Risk factors for postpartum urinary retention after vaginal delivery at term without epidural anesthesia

Influencing Factors in Urinary Retention in Parturients With Epidural Anesthesia Following Term Vaginal Birth

Background: Epidural analgesia is a widely employed method in obstetric care for labor pain management. Postpartum urinary retention is a common complication that can arise during the postnatal period. This study aimed to evaluate the current status and influencing factors of postpartum urinary retention in parturients who received epidural anesthesia. Methods: We retrospectively included parturients who underwent vaginal delivery at our institution from June 2022 to October 2024. The characteristics of parturients with and without postpartum urinary retention were analyzed and compared. Logistic regression analyses were conducted to evaluate the influencing factors of postpartum urinary retention. Results: This study enrolled a cohort consisting of 520 parturients who underwent epidural anesthesia, resulting in a total of 520 instances of childbirth. Among this population, 56 parturients were identified as experiencing postpartum urinary retention. The incidence of postpartum urinary retention in parturients with epidural anesthesia was 10.77%. Correlation analysis results showed that the parity (r = 0.582), duration of analgesia (r = 0.554), degree of perineal laceration (r = 0.656) and use of oxytocin (r = 0.580) were correlated with the occurrence of postpartum urinary retention among parturients with epidural anesthesia (all p < .05). Logistic regression analysis indicated that parity (OR = 2.587, 95% CI: 1.890∼3.225), duration of analgesia (OR = 2.778, 95% CI: 2.104∼3.467), degree of perineal laceration (OR = 3.265, 95% CI: 2.620∼3.815) and use of oxytocin (OR = 2.436, 95% CI: 1.909∼3.875) were the independent influencing factors of postpartum urinary retention (all p < .05). Conclusion: It is imperative that clinical healthcare providers implement targeted preventative and management strategies to reduce postpartum urinary retention.

Risk factors for postpartum urinary retention: An updated systematic review and meta-analysis

BACKGROUND

There are conflicting reports on the factors that increase the likelihood of postpartum urinary retention (PUR).

OBJECTIVES

We completed an updated systematic review and meta-analysis to identify the risk factors for PUR.

SEARCH STRATEGY

An exhaustive search of the literature was undertaken using multiple databases, including PubMed, Web of Science, the Cochrane Library, and Embase to identify pertinent studies published up until November 4, 2023.

SELECTION CRITERIA

Observational studies that provided outcomes to calculate the risk factors for PUR were included.

DATA COLLECTION AND ANALYSIS

Two investigators separately performed the extraction of pertinent data from the articles. The risk factors for PUR were identified by pooling adjusted and unadjusted odds ratios (ORs) and 95% confidence intervals (CIs). Heterogeneity test, sensitivity analysis, and publication bias assessment were performed.

MAIN RESULTS

This meta-analysis included 21 studies with a total of 36 951 participants. Meta-analysis was performed for 14 risk factors, and eight of these were statistically significant. The risk factors that were identified in this review included instrumental delivery (OR, 2.96 [95% CI, 1.82-4.80]; 95% prediction interval [PI], 0.67-12.98), relatively long duration of labor (OR, 1.04 [95% CI, 1.02-1.06]; 95% PI, 1.00-1.08), episiotomy (OR, 1.56 [95% CI, 1.19-2.06] 95% PI, 0.64-3.83), nulliparity (OR, 1.55 [95% CI, 1.30-1.84]; 95% PI, 0.94-2.77), epidural analgesia (OR, 2.99 [95% CI, 1.78-5.03]; 95% PI, 0.53-16.76), labor augmentation (OR, 2.21 [95% CI, 1.49-3.28]; 95% PI, 0.12-39.26), labor induction (OR, 1.73 [95% CI, 1.12-2.66]; 95% PI, 0.40-7.39), and perineal injury (OR, 2.75 [95% CI, 1.95-3.89]; 95% PI, 1.10-6.92).

CONCLUSION

Instrumental delivery, extended labor duration, episiotomy, nulliparity, epidural analgesia, labor augmentation/induction, and perineal injury are significant risk factors for PUR. The findings could help physicians identify patients at risk in the postpartum setting.

Epidural injection of hydromorphone for postoperative pain after episiotomy: a randomized controlled trial

Perineal incision resulting in post-partum pain and impact on puerperal life was the focus of our study. We recruited postpartum mothers who had undergone vaginal delivery to receive labor analgesia and episiotomy with an epidural injection of 0.5 mg hydromorphone to assess the therapeutic effects of postpartum analgesia. The participants were randomly allocated into two groups: the control group (Group NS) received an epidural injection of an equal amount of saline, while the study group (Group HY) received an epidural injection of 0.5 mg hydromorphone. We collected relevant data from electronic medical records to compare the differences between the two groups. The intervention group demonstrated lower pain scores at 4, 8, 12, 16, and 24 h compared to the control group (p < 0.001). Additionally, a higher number of patients in the control group required pain medication (7 (15.9%) compared to 2 (4.7%)). The time to first analgesia request in group NS was earlier than that in group HY (8.94 ± 1.27 h compared to 16.96 ± 3.38 h). The study group experienced higher rates of vomiting (P = 0.002) and itching (P < 0.001). However, there were no differences between the two groups in terms of urinary retention, dyskinesia, respiratory depression, dizziness, or neonatal feeding. The epidural injection of 0.5 mg hydromorphone proved to be effective in alleviating pain caused by maternal episiotomy and did not negatively affect neonatal feeding.Clinical trial registration: http://www.chictr.org.cn/usercenter.aspx identifier: ChiCTR2200064687.

The Risk Factors of Postpartum Urinary Retention for Women by Vaginal Birth: A Systematic Review and Meta-Analysis

INTRODUCTION AND HYPOTHESIS

Postpartum urinary retention is one of the most common complications in women during the immediate postpartum period. The objective was to systematically assess risk factors for postpartum urinary retention after vaginal delivery.

METHODS

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses, we retrieved relevant studies from PubMed, Embase, Cochrane Library, Web of Science Core Collection, China National Knowledge Internet, Wangfang Database, and Chinese Biomedical Database for observational studies investigating the risk factors for postpartum urinary retention from inception to 11 November 2022. The Newcastle-Ottawa Scale and Joanna Briggs Institute's tool were used to assess the risk of bias. We conducted a meta-analysis using RevMan 5.3.

RESULTS

In total, 3,074 articles were screened and data from 27 studies were used in the meta-analysis. Sixteen risk factors were identified, namely, labor augmentation (OR = 1.72, 95% CI = 1.17-2.51), primiparity (OR = 2.36, 95% CI = 1.64-3.38), manual fundal pressure (OR = 2.84, 95% CI = 1.00-8.11), perineal hematoma (OR = 7.28, 95% CI = 1.62-32.72), vulvar edema (OR = 7.99, 95% CI = 5.50-11.63), the total duration of labor (MD = 90.10, 95% CI = 49.11-131.08), the duration of the first stage of labor (MD = 33.97, 95% CI = 10.28-57.65), the duration of the second stage of labor (MD = 14.92, 95% CI = 11.79-18.05), the duration of the second stage of labor > 60 min (OR = 3.18, 95% CI = 1.32-7.67), mediolateral episiotomy (OR = 3.65, 95% CI = 1.70-7.83), severe perineal tear (OR = 3.21, 95% CI = 1.84-5.61), epidural analgesia (OR = 3.23, 95% CI = 1.50-6.96), forceps delivery (OR = 4.95, 95% CI = 2.88-8.51), vacuum delivery (OR = 2.44, 95% CI = 1.30-4.58), neonatal birth weight > 4,000 g (OR = 3.61, 95% CI = 1.96-6.65), and neonatal birth weight > 3,500 g (OR = 1.89, 95% CI = 1.12-3.19).

CONCLUSIONS

Our results demonstrated that labor augmentation, primiparity, manual fundal pressure, perineal hematoma, vulvar edema, the total duration of labor, the duration of the first stage of labor, the duration of the second stage of labor, the duration of the second stage of labor > 60 min, mediolateral episiotomy, severe perineal tear, epidural analgesia, forceps delivery, vacuum delivery, and neonatal birth weight > 4,000 g and > 3,500 g were risk factors for postpartum urinary retention in women with vaginal delivery. The specific ranges of the first and the second stages of labor causing postpartum urinary retention need to be clarified.

The Occurrence and Factors Associated with Overt Urinary Retention Among Postpartum Women After Vaginal Delivery with Labor Epidural Analgesia

Background

Early recognition and prompt intervention for overt postpartum urinary retention (PUR) takes on a critical significance when a woman chooses labor epidural analgesia for pain relief. However, there have been rare fewer reports on the incidence and factors influencing overt PUR in women after vaginal delivery with labor epidural analgesia in China. Therefore, this study aimed to investigate the incidence and factors correlated with overt urinary retention in postpartum women undergoing vaginal delivery with labor epidural analgesia.

Methods

In total, 462 Chinese postpartum women with labor epidural analgesia and vaginal delivery were recruited in one tertiary hospital in Beijing from Dec. 2020 to Nov. 2021. Factors associated with overt PUR for these women were identified through multivariate logistic regression analysis.

Results

The incidence of overt PUR was obtained as 10.2% among these women after vaginal delivery with labor epidural analgesia. As indicated by the result of univariate analysis, forceps-assisted delivery, lateral episiotomy, perineal pain, and fluid administration in the delivery room were correlated with PUR. The result of the multivariate logistic regression suggested that forceps-assisted delivery (odds ratio [OR]=2.46, 95% confidence interval [CI]: 1.14-5.32, P=0.022), lateral episiotomy (OR=4.55, 95% CI: 1.91-10.80, P=0.001), and perineal pain (OR=4.23, 95% CI: 2.05-8.73, P<0.001) were factors affecting overt PUR for these women.

Conclusion

Postpartum women undergoing vaginal delivery with labor epidural analgesia showed a high incidence of overt PUR, and health-care providers should pay more attention to their postpartum urination status in clinical practice. Effective and timely intervention is strongly recommended to reduce the occurrence of overt PUR for these kinds of postpartum women undergoing vaginal delivery with labor epidural analgesia, such as ones experienced forceps-assisted delivery, lateral episiotomy, and more severe perineal pain.

Prevalence of urinary retention after vaginal delivery: a systematic review and meta- analysis

INTRODUCTION AND HYPOTHESIS

Postpartum urinary retention requires timely detection and intervention as late detection can lead to long-term voiding dysfunction; however, trends in the prevalence of urinary retention during the postpartum period remain unclear. This systematic review and meta-analysis aimed to estimate the pooled overall prevalence of overt and covert urinary retention in women after vaginal delivery and the difference in prevalence within 4 days after delivery.

METHODS

MEDLINE, CINAHL, Ichu-shi web, and J-stage databases were searched up until October 2020. Two researchers screened and included observational studies reporting the prevalence of urinary retention up to 4 days postpartum based on inclusion criteria. The overall prevalence of overt and covert urinary retention was calculated.

RESULTS

From 24 studies, the overall overt and covert urinary retention prevalence rates were estimated to be 1% and 13%, respectively. The prevalence of overt urinary retention over time was 2% at 6 h postpartum, 1% at 6-12 h, and 3% from postpartum to 24 h postpartum. The prevalence of covert urinary retention over time was 19% (6 h postpartum), 15% (24 h postpartum), 11% (1 day postpartum), 7% (2 days postpartum), 8% (3 days postpartum), and 0.1% (4 days postpartum).

CONCLUSIONS

By postpartum day 4 after vaginal delivery, 14% of women were found to have experienced urinary retention. The highest prevalence was observed at 6 h postpartum, suggesting that urinary retention could be identified at 6 h postpartum.

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

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.

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

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.

Effect Observation on Modified Zishen Tongguan Decoction Combined with Acupuncture in Treatment of Urinary Retention after Cervical Cancer Surgery and Its Influence on the Incidence of Adverse Reactions

OBJECTIVE

To explore the effect observation on modified Zishen Tongguan decoction combined with acupuncture in the treatment of urinary retention after cervical cancer surgery and its influence on the incidence of adverse reactions.

METHODS

The clinical data of 84 patients suffered from urinary retention after radical resection of cervical cancer (December 2018-December 2019) in the oncology department of Jinan Municipal Hospital of Traditional Chinese Medicine were selected for retrospective analysis. According to the order of admission, they were divided into group A (n = 42), treated with conventional therapy, modified Zishen Tongguan decoction, and acupuncture, and group B (n = 42), treated with conventional therapy. The clinical efficacy of the two groups was observed, the urination function indexes after therapy were recorded, and the clinical efficacy and incidence of adverse reactions were analyzed.

RESULTS

After therapy, compared with group B, the average urinary flow rate, maximum urinary flow rate, bladder compliance (BC) level value, and the number of patients with good recovery of bladder function of group A were obviously higher (P < 0.05), and the urination time and detrusor pressure were obviously lower (P < 0.001). There was no significant difference in the average scoring of overactive bladder syndrome score (OABSS) between the two groups at 7 days of therapy (p > 0.05). The average OABSS of group A at 14 days of therapy was obviously lower than that of group B (P < 0.001). Compared with group B, the total clinical effective rate of group A was obviously higher (P < 0.05), while the total incidence of adverse reactions was obviously lower (P < 0.05).

CONCLUSION

Modified Zishen Tongguan decoction combined with acupuncture is a reliable method to treat urinary retention after cervical cancer surgery, which greatly improves the urination function of patients, as well as the clinical efficacy. Further research will help create a better solution for patients with urinary retention after cervical cancer surgery.

The risk factors of postpartum urinary retention after vaginal delivery: A systematic review

Objectives

This review aimed to explore the independent risk factors of postpartum urinary retention (PUR) after a vaginal delivery.

Methods

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was followed and relevant studies were retrieved from eleven databases. The quality of the included articles was assessed using Critical Appraisal Skills Programme tools or the Appraisal tool for Cross-Sectional Studies. The data analysis was performed using Review Manager version 5.3.

Results

A total of nine articles were included and five risk factors were identified, namely, episiotomy (OR = 2.99, 95%CI = 1.31–6.79, P = 0.009), epidural analgesia (OR = 2.48, 95%CI = 1.09–5.68, P = 0.03), primiparity (OR = 2.17, 95%CI = 1.06–4.46, P = 0.03), instrumental delivery (OR = 4.01, 95%CI = 1.97–8.18, P < 0.001), and the duration of the second stage of labor (MD = 15.24, 95%CI = 11.20–19.28, P < 0.001). However, fetal birth weights of more than 3800 g were not identified as an independent risk factor (MD = 64.41, 95%CI = −12.59 to 141.41, P = 0.10).

Conclusion

This systematic review indicated that the independent risk factors for PUR were found to include episiotomy, epidural analgesia, instrumental delivery, primiparity, and a longer second stage of labor. In clinical practice, healthcare providers could pay more attention to women with these factors and prevent postpartum urinary retention.

Postpartum urinary retention in women undergoing instrumental delivery: A cross-sectional analytical study

INTRODUCTION

Women undergoing instrumental delivery are known to be at higher risk of urinary retention, which can lead to long-term complications such as voiding dysfunction. Nulliparous women undergo a pronounced and sudden change in the perineum due to stretching during delivery, which may add to the perineal trauma from an episiotomy, increasing the risk of urinary retention. We aim to study the incidence and risk factors associated with postpartum urinary retention in women undergoing instrumental delivery.

MATERIAL AND METHODS

Pregnant women who had an instrumental delivery after 37 weeks of gestation at JIPMER, Puducherry, India, between January 2017 and June 2017 were included in the study. Postpartum urinary retention was defined as the inability to void spontaneously or ultrasonographic documentation of post-void residual volume of >150 mL, 6 hours after delivery. Demographic factors, clinical profile and follow-up of these patients were noted. Multivariate logistic regression analysis was performed to assess the risk factors associated with urinary retention and was presented as adjusted odds ratios (OR) with 95% confidence intervals (CI).

RESULTS

Postpartum urinary retention was noted in 124 (20.6%) women undergoing instrumental delivery. Overt and covert urinary retention occurred in 2.3% and 18.3%, respectively. After adjusting for other risk factors, nulliparity (adjusted OR = 4.05, 95% CI 2.02-8.12 compared with multiparity) and prolonged second stage (OR = 3.96, 95% CI 1.53-10.25) compared with suspected fetal compromise as an indication for instrumental delivery was associated with increased risk of postpartum urinary retention. Interaction was noted between parity and episiotomy on the occurrence of postpartum urinary retention (P = .010). Among nulliparous women, those with episiotomy (adjusted OR = 6.10, 95% CI 2.65-14.04) have higher odds of developing postpartum urinary retention compared with those without episiotomy.

CONCLUSIONS

Approximately one of five (20.6%) women undergoing instrumental delivery developed postpartum urinary retention. Among women undergoing instrumental delivery, episiotomy increased the chances of developing postpartum retention in nulliparous but not multiparous women. Prolonged second stage as an indication for instrumental delivery also increased the chances of retention. Future studies are needed to define the cutoff for diagnosis and to evaluate the long-term effects of covert postpartum urinary retention, as well to study the effect of episiotomy on development of postpartum urinary retention in women undergoing instrumental delivery.