Postpartum Urinary Retention after Vaginal Delivery: Frequency and Associated Factors from a Tertiary Care Hospital, Larkana, Pakistan

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.

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.

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.

This study aims to determine if systematic use of bladder scan accurately identifies more women with postpartum urinary retention compared with diagnosis using clinical signs and symptoms, alone. A prospective, quasi experimental study was performed at the Department of Obstetrics and Gynecology, County Hospital Ryhov, Jonkoping, Sweden. A total of 252 women participated in this study; they were women who gave birth between the period of March and April, 2011. One hundred and twenty-six women were included in an experimental group, they received ultrasound scanning of post-void residual bladder volume for identification of urinary retention; patients were catheterized if post-void residual bladder volume was ≥400 ml. A control group of 126 women, matched by parity and age, were also included. The latter group were catheterized on clinical signs or symptoms of urinary retention. Twenty-one women in the experimental group were identified as having post-void residual bladder volume ≥400 ml compared to 9 in the control group, verified by catheterization (p 120 min, active pushing >30 min and perineal tear. Oxytocin infusion and perineal tear were independent risk indicators in a multivariable regression analysis. Systematic bladder scanning identifies more women with postpartum urinary retention in women with vaginal delivery than diagnosis by clinical signs and symptoms, alone. Oxytocin infusion and perineal tear are independent risk indicators for urinary retention in new delivered women. Key words: Postpartum urinary retention, postpartum voiding dysfunction, bladder scanning, catheterization, birth.

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

Postpartum urinary retention and its associated obstetric risk factors among women undergoing vaginal delivery in tertiary care hospital

Objective: To determine the factors responsible for postpartum urinary retention after vaginal delivery in women. Materials and methods: This is an observational study conducted in the department of obstetrics and gynecology Rai medical College Sargodha. Study was completed in six months duration from July 2022 to December 2022. Patients undergoing spontaneous vaginal delivery and experienced urinary retention till six hours postpartum were labelled as case of postpartum urinary retention (PPUR). Total 120 cases of PPUR were included in this study after following inclusion and exclusion criteria. Results: Frequency of PPUR after vaginal delivery was 10(8.3%). Main factors causing PPUR include epidural analgesia in 3(37.5%) and prolong duration of labor in 2(25%) cases. Mean age of the study cases was 27.8 ± 4.2 years. Mean gestational age was 38.12 ± 2.2 weeks. Practical Implication: In this study our aim was to assess risk factors developing postpartum urinary retention (PPUR) in women who underwent vaginal delivery in order to identify women with increased risk of developing symptomatic PPUR so that this problem may be noted in post natal care and may be managed properly. There is no previously sufficient data related to this problem in our population so this study will help us to understand the disease burden in our society. Conclusion: Main risk factors of postpartum urinary retention after vaginal delivery include prolonged labor and epidural analgesia. Keywords: Postpartum hemorrhage, Vaginal delivery, Risk factors, Urinary retention, Prolong labor,

Management of postpartum urinary retention: a multi-center randomized controlled trial

To create a reference curve for postvoid residual volume (PVRV) in asymptomatic postpartum women who are at low risk of developing postpartum urinary retention (PUR), a well-known complication in the immediate postpartum period. This is a prospective observational study measuring PVRV after uncomplicated vaginal delivery. PVRV was assessed by transabdominal ultrasound using a portable ultrasound scanner within the first 26 h after delivery (PVRV 1) and on the day of discharge (day 2 or 3 postpartum) (PVRV 2). A PVRV of 150 mL or more was defined as the cut-off value for covert PUR. The prevalence of covert PUR was 7.1%. Primiparity, duration of second stage, and obstetric injury were correlated with higher PVRV 1. The median PVRV 1 was 21 mL and PVRV 2 was 11 mL. The subgroup of nulliparous women had a significantly higher PVRV 1 compared with multiparous women. At discharge, the majority (99.1%) of women had a PVRV of less than 150 mL. Asymptomatic women were at low risk of developing PUR. However, women with a prolonged second stage may benefit from a routine postpartum assessment. Our results allow for a better understanding of PVRV in the early postpartum period.

Postpartum urinary retention after vaginal delivery

Postpartum urinary retention after cesarean delivery

There is conflicting evidence on whether intermittent catheterization (IC) is less associated with urinary tract infection (UTI) and more likely to prevent urinary retention than continuous catheterization (CC). We aimed to compare the effect of IC with that of CC on the incidence of postpartum UTI, urinary retention and hemorrhage in laboring women with epidural analgesia. Electronic searches were performed in PubMed, EMBASE and Cochrane Library from their inception to October 2018. We selected RCTs comparing IC with CC in laboring women with epidural analgesia. A meta-analysis was performed using the RevMan software, and a random-effects model was used to pool the effect size. The Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach was used to rate the quality of evidence. Six RCTs (N = 850) were included in this review. The meta-analyses indicated that there was no significant difference between the IC and CC group in the incidence of postpartum UTI (RR = 1.25, 95% CI: 0.91 to 1.71, P = 0.16), postpartum urinary retention (RR = 0.76, 95% CI: 0.21 to 2.77, P = 0.68) and postpartum hemorrhage (RR = 1.72, 95% CI: 0.60 to 4.95, P = 0.31). GRADE assessment results showed that the quality of evidence was low. Based on the available evidence, there is no measurable difference in rates of UTI between CC and IC, not that neither stragety decreases UTI, since the included trials do not address this.

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.

Objective: To determine the frequency and factors contributing to post-partum urinary retention (PPUR) after vaginal delivery. Study Design: Observational study. Setting: Department of Obstetrics and Gynecology, Gambat Institute of Medical Sciences Gambat, Khairpur Sindh. Period: 1st November 2018 to 30th June 2019. Material &amp; Methods: Out of 114 patients delivered vaginaly at Gambat Institute of Medical Sciences Gambat, Khairpur Sindh, postnatal patients who do not urinate within 6 hours after normal viginal delivery, label as a case of PPUR following the inclusion and exclusion criteria. Results: Frequency of postpartum urinary retention (PPUR) after vaginal delivery was observed in 6.14% (7/114). Significant risk Factors contributing to post-partum urinary retention (PPUR) were Prolong labor and epidural analgesia. Conclusion: We concluded that statistically significant risk factors for postpartum urinary retention were epidural analgesia and prolong labor. So attention to bladder care during labor and vigilance in the early detection.

To assess the obstetrics risk factors for postpartum urinary retention after vaginal delivery. Of 234 women with a vaginal delivery, 19 (8.1%) women who had postpartum urinary retention were cases, and 215 (91.9%) women who did not were controls. Postpartum urinary retention was defined as the presence of postvoid residual bladder volume ≥150 mL or the inability to void within 6 hours after vaginal delivery. Logistic regression analysis identified risk factors for urinary retention. Prolonged duration of the second stage of labor (OR=0.46, 95% CI for OR=0.06-3.67, p<0.001), presence of episiotomy (OR=0.07, 95% CI for OR=0.01-0.68, p=0.022) and perineal laceration (OR=97.09, 95% CI for OR=7.93-1188.93, p<0.001), and birth weight of >4000 g for the newborn (OR=0.04, 95% CI for OR=0.01-0.20, p<0.001) were found as independent risk factors for postpartum urinary retention after vaginal delivery. Postpartum urinary retention after vaginal delivery is a relatively common condition. Awareness of risk factors, including prolonged second stage of labor, episiotomy, perineal lacerations, and macrosomic birth, may allow us to take the necessary precautions against this complication.