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

Abstract

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.