Postpartum urinary retention and its associated obstetric risk factors among women undergoing vaginal delivery in tertiary care hospital

Ain, Qurrat Ul; Shetty, Nikil; Supriya, K.

doi:10.1016/j.jogoh.2020.101837

Cited by 14 publications

(26 citation statements)

References 11 publications

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“…Instrument-assisted delivery may damage the pelvic, pudendal, and peripheral nerves, resulting in impairment of the reflexes and voluntary mechanisms required for urination [ 4 , 25 ], as well as mechanical outlet obstruction due to vulvar oedema or hematoma. Direct bladder or urethral trauma resulting from instrument-assisted delivery contributes to PUR [ 28 ]. Our study indicated that vulvar oedema increased the risk of PUR by up to 6.92-folds, which corroborates this statement.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and risk factors of overt postpartum urinary retention among primiparous women after vaginal delivery: a case-control study

Cao

Rao

Yuan

et al. 2022

BMC Pregnancy Childbirth

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Background Postpartum urinary retention (PUR) may lead to bladder neuromuscular damage and subsequently voiding dysfunction. However, the literature regarding the incidence of and risk factors for PUR remains unclear. Moreover, previously reported studies are limited to small sample sizes. Thus, this study aimed to assess the incidence of and risk factors for overt PUR after vaginal delivery. Methods This retrospective case-control study included all primiparas who delivered vaginally between July 1, 2017, and June 30, 2019, at our institution. The case group comprised 677 women diagnosed with overt PUR who required catheterisation after delivery. The control group comprised 677 women without overt PUR randomly selected in a 1:1 ratio matched for date of delivery and who delivered immediately after each woman with overt PUR to minimise the impact of variations over time in obstetric practice. Univariate and multivariate logistic regression analyses were performed to investigate the factors associated with overt PUR. Results Of the 12,609 women included in our study, 677 were diagnosed with overt PUR (incidence 5.37%). Univariate analysis identified epidural analgesia, episiotomy, perineal tears, instrument-assisted delivery, duration of labour stage, intrauterine operation, and vulvar oedema as risk factors for PUR. Multivariate logistic regression identified epidural analgesia (odds ratio [OR] = 1.41, 95% confidence interval [CI]: 1.11–1.79, P = 0.005), vulvar oedema (OR = 6.92, 95% CI: 4.65–10.31, P < 0.001), forceps delivery (OR = 8.42, 95% CI: 2.22–31.91, P = 0.002), episiotomy (OR = 1.37, 95% CI: 1.02–1.84, P = 0.035), and second-degree perineal tear (OR = 3.42, 95% CI: 2.37–4.94, P < 0.001) as significant independent risk factors for PUR. Conclusions PUR was highly associated with epidural analgesia, forceps delivery, vulvar oedema, episiotomy, and second-degree perineal tears. More attention should be paid to women at high risk to reduce the incidence of PUR.

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Section: Discussionmentioning

confidence: 99%

Prevalence and risk factors of overt postpartum urinary retention among primiparous women after vaginal delivery: a case-control study

Cao

Rao

Yuan

et al. 2022

BMC Pregnancy Childbirth

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“…Any misdiagnosis or delay in the diagnosis of postpartum urinary retention can cause bladder overdistension, leading to irreversible detrusor damage. 15 We found that acupoint hot compress significantly decreased the incidence of postpartum urinary retention for trial participants.…”

Section: Discussionmentioning

confidence: 73%

Effect of Acupoint Hot Compress on Postpartum Urinary Retention After Vaginal Delivery

et al. 2022

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“…The incidence of PUR ranges from 0.18 to 47% [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] depending on the varying definitions and the time interval of follow-up used.…”

Section: Introductionmentioning

confidence: 99%

“…Risk factors for PUR include: a prolonged second stage of labor [2, 4-6, 8, 18, 25-29] (duration of labor [first and second stage] >700 min predicts PUR [8,30]), vacuum-assisted [2,25], and instrumental delivery [5, 6, 8-11, 14, 23, 26, 27, 29, 31, 32], (high grade) perineal lacerations [3, 6, 10, 13, 18, 25-27, 29, 31, 33], and episiotomy [5,9,11,16,18,23,33], degree of perineal pain [5], fetal birth weight [6,16,18,32], use of systemic narcotics [16,29], nulliparity [3,5,6,9,11,13,23,[25][26][27], cesarean section (possibly after failure to progress in labor) [12,13,28,32,33], epidural analgesia (possibly by modifying other obstetrical parameters such as duration of labor) [5, 7, 9, 15, 16, 23, 25-27, 29, 32], intermittent catheterization during labor [3], an increasing number of catheterizations [34], and an absence of spontaneous voiding before leaving the delivery room [31]. One study identified urination just before delivery as a preventive factor for PUR [11].…”

Section: Introductionmentioning

confidence: 99%

“…The pathophysiology of PUR is poorly understood. Several theories have been suggested, including physiological, neurological, and mechanical processes during pregnancy and delivery [ 1 , 2 , 6 ]. Levator ani muscle avulsion seems to be associated with persistent postpartum voiding dysfunction [ 17 ], but the etiology of PUR is thought to be multifactorial.…”

Section: Introductionmentioning

confidence: 99%

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Postpartum urinary retention: what are the sequelae? A long-term study and review of the literature

et al. 2022

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Introduction and hypothesis Postpartum urinary retention (PUR) may cause long-term urogenital tract morbidity. The incidence ranges from 0.18 to 14.6%, but the importance of prompt diagnosis and appropriate management is often underappreciated. The paucity of data on long-term outcome after PUR contributes to these drawbacks. The aim of this study was to assess long-term persistence of elevated PVR (post-void residual urine) volume after PUR. Pathophysiology, risk factors and management of PUR are reviewed. Methods In our tertiary referral urogynecology unit in the University Women’s Hospital of Bern, Switzerland, all patients who were referred for PUR were asked to participate in this study. PVR was measured sonographically every 2 days until day 15, then after 6, 12, 24 and 36 months and, if increased, the patients were instructed to perform clean intermittent self-catheterization. If retention persisted longer than the lactation period, multichannel urodynamics was performed. Results Sixty-two patients were included. The median PVR normalized at day 7. Long-term voiding disorders were found in 8.2%, 6.7%, and 4.9% after 1, 2, and 3 years respectively. Multichannel urodynamics confirmed in all patients with persisting retention an acontractile detrusor and de novo stress urinary incontinence in 4 cases. Quantile regression did not reveal any factor contributing to earlier recovery. Eighty-nine percent of the patients with PUR had operative vaginal deliveries, emphasizing the importance of this risk factor for PUR. Conclusions In most cases PUR resolves early, but voiding difficulties persist more often than previously thought, and for these patients the consequences are devastating. Obstetric awareness, early active management, and developing management strategies in the postpartum period might preclude lower urinary tract morbidity.

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Postpartum urinary retention and its associated obstetric risk factors among women undergoing vaginal delivery in tertiary care hospital

Cited by 14 publications

References 11 publications

Prevalence and risk factors of overt postpartum urinary retention among primiparous women after vaginal delivery: a case-control study

Prevalence and risk factors of overt postpartum urinary retention among primiparous women after vaginal delivery: a case-control study

Effect of Acupoint Hot Compress on Postpartum Urinary Retention After Vaginal Delivery

Postpartum urinary retention: what are the sequelae? A long-term study and review of the literature

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