Self bladder emptying compared with Foley catheter placement for planned cesarean delivery: a randomized controlled trial

Abstract

BackgroundThe global cesarean delivery rate is high and continuing to increase. A bladder catheter is usually placed for the cesarean section as a distended bladder is assumed to be at higher risk of injury during surgery and to compromise surgical field exposure. Preliminary data suggest that self-bladder emptying (no catheter) at cesarean delivery may have advantages and be safe. ObjectiveTo evaluate self-bladder emptying to indwelling foley bladder catheterization for a planned cesarean on rate of postpartum urinary retention and maternal satisfaction. Study DesignA randomized controlled trial was conducted in a tertiary university hospital from January 10 2022 to March 22 2023. 400 participants scheduled for planned cesarean were randomized: 200 each to self-bladder emptying or indwelling foley catheter. The primary outcomes were postpartum urinary retention (overt and covert) and maternal satisfaction with allocated bladder care. Analyses were performed using t test, Mann-Whitney U and Chi-Square or Fisher exact test as appropriate. Logistic regression was used to adjust for characteristic differences. ResultsPostpartum urinary retention rates were 1/200 (0.6%) vs 0/200 p>0.99 (a solitary case of covert retention) and maternal satisfaction score (0-10 visual numerical rating scale) median [interquartile range] 9 [8-9.75] vs 8 [8-9] p=0.003 for self-bladder emptying vs indwelling foley catheter respectively. Of the secondary outcomes, for self-bladder emptying, recovery to flatus passage, satisfactory ambulation, urination, satisfactory urination, satisfactory breastfeeding, post-cesarean hospital discharge was quickened. Pain score at first urination was decreased and no lower urinary tract symptom was more likely to be reported. Surgical field view, operative blood loss, duration of surgery, culture-derived urinary tract infection, postvoid residual volume and pain score at movement were not different. There was no bladder injury. ConclusionSelf-bladder emptying increased maternal satisfaction without adversely impacting on postpartum urinary retention. Recovery was enhanced and urinary symptoms were improved. The surgeon was not impeded at operation. No safety concern was found