Intrapartum pudendal nerve block analgesia and risk of postpartum urinary retention: a cohort study

Åsa Henning Waldum,Ragnhild Sørum Falk,Mirjam Lukasse,Anne Flem Jacobsen,Anne Catherine Staff,Ingvil Krarup Sørbye

doi:10.1007/s00192-021-04768-0

Abstract

Introduction and hypothesisPudendal nerve block analgesia (PNB) is used as pain relief in the final stage of childbirth. We hypothesized that PNB is associated with higher rates of postpartum urinary retention.MethodsWe performed a cohort study among primiparous women with a singleton, cephalic vaginal birth at Oslo University Hospital, Norway. Women receiving PNB were included in the exposed group, while the subsequent woman giving birth without PNB was included in the unexposed group. We compared the likelihood of postpartum urinary retention, defined as catheterization within 3 h after birth. Logistic regression analysis stratified by mode of delivery was performed adjusting for epidural analgesia, episiotomy and birth unit.ResultsOf the 1007 included women, 499 were exposed to PNB and 508 were unexposed. In adjusted analyses, women exposed to PNB did not differ in likelihood of postpartum urinary retention compared to women unexposed to PNB in either spontaneous (odds ratio[OR]: 0.82, 95% confidence interval [CI] 0.55–1.22) or instrumental (OR 1.45, 95% CI 0.89–2.39) births. Furthermore, no differences between the groups were observed with excessive residual urine volume or catheterization after > 3 h.ConclusionsPNB was associated with neither risk of postpartum urinary retention nor excessive residual urine volume and is therefore unlikely to hamper future bladder function.

Highlights

Introduction and hypothesisPudendal nerve block analgesia (PNB) is used as pain relief in the final stage of childbirth
Adjusted analyses did not show any significant association between PNB and overt Postpartum urinary retention (PUR) in either spontaneous or instrumental births (Table 3)
Women exposed to PNB had 2 days longer gestational length at delivery and slightly larger babies compared to women unexposed to PNB

Summary

Introduction

Introduction and hypothesisPudendal nerve block analgesia (PNB) is used as pain relief in the final stage of childbirth. We hypothesized that PNB is associated with higher rates of postpartum urinary retention. Postpartum urinary retention (PUR) is a common condition following birth. PUR may lead to short- and long-term complications such as bladder dysfunction, recurrent urinary tract. The definitions by Yip et al [5] are frequently used [6, 7] They defined two distinct definitions: overt PUR (the inability to void at all the first 6 h after birth with the requirement of catheterization), which requires early intervention, and covert PUR (post-void residual urine volume of ≥ 150 ml after spontaneous micturition), which normalizes within 2–5 days in most cases [1, 5, 8]. Women with PUR volumes > 750 ml may need catheterization over an extended time period before normal bladder function restoration [10], there is no agreed retention volume above which there is a high risk for irreversible long-term bladder dysfunction

Methods

Results

Conclusion