Postpartum urinary retention: a systematic review of adverse effects and management

Mulder, Frits I.; Hakvoort, R. A.; Schoffelmeer, M. A.; Limpens, Jacqueline; Post, Joris A. M. van der; Roovers, JP

doi:10.1007/s00192-014-2418-6

Cited by 63 publications

(96 citation statements)

References 54 publications

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“…Although ultrasonographic measurement of PVRBV in the postpartum patient is doubtful, due to postpartum uterine size (7), several authors (23,24) offer assessment of the bladder accurately by ultrasound, even in the postpartum period. In a recent review including 24 studies, it was concluded that a standard treatment guideline for PPUR is necessary, since there is no sufficient evidence about the catheterization methods for overt PPUR (25). In the same review, it was recommended that both overt and covert PPUR should be regarded as serious conditions.…”

Section: Discussionmentioning

confidence: 99%

Postpartum urinary retention after vaginal delivery: Assessment of risk factors in a case-control study

Cavkaytar

Kokanali

Baylas

et al. 2014

J Turkish German Gynecol Assoc

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Objective:To assess the obstetrics risk factors for postpartum urinary retention after vaginal delivery. Material and Methods: 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.Results: 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. Conclusion: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. (J Turk Ger Gynecol Assoc 2014; 15: 140-3)

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Section: Discussionmentioning

confidence: 99%

Postpartum urinary retention after vaginal delivery: Assessment of risk factors in a case-control study

Cavkaytar

Kokanali

Baylas

et al. 2014

J Turkish German Gynecol Assoc

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“…Decrease in the adrenergic and cholinergic innervation of the bladder has been observed after induced urinary retention and bladder overdistension in rats (31,59). Whether women suffer neuroanatomic changes in the bladder with labor is unknown, although it is possible, since urinary retention is a well-known condition after childbirth, with epidural analgesia, prolonged labor, episiotomy, and high birth weight as risk factors (28,37,38). The epidural analgesia commonly used to avoid pain during labor causes bladder hypotonia and eliminates the normal sensation to void, leading to bladder overdistension (62), which may damage the detrusor and consequently induce long-term voiding difficulties (64).…”

Section: 56)mentioning

confidence: 99%

Neuroanatomic and behavioral correlates of urinary dysfunction induced by vaginal distension in rats

Palacios-Galicia

Juárez

Morán

et al. 2016

American Journal of Physiology-Renal Physiology

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-The aim of the present study was to use a model of simulated human childbirth in rats to determine the damage to genitourinary structures and behavioral signs of urinary dysfunction induced by vaginal distension (VD) in female rats. In experiment 1, the length of the genitourinary tract and the nerves associated with it were measured immediately after simulated human delivery induced by VD or sham (SH) procedures. Electroneurograms of the dorsal nerve of the clitoris (DNC) were also recorded. In experiment 2, histological characteristics of the bladder and major pelvic ganglion of VD and SH rats were evaluated. In experiment 3, urinary parameters were determined in conscious animals during 6 h of dark and 6 h of light before and 3 days after VD or SH procedures. VD significantly increased distal vagina width (P Ͻ 0.001) and the length of the motor branch of the sacral plexus (P Ͻ 0.05), DNC (P Ͻ 0.05), and vesical nerves (P Ͻ 0.01) and decreased DNC frequency and amplitude of firing. VD occluded the pelvic urethra, inducing urinary retention, hematomas in the bladder, and thinness of the epithelial (P Ͻ 0.05) and detrusor (P Ͻ 0.01) layers of the bladder. Major pelvic ganglion parameters were not modified after VD. Rats dripped urine in unusual places to void, without the stereotyped behavior of micturition after VD. The neuroanatomic injuries after VD occur alongside behavioral signs of urinary incontinence as determined by a new behavioral tool for assessing micturition in conscious animals. external urethral sphincter; dorsal nerve of the clitoris; major pelvic ganglion; micturition MICTURITION consists of two phases: storage and urine expulsion. During storage, the detrusor is relaxed while the bladder neck and urethra are activated, preventing involuntary bladder emptying (11). Extrinsic elements such as the levator ani muscle also contribute to the maintenance of continence (3). When the bladder reaches its threshold volume, spinal and supraspinal reflexes are triggered to induce bladder contraction and urethral relaxation, and urine flows through the urethra (11). Damage to the lower urinary tract and/or its innervation can induce urinary dysfunction (3,29,41).Urinary dysfunction affects the health of many women (60). Stress urinary incontinence has been described as involuntary loss of urine during effort and is the most prevalent urinary disorder related to vaginal childbirth, which is known to injure the pudendal nerve and denervate the external urethral sphincter (EUS) (3, 15, 57).Maternal pelvic viscera and nerve damage results from the difficulty of human childbirth due the large fetal head and brain relative to the maternal pelvis size. Neonates at birth have heads that are close to the size of the maternal birth canal through which they must pass during the second stage of parturition (48). Births of fetuses over 4 kg or fetal malposition often prolong parturition (30), retaining the fetus in the pelvic cavity, the main anatomic resistance to fetal expulsion. Prolonged second stage of parturition...

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“…Postpartum urinary retention (PUR), or voiding dysfunction, is a well-known phenomenon in the puerperium (Yip et al, 2004;Mulder et al, 2014). The incidence of PUR varies from 0.5 to 45% in women who have just delivered babies.…”

Section: Introductionmentioning

confidence: 99%

“…The pelvic floor muscles and pudendus nerve may be damaged during labour, resulting in reduced bladder sensitivity (Saint et al, 2009). Peri-urethral and valvular oedema may cause obstruction (Mulder et al, 2014). Finally, reduced pressure from the uterus after birth may lead to incomplete bladder emptying during the first hours to days after delivery (Saultz et al, 1991).…”

Section: Introductionmentioning

confidence: 99%

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Systematic bladder scanning identifies more women with postpartum urinary retention than diagnosis by clinical signs and symptoms

Blomstrand¹,

Boij²,

Christensson³

et al. 2015

Int. J. Nurs. Midwifery

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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, Jönköping, 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 < 0.05). Eleven women in the experimental group had covert urinary retention with a post-void residual bladder volume of 400 to 1200 ml. No woman who gave birth by caesarean section was identified with postpartum urinary retention. Univariable logistic regression analyses identified seven risk indicators of postpartum urinary retention: first pregnancy, delivery with use of ventouse, oxytocin infusion, epidural analgesia, second stage of >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.

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Postpartum urinary retention: a systematic review of adverse effects and management

Cited by 63 publications

References 54 publications

Postpartum urinary retention after vaginal delivery: Assessment of risk factors in a case-control study

Postpartum urinary retention after vaginal delivery: Assessment of risk factors in a case-control study

Neuroanatomic and behavioral correlates of urinary dysfunction induced by vaginal distension in rats

Systematic bladder scanning identifies more women with postpartum urinary retention than diagnosis by clinical signs and symptoms

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