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

Abstract

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)

Acceptable Postvoid Residual Urine Volume after Vaginal Delivery and Its Association with Various Obstetric Parameters

“…Our study did not show any significant difference with regard to maternal age, BMI, and gestational age at delivery with the risk of PPUR. This was consistent with the finding by Cavkaytar et al [ 2 ]. Similar to Carley et al[ 14 ] and Buchanan and Beckmann [ 15 ], we observed a higher PVR value in primigravidas.…”

“…In our study population, 92.3% had postvoid residual urine volume of <150 ml, and the similar cutoff value was taken as postpartum urinary retention by many authors [ 3 , 7 , 8 ]. The incidence of postpartum urinary retention was 7.7%, which is similar with previous studies such as the study by Cavkaytar et al that reported an incidence of 8.1% [ 2 ]. This was contradicting with the study done by Ajenifuja et al in which the prevalence of PPUR in their study population was 29.4% and very much higher than that of ours [ 8 ].…”

“…Voiding dysfunction is departure from normal sensation or function, experienced by the woman during or following the act of micturition [ 1 ]. However, the exact incidence of postpartum urinary retention (PPUR) is uncertain and varies considerably between 0.2% and 37.0% [ 2 – 5 ]. These vast differences may be due to different definition used to define PPUR, as well as the different diagnostic criteria and modalities used in different studies.…”

Can Urinary Catheterization Before Birth Reduce Postpartum Urinary Retention?

“…There may be an additional problem of starting or effectively maintaining micturition because of the effect on the ureter. 15 In the current study, labour was not as prolonged as in the above-mentioned studies. The two groups with and without PUR were evaluated in three stages: the active phase, stage 2 and stage 3 and the values were found to be similar for the three groups separately and for the total duration of labour in both groups (p>0.05).…”

“…There are studies that state that only a prolongation of the 2 nd stage of labour causes PUR. 15 In a prolonged 2 nd stage of labour, the extended duration of pressure on the bladder by the infant's head and pressure on the pelvic muscles may cause damage to both the pelvic nerve and muscles, and with this cause a reduction of detrusor sensitivity and motor function in the postpartum period. There may be an additional problem of starting or effectively maintaining micturition because of the effect on the ureter.…”