and 24h after delivery in the observation group was significantly less than in the control group (P&lt;0.05).Fewer cases of indwelling urinary catheters were found in the observation group than those in the control group (P&lt;0.05). The treatment efficiency and nursing satisfaction in the observation group were both significantly better than those in the control group (P&lt;0.05). Conclusion: The combination of preventive nursing with auricular acupressure can contribute to a higher satisfaction among parturients by alleviating postpartum urinary retention, shortening the time to first voiding, reducing residual urine volume, and avoiding indwelling urinary catheters, so it merits clinical promotion.

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.

Post-partum urinary retention: a comparison between two methods of epidural analgesia

The three objectives of this study are: to investigate the incidence of post-partum urinary retention after vaginal delivery, to investigate the relationship between various obstetric parameters and the post-partum post-void residual bladder volume and to study the natural progression of the post-void residual bladder volume in patients with covert post-partum urinary retention. Women who had a vaginal delivery (n = 691) in a teaching hospital during a 2-month period were studied. They were classified into three groups: normal patients, those with overt urinary retention, and covert urinary retention. Their day 1 post-partum post-void residual bladder volume were recorded and analyzed with respect to the obstetric parameters. Patients with covert retention were followed up daily with ultrasound to monitor their post-void residual volume. The incidences of overt and covert retention in our unit were 4.9% and 9.7%, respectively. The overall incidence of post-partum urinary retention after vaginal delivery was 14.6%. The duration of the first and second stages of labor were significantly associated with the post-partum post-void residual bladder volume. In all patients with covert retention, their post-void residual volume returned to normal within 4 days. Post-partum urinary retention is a common phenomenon that may be related to the process of parturition. Covert retention is a self-limiting phenomenon and specific treatment is unnecessary.

Effect of the Duration of Labor on Postpartum Postvoid Residual Bladder Volume