The effect of intermittent versus continuous bladder catheterization on labor duration and postpartum urinary retention and infection: a randomized trial

Evron, Shmuel; Dimitrochenko, Vladimir; Khazin, Vadim; Sherman, Alexander E.; Sadan, Oscar; Boaz, Mona; Ezri, Tiberiu

doi:10.1016/j.jclinane.2008.06.009

Cited by 36 publications

(17 citation statements)

References 22 publications

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“…Urinary catheterisation prior to caesarean section is a routine procedure in many countries. Several studies have investigated the effects of removing the catheter at various times and compared intermittent and indwelling catheterisation 7–11 . The results suggest that immediate postoperative removal of the urethral catheter is associated with a lower risk of urinary infection compared with an indwelling catheter, which is consistent with our results of UG having a lower UTI rate.…”

Section: Discussionsupporting

confidence: 88%

Is routine indwelling catheterisation of the bladder for caesarean section necessary? A systematic review

Wen

Wang

et al. 2010

BJOG: An International Journal of Obstetrics &Amp; Gynaecology

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Background Urinary catheterisation, which is associated with 80% of urinary tract infections (UTIs), is routinely performed prior to caesarean section without justification from the best available research evidence.Objectives To assess whether it is necessary to place indwelling urinary catheters routinely in caesarean section, and to determine the effects of this procedure on UTIs, urinary retention, intraoperative difficulties, operative complications, as well as other outcomes. Selection criteria Randomised controlled trials (RCTs) and nonrandomised controlled trials (NRCTs) comparing the use versus nonuse of indwelling urinary catheters in caesarean section were included.Data collection and analysis Two reviewers independently selected the studies and extracted the data. Results from the trials were combined to calculate relative risks (RRs) for dichotomous outcomes and mean differences (MDs) for continuous outcomes, with 95% confidence intervals (CIs).Main results Three trials (two RCTs and one NRCT) were included, involving a total of 1084 participants. Compared with the use of indwelling urinary catheters, nonuse had a significantly lower incidence of UTIs [RR 0.08; 95% CI 0.01, 0.64 (study design: RCT); RR 0.10; 95% CI 0.02, 0.57 (study design: NRCT)], a lower rate of discomfort at first voiding (RR 0.06; 95% CI 0.03, 0.12), less time until first voiding (MD -16.81; 95% CI -17.31, -16.31) and less time until ambulation (MD -6.01; 95% CI -6.68, -5.35); there were no statistically significant differences in the rate of urinary retention [RR 5.00; 95% CI 0.24, 103.18 (study design: RCT); RR 0.74; 95% CI 0.04, 15.18 (study design: NRCT)], operating time (MD -1.10; 95% CI -3.32, 1.12) and rate of intraoperative difficulties (RR 1.00; 95% CI -3.32, 1.12).Conclusions The nonuse of indwelling urinary catheters in caesarean section is associated with less UTIs and no increase in either urinary retention or intra-operative difficulties. Our results suggest that the routine use of indwelling urinary catheters for caesarean delivery in haemodynamically stable patients is not necessary, and can be harmful. However, better and larger randomised trials are needed to confirm these findings.

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Section: Discussionsupporting

confidence: 88%

Is routine indwelling catheterisation of the bladder for caesarean section necessary? A systematic review

Wen

Wang

et al. 2010

BJOG: An International Journal of Obstetrics &Amp; Gynaecology

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“…The Centers for Disease Control and Prevention (2009) report that virtually all nosocomial UTIs result from catheterization. In the aforementioned study by Evron et al (2009), 3 out of 10 women in both the CC and IC groups developed UTIs. In an editorial and critique of the Evron study, Srinivas (2009) states that catheter use in labor should be minimized to prevent UTIs.…”

Section: Research Resultsmentioning

confidence: 94%

“…Evron et al (2009) studied the impact of catheterization, both intermittent and continuous, on the labors of women who had received epidural anesthesia for pain management. Women were randomly assigned to receive either an indwelling CC catheter or intermittent catheterization (IC).…”

Section: Research Resultsmentioning

confidence: 99%

Urinary Catheterization During Epidural Anesthesia

Sevo

Semeraro

2010

Nursing for Women's Health

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“…Furthermore, epidural anaesthesia during labour is associated with co-morbidities arising from the need for urinary catheterisation to prevent urinary retention [27]. Urinary catheterisation is a primary source of urinary tract infection (UTI) with one study reporting an incidence of 30% amongst women who were catheterised during labour [28]; postpartum urinary retention and incontinence as a consequence of labour-related epidural use has also been reported [29-32]. …”

Section: Introductionmentioning

confidence: 99%

Impact on Caesarean section rates following injections of sterile water (ICARIS): a multicentre randomised controlled trial

Lee

Mårtensson

Homer

et al. 2013

BMC Pregnancy Childbirth

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BackgroundSterile water injections have been used as an effective intervention for the management of back pain during labour. The objective of the current research is to determine if sterile water injections, as an intervention for back pain in labour, will reduce the intrapartum caesarean section rate.Methods/designDesign: A double blind randomised placebo controlled trialSetting: Maternity hospitals in AustraliaParticipants: 1866 women in labour, ≥18 years of age who have a singleton pregnancy with a fetus in a cephalic presentation at term (between 37 + 0 and 41 + 6 weeks gestation), who assess their back pain as equal to or greater than seven on a visual analogue scale when requesting analgesia and able to provide informed consent.Intervention: Participants will be randomised to receive either 0.1 to 0.3 millilitres of sterile water or a normal saline placebo via four intradermal injections into four anatomical points surrounding the Michaelis’ rhomboid over the sacral area. Two injections will be administered over the posterior superior iliac spine (PSIS) and the remaining two at two centimetres posterior, and one centimetre medial to the PSIS respectively.Main outcome measure:Proportion of women who have a caesarean section in labour.Randomisation: Permuted blocks stratified by research site.Blinding (masking):Double-blind trial in which participants, clinicians and research staff blinded to group assignment.Funding:Funded by the National Health and Medical Research CouncilTrial registration:Australian New Zealand Clinical Trials Registry (No ACTRN12611000221954).DiscussionSterile water injections, which may have a positive effect on reducing the CS rate, have been shown to be a safe and simple analgesic suitable for most maternity settings. A procedure that could reduce intervention rates without adversely affecting safety for mother and baby would benefit Australian families and taxpayers and would reduce requirements for maternal operating theatre time. Results will have external validity, as the technique may be easily applied to maternity populations outside Australia. In summary, the results of this trial will contribute High level evidence on the impact of SWI on intrapartum CS rates and provide evidence of the analgesic effect of SWI on back pain.

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The effect of intermittent versus continuous bladder catheterization on labor duration and postpartum urinary retention and infection: a randomized trial

Cited by 36 publications

References 22 publications

Is routine indwelling catheterisation of the bladder for caesarean section necessary? A systematic review

Is routine indwelling catheterisation of the bladder for caesarean section necessary? A systematic review

Urinary Catheterization During Epidural Anesthesia

Impact on Caesarean section rates following injections of sterile water (ICARIS): a multicentre randomised controlled trial

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