Postpartum Urinary Retention After Cesarean Delivery

Abstract

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.