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Lawal OO, Morhason-Bello IO, Atalabi OM, Ojengbede OA. Incidence of postpartum urinary retention in a tertiary hospital in Ibadan, Nigeria. Int J Gynaecol Obstet 2021; 156:42-47. [PMID: 33626180 DOI: 10.1002/ijgo.13659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 02/15/2021] [Accepted: 02/22/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To determine the incidence of postpartum urinary retention (PUR) after vaginal delivery and associated risk factors. METHODS A total of 250 women were recruited following vaginal delivery at the UCH, Ibadan. Sociodemographic and obstetrical data were collected using a pro forma. Transabdominal ultrasound scan of the urinary bladder was performed 6 hours after delivery to estimate the post-void residual bladder volume (PVRBV) of participants. PVRBV was compared with obstetrical characteristics and labor events. Data collected were analyzed using SPSS 17.0. The level of statistical significance was set at P value less than 0.05. RESULTS The incidence of PUR was 17.6%. Women with PUR, had longer duration of first stage (591 versus 501 minutes; P = 0.001), and second stage (50 versus 32 minute; P < 0.001) of labor compared with those without PUR. There was evidence that augmentation of labor (P < 0.01), catheterization during labor (P < 0.01), perineal injury (P < 0.01), and episiotomy (P < 0.01) were associated with developing PUR. Also, women with PUR were more likely to experience storage and obstructive urinary symptoms than those without PUR. Resolution of PUR occurred within 24 hours. CONCLUSION This study showed that postpartum urinary retention is relatively common following vaginal delivery. Awareness of risk factors will increase index of suspicion especially in women with storage and obstructive symptoms.
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Affiliation(s)
- Olatunji Okikiola Lawal
- Department of Obstetrics and Gynecology, Faculty of Clinical Sciences, College of Medicine/University College Hospital Ibadan, University of Ibadan, Ibadan, Oyo, Nigeria
| | - Imran Oludare Morhason-Bello
- Department of Obstetrics and Gynecology, Faculty of Clinical Sciences, College of Medicine/University College Hospital Ibadan, University of Ibadan, Ibadan, Oyo, Nigeria
| | - Omolola Mojisola Atalabi
- Department of Radiology, Faculty of Clinical Sciences, College of Medicine/ University College Hospital Ibadan, University of Ibadan, Ibadan, Oyo, Nigeria
| | - Oladosu Akanbi Ojengbede
- Department of Obstetrics and Gynecology, Faculty of Clinical Sciences, College of Medicine/University College Hospital Ibadan, University of Ibadan, Ibadan, Oyo, Nigeria
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Menshawy A, Ghanem E, Menshawy E, Masoud AT, El-Sharkawy M, Taher A, Mahmoud M, Khamis Y, Haggag H, Khalifa M, Samy A, Abbas AM. Early versus delayed removal of indwelling urinary catheter after elective cesarean delivery: systematic review and meta-analysis of randomized controlled trials. J Matern Fetal Neonatal Med 2019; 33:2818-2825. [PMID: 30522371 DOI: 10.1080/14767058.2018.1557142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background: Timing of removal of the indwelling urinary catheter after elective cesarean delivery (CD) is controversial. Early removal could be associated with fewer urinary symptoms.Objective: This review aims to evaluate the evidence from published randomized clinical trials (RCTs) about the outcomes of early versus delayed removal of indwelling urinary catheter after elective cesarean delivery (CD).Data sources: Electronic databases were searched using the following MeSH terms (early Or Late Or immediate OR delayed removal) AND (Urinary catheter) AND (cesarean section OR cesarean delivery OR CS)Methods of study selection: All RCTs assessing the timing of removal of urinary catheter were considered for this meta-analysis. One hundred seventy-two studies were identified of which three studies deemed eligible for this review. Quality and risk of bias assessment were performed for all studies.Data extraction: Two researchers independently extracted the data from the individual articles and entered into RevMan software. The relative risk (RR), the weighted mean difference (WMD) and 95% confidence interval (CI) were calculated. The extracted outcomes were significant bacteriuria, urinary symptoms (urinary retention necessitating re-catheterization, dysuria, urinary frequency, urgency) postoperative oral rehydration and length of hospital stay.Results: Three RCTs (early removal: n = 298 and delayed removal: n = 311) were included. The pooled estimate showed that early removal significantly reduced dysuria (RR = 0.60, 95% CI [0.38, 0.95], p=.03), urinary frequency (RR = 0.32, 95% CI [0.16, 0.66], p=.002) and significant bacteriuria (RR = 0.49, 95% CI [0.30, 0.83], p=.007) than delayed removal.Conclusions: This meta-analysis suggests that early removal of the indwelling urinary catheter in patients who underwent elective CD showed significant less dysuria, less urinary frequency and a decrease in the incidence of significant bacteriuria.
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Affiliation(s)
- Amr Menshawy
- Faculty of Medicine, Al-Azhar University, Al-Azhar Medical Students' Association, Cairo, Egypt
| | - Esraa Ghanem
- Faculty of Medicine, Al-Azhar University, Al-Azhar Medical Students' Association, Cairo, Egypt
| | - Esraa Menshawy
- Faculty of Medicine, Al-Azhar University, Al-Azhar Medical Students' Association, Cairo, Egypt
| | | | - Mohamed El-Sharkawy
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ayman Taher
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mostafa Mahmoud
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Yasser Khamis
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Beni-Suef University, Egypt
| | - Hisham Haggag
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Department of Obstetrics and Gynaecology, University of Würzburg, Würzburg, Germany
| | - Mansour Khalifa
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed Samy
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed M Abbas
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Assiut University, Assiut, Egypt
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Basbug A, Yuksel A, Ellibeş Kaya A. Early versus delayed removal of indwelling catheters in patients after elective cesarean section: a prospective randomized trial. J Matern Fetal Neonatal Med 2018; 33:68-72. [PMID: 29886771 DOI: 10.1080/14767058.2018.1487394] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Purpose: We conducted a prospective randomized controlled trial to compare postoperative urinary catheter removal 2 versus 12 h after elective cesarean section in terms of irritative symptoms, first void time, incidence of urinary tract infection, postoperative mobilization time, and hospitalization time.Methods: A total of 134 women admitted to Duzce University Hospital for primary or recurrent elective cesarean section were randomized into two groups. A total of 62 women were enrolled in the early group, with indwelling catheter removal 2 h after cesarean section; 74 women were enrolled in the delayed group, with catheter removal 12 h after the cesarean section. The groups were prospectively compared in terms of irritative urinary symptoms, bacteriuria, hematuria, length of hospital stay, and mobilization time.Results: Urinary frequency (p = .04), microscopic hematuria incidence (p = .04), postoperative mobilization time (p = .01), and length of hospital stay (p = .009) were significantly lower in the early group than in the delayed group. There were no significant differences in terms of bacteruria, urinary retention, dysuria, and first postoperative voiding time.Conclusions: Early removal of urinary catheters after elective cesarean section is associated with reduced mobilization time and hospital stay.
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Affiliation(s)
- Alper Basbug
- Department of Obstetrics and Gynecology, Faculty of Medicine, Duzce University, Duzce, Turkey
| | - Alpaslan Yuksel
- Department of Urology, Faculty of Medicine, Duzce University, Duzce, Turkey
| | - Aşkı Ellibeş Kaya
- Department of Obstetrics and Gynecology, Faculty of Medicine, Duzce University, Duzce, Turkey
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Mulder FEM, Hakvoort RA, de Bruin JP, Janszen EW, van der Post JAM, Roovers JPWR. Long-term micturition problems of asymptomatic postpartum urinary retention: a prospective case-control study. Int Urogynecol J 2018; 29:481-488. [PMID: 28871388 PMCID: PMC5876278 DOI: 10.1007/s00192-017-3457-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 08/10/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Covert (asymptomatic) postpartum urinary retention (PUR) is defined as post-void residual volume (PVRV) ≥150 mL. Although often supposed to be a common and harmless phenomenon, no data are available on the potential long-term micturition problems of increased PVRV after vaginal delivery. METHODS After the first spontaneous void post-vaginal delivery, PVRV was measured using a portable scanning device. Micturition symptoms were compared using validated questionnaires between women with PVRV < 150 mL and those with PVRV ≥150 mL until 1 year after delivery. Women with PVRV ≥ 150 mL were followed until complete bladder emptying was achieved. RESULTS Data of 105 patients with PVRV < 150 mL and 119 with PVRV ≥ 150 mL were available for analysis. 75% of all patients included had PVRV ≥ 250 mL. More primiparous patients had PVRV ≥ 150 mL (p < 0.02). 92% of women with PVRV ≥ 150 mL after delivery were able to adequately empty their bladder within 4 days. One year after delivery, no statistically significant differences were found. CONCLUSIONS Covert PUR according to the definition of PVRV ≥ 150 mL, is a common and transient phenomenon that does not result in more lower urinary tract symptoms 1 year after delivery. Although the current definition is not useful in identifying postpartum women with a pathological condition, we suggest that the definition of covert PUR should be change to: "PVRV≥500 mL after the first spontaneous void after (vaginal) delivery." This cut-off value is the value at which some women do need more time to normalise emptying of the bladder. The exact clinical implications of covert PUR need to be further studied in this subcategory of women.
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Affiliation(s)
- Femke E M Mulder
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Meibergdreef 9-room H4.240, 1105 AZ, Amsterdam, The Netherlands.
| | - Robert A Hakvoort
- Department of Obstetrics and Gynaecology, Martini Hospital, Groningen, The Netherlands
| | - Jan-Peter de Bruin
- Department of Obstetrics and Gynaecology, Jeroen Bosch Ziekenhuis, 's Hertogenbosch, The Netherlands
| | - Erica W Janszen
- Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Joris A M van der Post
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Meibergdreef 9-room H4.240, 1105 AZ, Amsterdam, The Netherlands
| | - Jan-Paul W R Roovers
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Meibergdreef 9-room H4.240, 1105 AZ, Amsterdam, The Netherlands
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Comparison of clean intermittent and transurethral indwelling catheterization for the treatment of overt urinary retention after vaginal delivery: a multicentre randomized controlled clinical trial. Int Urogynecol J 2017; 29:1281-1287. [PMID: 28856403 PMCID: PMC6132660 DOI: 10.1007/s00192-017-3452-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 08/09/2017] [Indexed: 11/20/2022]
Abstract
Introduction and hypothesis Overt postpartum urinary retention (PUR) is the inability to void after delivery and affects up to 7% of patients. Clean intermittent catheterization (CIC) and transurethral indwelling catheterization (TIC) are both standard treatments, but have not previously been compared. Clinical guidelines on postpartum bladder management are lacking. Methods A total of 85 patients were randomised for TIC (n=45) and CIC (n=40). In total 68 patients (34 patients with TIC and 34 patients with CIC) completed the UDI-6 questionnaire 3 months after delivery.. Patients allocated to TIC received an indwelling catheter for 24 h and if necessary, another catheter for 48 h. Patients with CIC were intermittently catheterized or taught to self-catheterize until adequate voiding with a postvoid residual volume (PVRV) of <150 mL was achieved. The primary outcome was the presence of bothersome micturition symptoms as measured using the Dutch-validated Urogenital Distress Inventory (UDI-6). Results Only seven patients (10%) reported bothersome micturition problems 3 months after delivery. No significant differences in the occurrence of micturition symptoms were found. Median PVRV was 800 mL in the CIC group and 650 mL in the TIC group. PVRV was ≥1,000 mL in 24% of the patients. The median duration of catheterization was significantly shorter in the CIC group than in the TIC group (12 h vs. 24 h, p < 0,01). In patients with CIC, 35% required only one catheterization before complete bladder emptying occurred. The duration of treatment was not related to the initial PVRV. Both treatments were equally well accepted by the patients. Conclusions In patients with overt PUR, CIC is the preferred treatment as a considerable percentage of patients appear to be over-treated when the standard duration of TIC is 24 h. The occurrence of micturition symptoms is not associated with the catheterization method used. CIC is well tolerated in patients with overt PUR.
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Abstract
Introduction and hypothesis Postpartum urinary retention (PUR) is a common consequence of bladder dysfunction after vaginal delivery. Patients with covert PUR are able to void spontaneously but have a postvoid residual bladder volume (PVRV) of ≥150 mL. Incomplete bladder emptying may predispose to bladder dysfunction at a later stage of life. The aim of this cross-sectional study was to identify independent delivery-related risk factors for covert PUR after vaginal delivery in order to identify women with an increased risk of covert PUR. Methods The PVRV of women who delivered vaginally was measured after the first spontaneous micturition with a portable bladder-scanning device. A PVRV of 150 mL or more was defined as covert PUR. Independent risk factors for covert PUR were identified in multivariate regression analysis. Results Of 745 included women, 347 (47 %) were diagnosed with covert PUR (PVRV ≥150 mL), of whom 197 (26 %) had a PVRV ≥250 mL (75th percentile) and 50 (7 %) a PVRV ≥500 mL (95th percentile). In multivariate regression analysis, episiotomy (OR 1.7, 95 % CI 1.02 – 2.71), epidural analgesia (OR 2.08, 95 % CI 1.36 – 3.19) and birth weight (OR 1.03, 95 % CI 1.01 – 1.06) were independent risk factors for covert PUR. Opioid analgesia during labour (OR 3.19, 95 % CI 1.46 – 6.98), epidural analgesia (OR 3.54, 95 % CI 1.64 – 7.64) and episiotomy (OR 3.72, 95 % CI 1.71 – 8.08) were risk factors for PVRV ≥500 mL. Conclusions Episiotomy, epidural analgesia and birth weight are risk factors for covert PUR. We suggest that the current cut-off values for covert PUR should be reevaluated when data on the clinical consequences of abnormal PVRV become available.
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Oh JJ, Kim SH, Shin JS, Shin SJ. Risk factors for acute postpartum urinary retention after vaginal delivery: focus on episiotomy direction. J Matern Fetal Neonatal Med 2015; 29:408-11. [PMID: 25731655 DOI: 10.3109/14767058.2014.1002395] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study aimed to investigate the independent factors for acute postpartum urinary retention (APUR) after vaginal delivery. METHODS From January 2008 to December 2013, 98 patients with APUR after vaginal delivery without instrument use were compared with 108 control patients matched by age and medical history. Multivariate logistic regression analysis was performed to identify independent risk factors for APUR. Predictive accuracy for the multivariate model was assessed using the derived area under a receiver operating characteristics curve. RESULTS Among maternal previous partial history, mean live birth history was lower in the APUR group (0.12 versus 0.31, p = 0.017). Regional anesthesia use (76.5% versus 60.2%, p = 0.036), mediolateral episiotomy (63.3% versus 31.5%, p < 0.001) and labor time were significantly higher in the APUR group. Multivariate logistic regression analysis showed that mediolateral episiotomy, labor time and the presence of regional anesthesia were independent contributing factors for the development of APUR. This model's predictive accuracy for APUR was 73.1%. CONCLUSION Prolonged labor time, regional anesthesia and mediolateral episiotomy were independent factors for APUR. Therefore, we considered median episiotomy to be the best approach during vaginal delivery avoiding APUR.
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Affiliation(s)
- Jong Jin Oh
- a Department of Urology , Seoul National University Bundang Hospital , Seongnam , Korea and
| | - Soo Hyun Kim
- b Department of Obstetrics and Gynecology , Gangnam CHA Medical Center, CHA University , Seongnam , Korea
| | - Joong Sik Shin
- b Department of Obstetrics and Gynecology , Gangnam CHA Medical Center, CHA University , Seongnam , Korea
| | - Seung Ju Shin
- b Department of Obstetrics and Gynecology , Gangnam CHA Medical Center, CHA University , Seongnam , Korea
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Cavkaytar S, Kokanalı MK, Baylas A, Topçu HO, Laleli B, Taşçı Y. Postpartum urinary retention after vaginal delivery: Assessment of risk factors in a case-control study. J Turk Ger Gynecol Assoc 2014; 15:140-3. [PMID: 25317040 DOI: 10.5152/jtgga.2014.13102] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 07/14/2014] [Indexed: 11/22/2022] Open
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.
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Affiliation(s)
- Sabri Cavkaytar
- Department of Obstetrics and Gynecology, Dr. Zekai Tahir Burak Woman's Health Education and Research Hospital, Ankara, Turkey
| | - Mahmut Kuntay Kokanalı
- Department of Obstetrics and Gynecology, Dr. Zekai Tahir Burak Woman's Health Education and Research Hospital, Ankara, Turkey
| | - Ayşegül Baylas
- Department of Obstetrics and Gynecology, Dr. Zekai Tahir Burak Woman's Health Education and Research Hospital, Ankara, Turkey
| | - Hasan Onur Topçu
- Department of Obstetrics and Gynecology, Dr. Zekai Tahir Burak Woman's Health Education and Research Hospital, Ankara, Turkey
| | - Bergen Laleli
- Department of Obstetrics and Gynecology, Dr. Zekai Tahir Burak Woman's Health Education and Research Hospital, Ankara, Turkey
| | - Yasemin Taşçı
- Department of Obstetrics and Gynecology, Dr. Zekai Tahir Burak Woman's Health Education and Research Hospital, Ankara, Turkey
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Mulder FEM, Hakvoort RA, Schoffelmeer MA, Limpens J, Van der Post JAM, Roovers JPWR. Postpartum urinary retention: a systematic review of adverse effects and management. Int Urogynecol J 2014; 25:1605-12. [DOI: 10.1007/s00192-014-2418-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 04/22/2014] [Indexed: 10/25/2022]
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Is portable three-dimensional ultrasound a valid technique for measurement of postpartum urinary bladder volume? Taiwan J Obstet Gynecol 2014; 53:12-6. [PMID: 24767639 DOI: 10.1016/j.tjog.2013.01.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2013] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To determine the accuracy of bladder volume (BV) measurement and to identify factors that influenced the ultrasound bladder scanner (UBS) measurement of BV in postpartum women compared with transurethral catheterization. MATERIALS, METHODS AND RESULTS A total of 190 paired measurements were performed on 190 women aged between 16 and 47 years. Majority of the women (36.9%) were in their first parity (range: 1-9). The mean BV was 159.46 mL [standard deviation (SD) = 99.78; range: 17-593 mL] on three-dimensional (3D) UBS and 143.76 mL (SD = 104.89; range: 2-588 mL) on catheterization. The mean difference between the two values was 15.70 mL (SD = 69.31, p < 0.001). The Foley's catheter was clamped for a minimum of 30 minutes and a maximum of 260 minutes. The UBS measurements were highly correlated with the BV obtained by catheterization (r = 0.819; p < 0.001). There was no significant difference between UBS and catheterized volume in a different volume subgroup. There were 35 cases (18.2%) with the difference in measurement of more than 25%. Twenty-five cases were associated with a catheterized volume less than 50 mL. There were a total of 33 cases with true BV of less than 50 mL, and only eight cases (24.24%) had an accurate measurement. The UBS tends to overestimate BV between 2 and 270 mL in this group. There was a significant linear relationship between the difference in measurement and body weight and duration of clamping. CONCLUSION Measurement of BV in immediate postpartum period using UBS is comparable with urethral catheterization. The accuracy of measurement is affected by body weight and increasing amount of BV.
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Ajenifuja KO, Oyetunji IO, Orji EO, Adepiti CA, Loto OM, Tijani MA, Dare FO. Post-partum urinary retention in a teaching hospital in southwestern Nigeria. J Obstet Gynaecol Res 2013; 39:1308-13. [PMID: 23815569 DOI: 10.1111/jog.12069] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 12/28/2012] [Indexed: 11/30/2022]
Abstract
AIM This study was undertaken to determine the prevalence of post-partum urinary retention after vaginal delivery and to examine the associated risk factors. MATERIAL AND METHODS This was a prospective observational study carried out over a 2-month period at the major university teaching hospital in southwestern Nigeria. RESULTS Prevalence of post-partum urinary retention was 29.4%. The majority (93.3%) of women had covert urinary retention while 6.7% had overt urinary retention. From the bivariate analysis, episiotomy, reduced voiding desire and primiparity were risk factors for post-partum urinary retention (66.6% vs 30.6%; P = 0.017; 47.75% vs 13.9%; P = 0.037; and 60.0% vs 30.6%; P = 0.05; respectively). CONCLUSION Post-partum urinary retention, particularly covert retention, is a common complication of labor and delivery in our clinical practice but is rarely reported in the published work, especially from this part of the world. No factor has been found to be independently associated with its occurrence, hence there is need for vigilance in the immediate post-partum period as most cases of urinary retention would have been avoided if women were encouraged to void early following delivery.
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Bouhours AC, Bigot P, Orsat M, Hoarau N, Descamps P, Fournié A, Azzouzi AR. [Postpartum urinary retention]. Prog Urol 2011; 21:11-7. [PMID: 21193140 DOI: 10.1016/j.purol.2010.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Revised: 07/14/2010] [Accepted: 08/08/2010] [Indexed: 10/19/2022]
Abstract
Postpartum urinary retention is an uncommon event that occurs in 0.7 to 0.9% of vaginal deliveries. An ignorance of this situation can lead to delayed diagnosis worsening the prognosis and to inadequate treatments. This complication is defined as the absence of spontaneous micturition within 6hours of vaginal delivery with a bladder volume above 400mL. The etiology depends on multiple factors. Because of physiological changes during pregnancy, the bladder is hypotonic with an increased post-void residual volume. The occurrence of a perineal neuropathy during delivery may cause a urinary retention. Risk factors are primiparity, prolonged labour, instrumental delivery and perineal lacerations. Treatment consists on clean intermittent catheterization and recovery occurs generally in 72hours. Persistent urinary retention is the principal short-term complication and should be treated by clean intermittent self-catheterization. Long-term consequences are poorly reported in the literature.
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Affiliation(s)
- A C Bouhours
- Service de gynécologie-obstétrique, CHU d'Angers, 4, rue Larrey, 49933 Angers, France
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Ismail SIMF, Emery SJ. The prevalence of silent postpartum retention of urine in a heterogenous cohort. J OBSTET GYNAECOL 2009; 28:504-7. [DOI: 10.1080/01443610802217884] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Mathew S, Horne AW, Murray LS, Tydeman G, McKinley CA. Are portable bladder scanning and real-time ultrasound accurate measures of bladder volume in postnatal women? J OBSTET GYNAECOL 2009; 27:564-7. [PMID: 17896250 DOI: 10.1080/01443610701482076] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Real-time ultrasound and portable bladder scanners are commonly used instead of catheterisation to determine bladder volumes in postnatal women but it is not known whether these are accurate. Change in bladder volumes measured by ultrasound and portable scanners were compared with actual voided volume (VV) in 100 postnatal women. The VV was on average 41 ml (CI 29 - 54 ml) higher than that measured by ultrasound, and 33 ml (CI 17 - 48 ml) higher than that measured by portable scanners. Portable scanner volumes were 9 ml (CI -8 - 26 ml) higher than those measured by ultrasound. Neither method is an accurate tool for detecting bladder volume in postnatal women.
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Affiliation(s)
- S Mathew
- Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, UK
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Demaria F, Boquet B, Porcher R, Rosenblatt J, Pedretti P, Raibaut P, Amarenco G, Benifla JL. Post-voiding residual volume in 154 primiparae 3 days after vaginal delivery under epidural anesthesia. Eur J Obstet Gynecol Reprod Biol 2008; 138:110-3. [PMID: 18242817 DOI: 10.1016/j.ejogrb.2007.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2006] [Revised: 11/19/2007] [Accepted: 12/17/2007] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To use 3-dimensional ultrasonography (3D-US) to determine the frequency of post-voiding residual volume (PVRV) > or =100 mL in primiparae 3 days after receiving epidural anesthesia for vaginal delivery. Potential relationships between day-3 PVRV > or =100 mL and obstetrical-pediatric parameters, especially those possibly implicated in post-obstetrical bladder dysfunction, were examined. STUDY DESIGN We recruited 154 primiparae who vaginally delivered term singletons following uncomplicated pregnancies in the maternity unit of a French teaching hospital. All women had been systematically catheterized 2-h postpartum to measure precisely the volume of urine retained. On the morning of discharge (day 3), when the patient felt the urge to urinate, her 3D-US pre-voiding bladder volume was determined with BladderScan (BVI-3000), then her spontaneously voided urine was collected to accurately quantify its volume and 3D-US was repeated immediately to evaluate the PVRV. PVRV > or =100 mL on day 3 was considered pathological. RESULT Among these 154 women, 88 (57%) felt the need to urinate and 97 (63%) had a retained volume > or =500 mL at 2-h postpartum. On day-3 postpartum, the median [range] volumes for the entire cohort were: 426.7 [158-999.7] mL 3D-US-measured pre-voiding, 350 [15-1000] mL collected by spontaneous urination, 82.2 [5.3-433.3] mL 3D-US-determined post-voiding; PVRV exceeded 100 mL for 55 (36%). According to our univariate analysis, no factor considered was able to predict PVRV > or =100 mL on day 3. CONCLUSION Our observations confirmed the existence of PVRV > or =100 mL on day 3 in more than one-third of these primiparae who delivered vaginally under epidural anesthesia. No obstetrical-pediatric factor could be implicated in this bladder dysfunction. Therefore, we recommend frequent and systematic non-invasive 3D-US monitoring of all postpartum patients at least until day 3 to avoid excessive urine retention.
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Affiliation(s)
- Fabien Demaria
- Service de Gynécologie-Obstétrique, Hôpital Rothschild, Paris Cedex 12, France.
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Lee JWS, Doumouchtsis SK, Fynes MM. Is Doppler planimetry a valid technique for the evaluation of postpartum urinary bladder volume? Int Urogynecol J 2008; 19:1019-25. [DOI: 10.1007/s00192-007-0552-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2007] [Accepted: 12/17/2007] [Indexed: 11/30/2022]
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Prevalence and associated risk factors of retention of urine after caesarean section. Int Urogynecol J 2007; 19:537-42. [DOI: 10.1007/s00192-007-0470-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2007] [Accepted: 09/12/2007] [Indexed: 10/22/2022]
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Teo R, Punter J, Abrams K, Mayne C, Tincello D. Clinically overt postpartum urinary retention after vaginal delivery: a retrospective case-control study. Int Urogynecol J 2006; 18:521-4. [PMID: 16927042 DOI: 10.1007/s00192-006-0183-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2006] [Accepted: 06/28/2006] [Indexed: 12/01/2022]
Abstract
We set out to determine the incidence of symptomatic postpartum urinary retention (PUR) after vaginal delivery and to establish any associated risk factors. We carried out a retrospective case-control study of women having PUR after vaginal delivery from 2001 to 2005. Four controls, matched for date of delivery, were selected for each case in univariate and multivariate conditional logistic regression analyses. There were 15,757 deliveries and 30 cases of PUR (incidence 0.2%). Median duration of PUR was 19 days (range 3-85). Eighty percent were managed with intermittent self-catheterization. The use of regional analgesia increased the risk of PUR [odds ratio (OR) 6.33, 95% confidence interval (CI) 2.01-19.96], while ethnicity (Caucasian vs Asian) reduced the risk (OR 0.27, CI 0.08-0.85) (p<0.05). PUR is uncommon but carries significant morbidity. Epidural analgesia and Asian ethnic origin increase the risk. We recommend routine catheterization for up to 24 h after delivery after epidural analgesia.
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Affiliation(s)
- Roderick Teo
- Urogynaecology Department, Leicester General Hospital, Gwendolen Road, Leicester, UK.
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Mazouni C, Bretelle F, Collette E, Heckenroth H, Bonnier P, Gamerre M. Maternal and neonatal morbidity after first vaginal delivery using Thierry's spatulas. Aust N Z J Obstet Gynaecol 2005; 45:405-9. [PMID: 16171477 DOI: 10.1111/j.1479-828x.2005.00450.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To analyse maternal and neonatal morbidity associated with instrumental delivery using Thierry's spatulas. METHODS Between January 2001 and December 2003, 570 nulliparous women with term, singleton, cephalic pregnancies gave birth by either instrumental (n = 279) or spontaneous vaginal delivery (n = 291) and were studied in a retrospective case-control study. Maternal and neonatal morbidity were compared in the instrumental vs. spontaneous delivery groups. RESULTS Women who underwent instrumental delivery using Thierry's spatula were more likely to have severe perineal tears (ORa 7.5, 95% CI 1.5, 32.3), urinary retention (OR 2.7, 95% CI 1.3, 5.6), postpartum blood loss (ORa 3.4, 2.4, 4.9) and extended hospital stay (OR 3.21, 95% CI 2.3, 4.6) than women having a spontaneous vaginal birth. Regarding the infant, one case of subgaleal haematoma was noted. No significant difference was noted in neonatal period. CONCLUSION This data support the safety of Thierry's spatula on infant outcome. Maternal morbidity observed with Thierry spatulas was similar to that reported in the literature for other modes of instrumental delivery but the risk for perineal morbidity was higher than for spontaneous delivery. Neonatal morbidity appeared to be limited.
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Affiliation(s)
- Chafika Mazouni
- Department of Gynecology and Obstetrics, Marseille Public Hospital System (APHM), Marseille, France.
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Yip SK, Sahota D, Pang MW, Chang A. Screening test model using duration of labor for the detection of postpartum urinary retention. Neurourol Urodyn 2005; 24:248-53. [PMID: 15791626 DOI: 10.1002/nau.20111] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AIMS To construct a screening test model for postpartum urinary retention (PUR), using the duration of labor, which was shown to be the risk factor for PUR. METHODS A group of 691 consecutive patients were recruited at postpartum day 1. Of the 691 patients, 101 (14.6%) had PUR. The 691 patients were computer-randomized into two groups, 'A' and 'B.' A receiver operating characteristic (ROC) curve was constructed for Group A to determine the optimum cutoff value for screening PUR using the duration of labor. The cutoff value was then applied to Group B to determine the screening test characteristics of the duration of labor: sensitivity, specificity, predictive values, and likelihood ratios. RESULTS An ROC curve with an area under curve (AUC) of 0.63 (95% CI 0.57-0.69, P < 0.0001) was constructed. A range of cutoff values (with specificity ranging from 0.60 to 0.99) for the duration of labor was determined and the test characteristics computed. According to the test characteristics the optimal cutoff value for the duration of labor was 700 min. This cutoff value for the duration of labor has a specificity of 0.95, negative predicative value of 0.86, and likelihood ratio for a positive test of 0.88. CONCLUSION A screening test model using the duration of labor can be constructed to predict PUR.
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Affiliation(s)
- Shing-Kai Yip
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong.
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Affiliation(s)
- Shing-Kai Yip
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
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Abstract
AIM To assess the validity of a commercially available bladder volume scanner in the puerperium. METHODS A prospective blinded comparison of bladder volume measurement after vaginal delivery using the BladderScan bladder volume instrument (BVI) 3000 and Foley catheter; comparison using the intraclass correlation coefficient. RESULTS The mean difference between the two measurements was a 130-mL over-measurement by the bladder scanner (range: -156 mL to +422 mL). The intraclass correlation coefficient was 0.23 (95% confidence interval 0.00, 0.59). CONCLUSIONS The BladderScan BVI 3000 is not an accurate instrument to assess bladder volume the day after vaginal delivery. Some of the discrepancy might relate to use of the Foley catheter as the reference standard. Further comparison between the BladderScan and a short female catheter or real time ultrasound is indicated.
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Affiliation(s)
- Lucinda M Pallis
- University of Queensland, Department of Obstetrics and Gynaecology, Gold Coast Hospital, Southport, Queensland, Australia.
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Carley ME, Carley JM, Vasdev G, Lesnick TG, Webb MJ, Ramin KD, Lee RA. Factors that are associated with clinically overt postpartum urinary retention after vaginal delivery. Am J Obstet Gynecol 2002; 187:430-3. [PMID: 12193938 DOI: 10.1067/mob.2002.123609] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study was undertaken to determine the incidence of clinically overt postpartum urinary retention after vaginal delivery and to examine what maternal, fetal, and obstetric factors are associated with this problem. STUDY DESIGN This was a retrospective case-controlled study of women who had overt postpartum urinary retention after vaginal delivery from August 1992 through April 2000. RESULTS Fifty-one of 11,332 (0.45%) vaginal deliveries were complicated by clinically overt postpartum urinary retention. In most cases (80.4%), the problem had resolved before hospital dismissal. Persons with urinary retention were more likely than control subjects to be primiparous (66.7% vs 40.0%; P <.001), to have had an instrument-assisted delivery (47.1% vs 12.4%; P <.001), to have received regional analgesia (98.0% vs 68.8%; P <.001), and to have had a mediolateral episiotomy (39.2% vs 12.5%; P <.001). On multivariate logistic regression analysis, of these 4 variables, only instrument-assisted delivery and regional analgesia were significant independent risk factors. CONCLUSION Clinically overt postpartum urinary retention complicates approximately 1 in 200 vaginal deliveries, with most resolving before hospital dismissal. Factors that are independently associated with its occurrence include instrument-assisted delivery and regional analgesia.
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Affiliation(s)
- Michael E Carley
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN 55905, USA
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