Risk Of Postpartum Urinary Retention Research Articles

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 < 0.001), with fewer initial postpartum urine (163.54 ± 24.67 mL vs 143.72 ± 23.95 mL, P < 0.001), more residual bladder urine (54.81 ± 10.78 mL vs 65.25 ± 13.52 mL, P < 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 < 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.

RESEARCH ON POSTPARTUM URINARY RETENTUON AND SOME RELATED FACTORS IN VAGINAL DELIVERY IN DA NANG HOSPITAL FOR WOMEN AND CHIDREN

Objective: To determine the rate of urinary retention after vaginal delivery and evaluation some factorsrelated to urinary retention after vaginal delivery at Da Nang Hospital For Women And Chidren.Methods: Cross-sectional study describing 673 women giving birth vaginally, at Da Nang HospitalFor Women And Chidren from March 2018 to the end of September 2018. The pregnant womenin the research group will be examined, interviewed, and refer to the medical records to record thevariables according to the research questionnaire.Results: Women who are primigravida with postpartum urinary retention rate 6.6%, higher than2.4% for multigravida who have postpartum urinary retention. In infants with a weight of ≥ 3500grams, the prevalence of birth urinary retention was 16.7%, higher than that of women with babies<3500 grams with neonatal urinary retention (1.7%). The rate of postpartum urinary retention amongwomen who had a baby with a head circumference ≥ 36 cm was 24.3% higher than for women with ahead circumference <36 cm (3.6%). The rate of urinary retention in pregnant women: asisted vaginaldelivery was 50.0%; time of labor in stage 1 lasted ≥ 12 hours was 13.0%; the duration of second stagelabor was 16.4% prolonged, higher than the rate of urinary retention in the group of pregnant women:vaginal delivery (4.6%); period of labor for stage 1 <12 hours (2.1%); period of labor for stage 2 didnot last long (3.3%). In the group of women who did not exercise early after giving birth, the rate ofurinary retention was 37.5%, higher than this group of women with early movement after birth, 1.3%.Conclusion: The rate of urinary retention after vaginal delivery is 4.8%. Factors: giving birth incomparison, giving birth to a large baby with a gestational weight: ≥ 3500 grams, head circumference≥36 cm, asisted vaginal delivery, long stage 1 labor, long stage 2 labor, early postpartum inactivityincreases the risk of postpartum urinary retention

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

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.

Postpartum urinary retention in women undergoing instrumental delivery: A cross-sectional analytical study.

Women undergoing instrumental delivery are known to be at higher risk of urinary retention, which can lead to long-term complications such as voiding dysfunction. Nulliparous women undergo a pronounced and sudden change in the perineum due to stretching during delivery, which may add to the perineal trauma from an episiotomy, increasing the risk of urinary retention. We aim to study the incidence and risk factors associated with postpartum urinary retention in women undergoing instrumental delivery. Pregnant women who had an instrumental delivery after 37weeks of gestation at JIPMER, Puducherry, India, between January 2017 and June 2017 were included in the study. Postpartum urinary retention was defined as the inability to void spontaneously or ultrasonographic documentation of post-void residual volume of >150mL, 6hours after delivery. Demographic factors, clinical profile and follow-up of these patients were noted. Multivariate logistic regression analysis was performed to assess the risk factors associated with urinary retention and was presented as adjusted odds ratios (OR) with 95% confidence intervals (CI). Postpartum urinary retention was noted in 124 (20.6%) women undergoing instrumental delivery. Overt and covert urinary retention occurred in 2.3% and 18.3%, respectively. After adjusting for other risk factors, nulliparity (adjusted OR=4.05, 95% CI 2.02-8.12 compared with multiparity) and prolonged second stage (OR=3.96, 95% CI 1.53-10.25) compared with suspected fetal compromise as an indication for instrumental delivery was associated with increased risk of postpartum urinary retention. Interaction was noted between parity and episiotomy on the occurrence of postpartum urinary retention (P=.010). Among nulliparous women, those with episiotomy (adjusted OR=6.10, 95% CI 2.65-14.04) have higher odds of developing postpartum urinary retention compared with those without episiotomy. Approximately one of five (20.6%) women undergoing instrumental delivery developed postpartum urinary retention. Among women undergoing instrumental delivery, episiotomy increased the chances of developing postpartum retention in nulliparous but not multiparous women. Prolonged second stage as an indication for instrumental delivery also increased the chances of retention. Future studies are needed to define the cutoff for diagnosis and to evaluate the long-term effects of covert postpartum urinary retention, as well to study the effect of episiotomy on development of postpartum urinary retention in women undergoing instrumental delivery.

Overt and Covert Postpartum Urinary Retention, Risk Factors and Complications

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.
 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.
 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).
 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.

The application of nursing cooperation between parturient and postpartum nurses in the management of micturition after vaginal delivery

Objective To observe the effect of nursing cooperation between parturient and postpartum nurses in the management of micturition after vaginal delivery. Methods A total of 100 cases of pregnant women who were produced by vaginal delivery in the Second People's Hospital of Zhanjiang City, Guangdong Province (the Second Affiliated Hospital of Guangdong Medical University) (January to March 2018) and a total of 100 cases of pregnant women after the implementation (April to June 2018) were divided into the control group and the test group.The control group received routine post-natal urine discharge management, and the test group received the intervention of nursing management in post-natal and post-natal urination in the area of maternity ward and postpartum zone.The observation indexes of the two groups after intervention were compared. Results The first time of spontaneous excretion of urine and the incidence of postpartum urinary retention in the trial group were significantly lower than those in the control group, and the score of nursing satisfaction after puerperal urination was significantly higher than that in the control group, and the differences were satistically significant (P<0.05). Conclusions Using the collaboration between the delivery room and the post natal nurses to develop the nursing mode to carry out the urination management after vaginal delivery can help the parturient to successfully grasp the period of postpartum urination window, reduce the risk of postpartum urinary retention and improve the satisfaction of postpartum urination nursing. Key words: Crucial care; Vaginal delivery; Postpartum urination; Urinary retention

Risk factors for overt postpartum urinary retention-the effect of the number of catheterizations during labor.

Our aim was to examine the effect of the number of catheterizations during labor on the development of overt postpartum urinary retention (PUR) in women who had a vaginal delivery with epidural anesthesia. A single-center retrospective matched case-control study between 1 January 2015 and 31 December 2016. Women who developed overt PUR were compared with those who did not following a singleton vaginal delivery with epidural anesthesia. For each study two controls, matched for maternal age, gestational age at delivery, and parity, were selected. Each woman's controls were the immediate subsequent or previous delivery that met matching criteria. Two hundred parturients with overt PUR were matched with 400 parturients without overt PUR. In univariate analysis, women with PUR underwent significantly more catheterizations during labor, had an epidural for a longer period of time, and were more likely to have undergone a vacuum-assisted delivery and a mediolateral episiotomy (p < 0.01 for all). In multivariate analysis controlling for epidural duration, episiotomy, and vacuum-assisted delivery, the risk of PUR among women with at least two catheterizations was greater when fewer catheterizations were performed (OR = 0.78, 95% CI 0.61-0.99). When controlling for the number of catheterizations overall, episiotomy, and vacuum-assisted delivery, PUR risk significantly increased with a longer epidural duration (OR 1.23, 95% CI 1.17-1.29). Episiotomy and vacuum-assisted delivery had no significant effect on PUR. The risk of PUR decreases as the number of catheterizations increases. Although longer epidural duration independently increases the risk of PUR, episiotomy and vacuum-assisted delivery do not.

Postpartum Urinary Retention After Cesarean Delivery

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.

Prevalence and associated risk factors of retention of urine after caesarean section

Caesarean section poses higher risk of postpartum urinary retention (PUR) than vaginal delivery. The aim of this study was to identify the prevalence and the associated risk factors of PUR after caesarean section. Two hundred seven parturients (mean age = 31.26 years old, median parity = 0) who delivered by caesarean section were recruited from the postnatal unit of a tertiary hospital in Hong Kong. Voiding was encouraged 6 h after removal of Foley catheters. Transvaginal ultrasound scan was performed immediately after voiding to estimate the postvoid residual bladder volume (PVR). PUR after caesarean section was defined as PVR of more than 150 ml. The results indicated a prevalence of 3.38%. Logistic regression analysis indicating 'lack of progress of labor' was the only significant associated factor (p < 0.001). The findings of this study provide information for further exploration on how to reduce the morbidity caused by PUR in the postoperative period of caesarean section.

Post-partum urinary retention: a comparison between two methods of epidural analgesia

Objective: To compare two methods of epidural labor analgesia regarding the incidence of post-partum urinary retention. Study design: One thousand parturients who requested epidural analgesia for the relief of labor pain received, at random, either bupivacaine 0.25% with adrenaline 1:200 000 ( n = 500) or bupivacaine 0.125% with 10 μg sufentanil ( n = 500). During the same observation period all women with clinically significant urinary retention (> 500 ml, requiring indwelling catheter) were registered. Result: Altogether 30 3.364 parturients had clinically significant urinary retention. Twenty-seven of these had received epidural analgesia (EDA) (17 with bupivacaine/adrenaline and ten with bupivacaine/sufentanil, a non-significant differences). The number of parturients with urinary retention was highly increased following EDA ( 27 1000 ) as compared to those not receiving EDA ( 3 2364 ), P < 0.001 (Fisher's exact test). In patients with EDA and urinary retention there were no difference between the groups in the incidence of instrumental deliveries or vaginal/perirectal tears. All parturients regained normal bladder function. Conclusion: EDA significantly increased the risk of post-partum urinary retention but no difference was found between the two epidural techniques.