Postpartum Urinary Retention Research Articles

Influencing Factors in Urinary Retention in Parturients With Epidural Anesthesia Following Term Vaginal Birth.

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.

Diagnoses of postpartum urinary retention using next-generation non-piezo ultrasound technology: assessing the accuracy and benefits

Postpartum urinary retention has a wide range of publicized incidences, likely caused by frequent misdiagnosis of this puerperal complication. Especially covert postpartum urinary retention has a high number of missed diagnoses due to the lack of symptoms and the time-extensive diagnostics via ultrasound, leading to no treatment and no appropriate follow-up. To simplify the diagnosis and establish a screening tool we analyzed the application of portable handheld-ultrasound devices (PUD) as used in Point-of-care diagnostics in comparison to established standard ultrasound devices (SUD). This prospective study aimed to evaluate the reliability of non-piezo, chip-based PUD in comparison to the measurement withSUD, containing a piezo transducer, as golden standard for the ultrasound diagnosis of postpartum urinary retention. Randomly, 100 participants between the first and seventh day after delivery in an obstetric ward underwent ultrasound examinations using a EPIQ 5 W (Philips) as SUD and a Butterfly iQ (Butterfly Network) as PUD to compare the accuracy in bladder size after micturition and the estimated post-void residual volume. Intraclass correlation coefficients, Bland-Altman plots, and Pearson correlation coefficients were used for analyzing the reliability and agreement between the measurements of these devices and were calculated for subgroups as body mass index, mode of delivery and timepoint of delivery. The results show a near-perfect agreement (0.994) and correlation (r = 0.982) for estimated post-void residual volume and for most measurements between the two types of ultrasound devices. The agreement rate for the diagnosis of covert postpartum urinary retention is 100%. Subgroup analyses lack a significant difference reflected by agreement and correlation rates. These findings affirm the high reliability of PUD for the diagnosis of postpartum urinary retention and supports their integration into daily clinical practice, thereby simplifying regular controls of the bladder by physicians during daily rounds on the ward. This technology may allow a higher diagnosis rate so that patient care can be optimized and the long-term impact on continence and quality of life can be studied and analysed.

Profile of postpartum patients with urinary retention at Koja Regional Hospital, Jakarta, Indonesia

HIGHLIGHTS Maternal age and fetal birth weight are key risk factors for PPUR. Among 300 subjects, 63.7% experienced PPUR, identified using the Suskhan score, with catheterization as a useful tool for prevention and management planning. ABSTRACT Objective: Postpartum urinary retention (PPUR) is a common voiding disorder, defined as the inability to void spontaneously within 6 hours after delivery with a residual bladder volume exceeding 200 mL. High rates of PPUR in Indonesia indicate a need for greater awareness and intervention. This study aims to assess the incidence and potential contributing factors of PPUR among postpartum patients at Koja Regional Hospital in Jakarta, Indonesia. Materials and Methods: A descriptive case-control study was conducted, including women who experienced urinary retention following vaginal delivery at Koja Hospital between September and December 2022. Residual urine volume was measured by catheterization 6 hours after delivery. Data analysis, performed using SPSS version 22, included patient demographics and clinical factors such as maternal age, parity, gestational age, neonatal birth weight, and postvoid residual urine volume. These factors were analyzed to determine their association with PPUR. Results: Out of 300 subjects selected through consecutive random sampling, 63.7% experienced PPUR, while 36.3% had normal urinary function. Patients with a mean age of 26.91 ± 5.02 years (p = 0.000), primiparous status (first-time mothers) (p &lt; 0.001), and a mean neonatal birth weight of 2980.95 ± 450.52 grams (p = 0.000) showed a higher risk of developing PPUR compared to other postpartum patients. Conclusion: The study indicates a significant association between postpartum urinary retention and maternal factors, including younger age, primiparity, and higher neonatal birth weight. Identifying these high-risk factors can enhance PPUR management, allowing healthcare providers to implement targeted monitoring and preventive measures, potentially improving postpartum outcomes in this patient population. This underscores the importance of monitoring these risk factors to better manage and potentially mitigate the incidence of PPUR.

The Risk Factors of Postpartum Urinary Retention for Women by Vaginal Birth: A Systematic Review and Meta-Analysis.

Postpartum urinary retention is one of the most common complications in women during the immediate postpartum period. The objective was to systematically assess risk factors for postpartum urinary retention after vaginal delivery. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses, we retrieved relevant studies from PubMed, Embase, Cochrane Library, Web of Science Core Collection, China National Knowledge Internet, Wangfang Database, and Chinese Biomedical Database for observational studies investigating the risk factors for postpartum urinary retention from inception to 11 November 2022. The Newcastle-Ottawa Scale and Joanna Briggs Institute's tool were used to assess the risk of bias. We conducted a meta-analysis using RevMan 5.3. In total, 3,074 articles were screened and data from 27 studies were used in the meta-analysis. Sixteen risk factors were identified, namely, labor augmentation (OR = 1.72, 95% CI = 1.17-2.51), primiparity (OR = 2.36, 95% CI = 1.64-3.38), manual fundal pressure (OR = 2.84, 95% CI = 1.00-8.11), perineal hematoma (OR = 7.28, 95% CI = 1.62-32.72), vulvar edema (OR = 7.99, 95% CI = 5.50-11.63), the total duration of labor (MD = 90.10, 95% CI = 49.11-131.08), the duration of the first stage of labor (MD = 33.97, 95% CI = 10.28-57.65), the duration of the second stage of labor (MD = 14.92, 95% CI = 11.79-18.05), the duration of the second stage of labor > 60min (OR = 3.18, 95% CI = 1.32-7.67), mediolateral episiotomy (OR = 3.65, 95% CI = 1.70-7.83), severe perineal tear (OR = 3.21, 95% CI = 1.84-5.61), epidural analgesia (OR = 3.23, 95% CI = 1.50-6.96), forceps delivery (OR = 4.95, 95% CI = 2.88-8.51), vacuum delivery (OR = 2.44, 95% CI = 1.30-4.58), neonatal birth weight > 4,000g (OR = 3.61, 95% CI = 1.96-6.65), and neonatal birth weight > 3,500g (OR = 1.89, 95% CI = 1.12-3.19). Our results demonstrated that labor augmentation, primiparity, manual fundal pressure, perineal hematoma, vulvar edema, the total duration of labor, the duration of the first stage of labor, the duration of the second stage of labor, the duration of the second stage of labor > 60min, mediolateral episiotomy, severe perineal tear, epidural analgesia, forceps delivery, vacuum delivery, and neonatal birth weight > 4,000g and > 3,500g were risk factors for postpartum urinary retention in women with vaginal delivery. The specific ranges of the first and the second stages of labor causing postpartum urinary retention need to be clarified.

Incidence, risk factors and diagnostic accuracy of clinical palpation in picking up post-void residual urine in postnatal women.

To determine the incidence of covert and overt postpartum urinary retention after vaginal delivery and the associated risk factors for postpartum urinary retention. To determine how well clinical examination by abdominal palpation correlates with ultrasound findings of urinary retention. Patients after delivery were screened with ultrasound and examined clinically to check for retention of urine after voiding. A total of 822 of women were recruited in the study of which 86 (10.5%) women had significant post-void residue of urine. 33 (38.4%) had overt retention, while 53 (61.6%) had covert retention. Duration of labour and an increased VAS score were found to be significantly higher among those with urinary retention. Using clinical examination to diagnose postpartum urinary retention had a sensitivity of 66.1%, specificity of 88.6%, positive predictive value of 76.5% and negative predictive value of 82.3%. Clinical examination by abdominal palpation is not a very sensitive test in diagnosing PPUR.

Risk factors for postpartum urinary retention: An updated systematic review and meta-analysis.

There are conflicting reports on the factors that increase the likelihood of postpartum urinary retention (PUR). We completed an updated systematic review and meta-analysis to identify the risk factors for PUR. An exhaustive search of the literature was undertaken using multiple databases, including PubMed, Web of Science, the Cochrane Library, and Embase to identify pertinent studies published up until November 4, 2023. Observational studies that provided outcomes to calculate the risk factors for PUR were included. Two investigators separately performed the extraction of pertinent data from the articles. The risk factors for PUR were identified by pooling adjusted and unadjusted odds ratios (ORs) and 95% confidence intervals (CIs). Heterogeneity test, sensitivity analysis, and publication bias assessment were performed. This meta-analysis included 21 studies with a total of 36 951 participants. Meta-analysis was performed for 14 risk factors, and eight of these were statistically significant. The risk factors that were identified in this review included instrumental delivery (OR, 2.96 [95% CI, 1.82-4.80]; 95% prediction interval [PI], 0.67-12.98), relatively long duration of labor (OR, 1.04 [95% CI, 1.02-1.06]; 95% PI, 1.00-1.08), episiotomy (OR, 1.56 [95% CI, 1.19-2.06] 95% PI, 0.64-3.83), nulliparity (OR, 1.55 [95% CI, 1.30-1.84]; 95% PI, 0.94-2.77), epidural analgesia (OR, 2.99 [95% CI, 1.78-5.03]; 95% PI, 0.53-16.76), labor augmentation (OR, 2.21 [95% CI, 1.49-3.28]; 95% PI, 0.12-39.26), labor induction (OR, 1.73 [95% CI, 1.12-2.66]; 95% PI, 0.40-7.39), and perineal injury (OR, 2.75 [95% CI, 1.95-3.89]; 95% PI, 1.10-6.92). Instrumental delivery, extended labor duration, episiotomy, nulliparity, epidural analgesia, labor augmentation/induction, and perineal injury are significant risk factors for PUR. The findings could help physicians identify patients at risk in the postpartum setting.

Acupoint massage, acupoint sticking combined with moxibustion for postpartum urinary retention: a randomized controlled trial

To observe the clinical efficacy of acupoint massage, acupoint sticking combined with moxibustion at Shuidao (ST 28) for postpartum urinary retention. A total of 120 patients with postpartum urinary retention were randomly divided a triple-combination group, a double-combination group, and a massage group, with 40 patients in each group. All groups received standard postpartum care to stimulate urination. The patients in the massage group received rapid acupoint massage at the bilateral Shuidao (ST 28); the patients in the double-combination group additionally received acupoint sticking of self-made Tongquan powder at bilateral Shuidao (ST 28); the patients in the triple-combination group further received moxibustion at bilateral Shuidao (ST 28). The treatment was given once in all three groups. After 5 hours of treatment completion, bladder residual volume was measured; the time and volume of first urination as well as total urination volume after 5 hours of treatment completion were recorded; the patients' sensation of urination smoothness, satisfaction rate, length of hospital stay, and hospital costs were evaluated. The triple-combination group showed significantly lower residual urine volumes (P<0.05), earlier first urination time (P<0.05, P<0.001), and higher first urination volumes and total urination volumes after 5 hours of treatment completion compared to the other two groups (P<0.05, P<0.001). The sensation of urination smoothness and patient satisfaction were also significantly better in the triple-combination group (P<0.001, P<0.05). The double-combination group had higher volume of first urination and total urination volume after 5 hours of treatment completion than the massage group (P<0.05), and better sensation of urination smoothness and patient satisfaction (P<0.05). There was no significant difference in the length of hospital stay and costs among the three groups (P>0.05). The total effective rates were 100.0% (40/40) for the triple-combination group, 90.0% (36/40) for the double-combination group, and 70.0% (28/40) for the massage group, with the triple-combination group significantly outperforming the other two groups (P<0.05, P<0.001), and double-combination group outperforming the massage group (P<0.05). Acupoint massage, acupoint sticking combined with moxibustion at Shuidao (ST 28) could effectively improve urination in patients with postpartum urinary retention, and enhance patient satisfaction.

The Effectiveness and Safety of Intrapartum or Postpartum Catheterization in the Prevention of Postpartum Urinary Retention: A Scoping Review.

Catheterization is a common treatment for postpartum urinary retention (PUR); however, its application before diagnosis of PUR remains unclear. The aim was to give an overview of the existing literature on the effectiveness and safety of intrapartum or postpartum catheterization in the prevention of PUR. This scoping review followed a methodological framework. PubMed, the Cochrane Library, Embase, Web of Science, the China National Knowledge Infrastructure, WanFang, the China Science and Technology Journal Database, and the China Biomedical Literature Database were searched from the inception of each database to 21 May 2023. The search revealed 16 studies examining three different catheterization methodologies, including 12 intrapartum studies. Ten studies concluded that intrapartum or postpartum catheterization prevented PUR, two of which were only for overt or covert PUR. In 4 out of 13 experimental studies, no significant difference was found: one for intrapartum catheterization versus routine nursing, the other for intrapartum or postpartum intermittent versus indwelling catheterization. However, one found that postpartum disposable catheterization after ineffective targeted care reduced the incidence of PUR compared with indwelling catheterization. One out of the 3 case-control studies concluded that prenatal catheterization ≥2 times was a risk factor for PUR. Based on the findings in this scoping review, catheterization prior to the diagnosis of PUR appears to play a role in preventing PUR and is safe. Preliminary evidence is accumulating on the effectiveness of three types of catheterization methods in preventing PUR, but more comprehensive studies are needed to establish these findings.

Effect of percutaneous electrical stimulation at the Baliao point on preventing postpartum urinary retention after labor analgesia

BACKGROUND Anesthetic drugs used in labor analgesia also paralyze the bladder muscle by blocking the sacral plexus, thereby affecting maternal postpartum spontaneous urination and increasing the risk of postpartum urinary retention (PUR). AIM To analyze the effect of percutaneous electrical stimulation at the Baliao point combined with biofeedback therapy for PUR prevention. METHODS We selected 182 pregnant women who received labor analgesia in obstetrics between June 2022 and December 2023. They were divided into the combined therapy group (transcutaneous electrical stimulation of the Baliao point combined with biofeedback therapy) and the control group (biofeedback therapy alone). The first spontaneous urination time, first postpartum urine volume, bladder residual urine volume, postpartum hemorrhage volume, pre-urination waiting time, PUR incidence, adverse reactions, and the intervention’s clinical efficacy were compared between the two groups. RESULTS The first spontaneous urination time after delivery was more delayed (2.92 ± 1.04 h vs 3.61 ± 1.13 h, P &lt; 0.001), with fewer initial postpartum urine (163.54 ± 24.67 mL vs 143.72 ± 23.95 mL, P &lt; 0.001), more residual bladder urine (54.81 ± 10.78 mL vs 65.25 ± 13.52 mL, P &lt; 0.001), more postpartum bleeding (323.15 ± 46.95 mL vs 348.12 ± 45.03 mL, P = 0.001), and longer waiting time for urination (0.94 ± 0.31 min vs 1.29 ± 0.42 min, P &lt; 0.001), in the control group than in the combined therapy group. The control group also had higher PUR incidence (4.65% vs 15.85%, P = 0.016). Both groups had no adverse reactions, but the clinical total efficacy rate of the intervention was significantly higher in the combined therapy group than in the control group (95.35% vs 84.15%, P = 0.016). CONCLUSION Percutaneous electrical stimulation of the Baliao point combined with biofeedback can significantly promote postpartum micturition of parturients with labor analgesia, thereby effectively preventing PUR occurrence.

Effect of Low-Frequency Pulsed Electrotherapy Combined with Acupoint Nursing on Postpartum Urinary Retention in Patients with Vaginal Delivery.

This study was carried out to investigate the effect of low-frequency pulsed electrotherapy combined with acupoint massage on postpartum urinary retention (PUR). The patients were divided into control group, intervention group 1, and intervention group 2 according to the nursing method. The control group received conventional postpartum care, intervention group 1 received conventional postpartum care and low frequency pulsed electrotherapy, and intervention group 2 received conventional postpartum care, low-frequency pulsed electrotherapy, and Shuidao point massage. The bladder function, comfort score, and quality of life score before and after intervention were compared among the three groups. The bladder function, comfort level, and quality of life of intervention group 1 and intervention group 2 after nursing were significantly better than those of the control group. In addition, intervention group 2 had better bladder function than intervention group 1, with lower residual urine volume and higher bladder compliance. In the Kolcaba score, the mental dimension of intervention group 2 was significantly higher than that of intervention group 1. In terms of QOL scores, the social function, physical function, and state of material life scores of intervention group 2 were significantly higher than those of intervention group 1. Low-frequency pulsed electrotherapy combined with acupoint massage can significantly improve the bladder function, comfort, and quality of life of patients with PUR.

Postpartum Urinary Retention With Essential Oils

Postpartum Urinary Retention With Essential Oils

Study on the Application Effect of Flexible Nursing Care in Patients with Postpartum Urinary Retention and its Effect on Lactation

Objective: To study the application effect of flexible nursing in patients with postpartum urinary retention and its effect on lactation. Methods: A total of 200 cases of postpartum urinary retention patients admitted between January 2021 and January 2022 were selected and randomly grouped into two groups, a control group (conventional nursing) and an observation group (flexible nursing), of 100 cases each. The time of onset of lactation, the lactation volume score, urinary indicators, the amount of post-partum hemorrhage, and the quality of life score of the two groups were compared. Results: The observation group’s lactation initiation time (21.41 ± 1.52) h and lactation volume score (2.11 ± 0.52) were better than that of the control group (P &lt; 0.05). The observation group’s first urination time (2.11 ± 0.51) min was lower than the control group, while the urinary retention completely relieved time (33.12 ± 8.61) h, and first urinary volume (262.17 ± 52.41) mL was higher than that of the control group (P &lt; 0.05). The amount of postpartum hemorrhage in the observation group (151.21 ± 22.12) mL was less than that in the control group (P &lt; 0.05). The scores of somatic functioning (86.25 ± 2.20), psychological functioning (91.56 ± 1.45), social functioning (89.25 ± 2.45), and material life (89.75 ± 1.45) of the observation group were higher than those of the control group after nursing (P &lt; 0.05). Conclusion: Flexible nursing care in patients with postpartum urinary retention exhibited significant nursing effects and lactation function was effectively improved.

Risk factors for postpartum urinary retention: a case-control study

Risk factors for postpartum urinary retention: a case-control study

STUDI KASUS: ASUHAN KEBIDANAN PASKA PERSALINAN DENGAN RETENSIO URINE

Postpartum urinary retention is defined as the absence of spontaneous urination or the inability to urinate spontaneously starting 6 hours after vaginal delivery, and the inability to urinate spontaneously 6 hours after catheter removal during delivery with the following actions:caesarean section. This complaint can be caused by hormonal changes, changes in the contractile response of the bladder, innervation trauma that occurs in the bladder, and several other risk factors, namely perineal laceration or episiotomy, delivery with the help of tools, duration of the first stage of labor.&gt;12 hours, duration of second stage of labor&gt;1 hour in multiparas, and birth weight of the baby&gt;3800 grams. The aim of this research is to provide midwifery care to mothers after giving birth who complain of not being able to urinate since 3 days after giving birth. Care is carried out by paying attention to midwifery management steps according to Helen Varney. The research was carried out from 27 March to 09 April 2023 at Gunung Jati Hospital, Cirebon City, using a case study research method and the research subject was Mrs W P1 A0 aged 23 years. Primary and secondary data collection. Primary data was obtained through interviews, observation and physical examination, while secondary data was obtained through documentation and literature studies. The analysis used is descriptive and exploratory through studying data from research subjects. The results of the care were discussed by taking into account similar previous research and a review of relevant literature so that it could be concluded that there was no gap between theory and the care given to Mrs W

Evaluation of risk factors of postpartum urinary retention after vaginal delivery

BackgroundUrinary retention is a condition where a person is unable to urinate even after making sufficient efforts. It can be classified as either acute or chronic, as well as overt or covert. Urinary retention can be caused by various factors such as poor detrusor muscle contraction, a decrease in bladder contractility, anatomical anomalies, impaired neurological coordination while urinating, and disruption of outlet relaxation. The objective of this study was to identify the risk factors of postpartum urinary retention (PPUR) after vaginal delivery. MethodsA cross-sectional study was conducted involving 500 female subjects who were in labor. All data obtained including variables such as age, parity, perineal rupture, episiotomy, history of using assisted vaginal birth during labor, and newborn weight, were compared between female subjects with and without postpartum urinary retention. The data were was analyzed using chi square test and multiple logistic regression analyses as a means to identify risk factors for PPUR. Results Among the 500 patients recruited to our study, 68 (13.6%) had PPUR. Episiotomy and parity were found to be potential risk factors for PPUR (OR=1.84;95% CI = 1.06-3.18 and OR=2.19;95% CI = 1.16-4.12, respectively). Severe perineal rupture was not a risk factor of PPUR (OR= 0.82;95% CI =0.82-5.89). ConclusionThe prevalence of PPUR was quite high. Risk factors identified for PPUR were parity and episiotomy. In clinical practice, healthcare providers should pay more attention to women with these risk factors to prevent PPUR.

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

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

Use of Opioids and Epidural Anaesthesia in Labor Analgesia as Important Risk Factors for Apparent Postpartum Urinary Retention: A Case-Control Study.

Labor analgesic interventions, particularly the use of opioids and epidural anaesthesia, have raised concerns regarding their potential impact on postpartum urinary retention (PUR), necessitating a comprehensive investigation into their association with this clinical outcome. This retrospective case-control study analysed clinical data from postpartum patients at our hospital from January 2023 to December 2023. Anaesthetic methods, including opioid and non-opioid drug usage, epidural analgesia and non-use of analgesia, were assessed. Logistic regression analysis was also performed to determine important associations with apparent PUR. This study included clinical data from 54 postpartum patients with PUR and 54 without urinary retention. A higher percentage of women with apparent PUR received opioids during labour compared with those without PUR (p = 0.033). Conversely, a lower percentage of women with apparent PUR received non-opioid analgesics compared with those without PUR (p = 0.026). In addition, a higher percentage of women with apparent PUR received epidural analgesia compared with those without PUR (p = 0.041). Logistic regression analysis demonstrated that opioid consumption during labour was significantly associated with apparent PUR (odds ratio (OR) = 2.469, p = 0.022). By contrast, non-opioid consumption during labour was inversely associated with apparent PUR (OR = 0.297, 95% CI = 0.123-0.681, p = 0.005). In addition, the use of epidural analgesia during labour showed a remarkable association with apparent PUR (OR = 2.857, 95% CI = 1.289-6.552, p = 0.011). Opioid use during labour and the use of epidural analgesia were identified as important risk factors for apparent PUR. These findings emphasise the need for a thoughtful and balanced approach to analgesic management during labour to minimise the risk of PUR in obstetric patients.

Effectiveness of Hydromorphone Hydrochloride Combined with Bupivacaine for Combined Spinal and Epidural Anaesthesia in Reducing Postpartum Urinary Retention: A Retrospective Study.

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.

Задержка мочеиспускания как следствие родовых травм матери

Postpartum urinary retention (ischuria, PUR) is the absence of spontaneous urination in a woman in labor more than 6 hours after the birth of a child or a condition in which the residual volume of urine after urination is less than 150 cm3. The ischuria pathophysiology is not fully understood, but there are several hypotheses that may cause the occurrence of urinary retention in the early postpartum period. For example, trauma to the pelvic floor muscles and innervation can lead to decreased bladder sensitivity, and swelling of the ureters and vagina after childbirth can lead to urinary tract obstruction. Despite the frequency of complications in the form of ischuria, the maternity hospital staff does not pay sufficient attention to screening for these problems in the early and late postpartum periods. This literature review examines risk factors, clinical presentation, prevention methods and examples of treatment for this dangerous complication.

Prolonged second stage of labor in delivery using epidural analgesia is a risk factor for postpartum urinary retention.

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.