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Ren HY, Zhang HF, Chen YY, Luo TZ. Factors associated with urinary retention after vaginal delivery under intraspinal anesthesia: a path analysis model. Int Urogynecol J 2024; 35:157-166. [PMID: 37999762 PMCID: PMC10810937 DOI: 10.1007/s00192-023-05684-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 10/20/2023] [Indexed: 11/25/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Women who have intraspinal anesthesia for delivery are more likely to experience postpartum urinary retention (PUR), which, if not recognized and treated promptly, can result in long-term urinary dysfunction. Many factors influencing PUR have been proposed, but no study has been conducted to investigate the relationship between them. This study is aimed at determining the influencing factors of PUR and to explore the relationship between them. METHODS A prospective, cross-sectional survey using self-made questionnaires was conducted among 372 puerperae in a Grade A hospital in Guangzhou, China, from April to September 2022. SPSS25.0 and AMOS24.0 were used for data analysis, and a path analysis model was established to determine the relationship between the influencing factors. RESULTS The incidence of PUR was 49.85%. Residence, the level of postpartum pain, and the change of postnatal urination position had a direct effect on PUR. Episiotomy and analgesic duration have both direct and indirect effects on PUR. Forceps delivery, perineal edema and oxytocin had an indirect effect on PUR. Variables could influence the occurrence of PUR by mediating the analgesic duration, episiotomy, postpartum pain level, and postnatal urination position changes. CONCLUSIONS This study provides an empirical model to illustrate the relationship between PUR and related factors in women who delivered under intraspinal anesthesia. In future management, more attention should be paid to women who live in cities, have higher levels of postpartum pain, longer analgesic duration, higher grade of perineal edema, and received episiotomy, forceps delivery, and oxytocin during labor.
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Affiliation(s)
- Hong-Yan Ren
- The Third Clinical College of Guangzhou Medical University, The Nursing College of Guangzhou Medical University, 195 West Dongfeng Road, Guangzhou, 510182, China
| | - Huan-Fang Zhang
- Department of Obstetrics and Gynecology, Obstetrics, Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, The Third Affiliated Hospital of Guangzhou Medical University, No. 63 Duobao Road, Guangzhou, 510145, China
| | - Yu-Yi Chen
- Department of Obstetrics and Gynecology, Obstetrics, Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, The Third Affiliated Hospital of Guangzhou Medical University, No. 63 Duobao Road, Guangzhou, 510145, China
| | - Tai-Zhen Luo
- Department of Nursing, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, No. 63, Duobao Road, 510145, Guangzhou, China.
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Gautier N, Lejeune D, Al Zein L, Kesteloot C, Ciccarella Y, Brichant JF, Bouvet L, Cops J, Hadzic A, Gautier PE. The effects of intrathecal morphine on urinary bladder function and recovery in patients having a cesarean delivery - A randomized clinical trial. Anaesth Crit Care Pain Med 2023; 42:101269. [PMID: 37364852 DOI: 10.1016/j.accpm.2023.101269] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 06/13/2023] [Accepted: 06/16/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION Spinal anesthesia with intrathecal morphine (ITM) is a common anesthesia technique for cesarean delivery. The hypothesis was that the addition of ITM will delay micturition in women undergoing cesarean delivery. METHODS Fifty-six ASA physical status I and II women scheduled to undergo elective cesarean delivery under spinal anesthesia were randomized to the PSM group (50 mg prilocaine + 2.5 mcg sufentanil + 100 mcg morphine; n = 30) or PS group (50 mg prilocaine + 2.5 mcg sufentanil; n = 24). The patients in the PS group received a bilateral transverse abdominal plane (TAP) block. The primary outcome was the effect of ITM on the time to micturition and the secondary outcome was the need for bladder re-catheterization. RESULTS The time to first urge to urinate (8 [6-10] hours in the PSM group versus 6 [4-6] hours in the PS group) and the time to first micturition (10 [8-12] hours in the PSM group versus 6 [6-8] hours in the PS group) were significantly (p < 0.001) prolonged in the PSM group. Two patients in the PSM group met the 800 mL criterium for urinary catheterization after 6 and 8 h respectively. CONCLUSION This study is the first randomized trial to demonstrate that the addition of ITM to the standardized mixture of prilocaine and sufentanil significantly delayed micturition.
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Affiliation(s)
- Nicolas Gautier
- Department of Anesthesiology, Clinique Sainte-Anne Saint-Rémi - CHIREC, Anderlecht, Belgium
| | - Delphine Lejeune
- Department of Anesthesiology, Clinique Sainte-Anne Saint-Rémi - CHIREC, Anderlecht, Belgium
| | - Lilas Al Zein
- Department of Anesthesiology, Clinique Sainte-Anne Saint-Rémi - CHIREC, Anderlecht, Belgium
| | - Cédric Kesteloot
- Department of Anesthesiology, Clinique Sainte-Anne Saint-Rémi - CHIREC, Anderlecht, Belgium
| | - Yannick Ciccarella
- Department of Anesthesiology, Clinique Sainte-Anne Saint-Rémi - CHIREC, Anderlecht, Belgium
| | - Jean-François Brichant
- Department of Anesthesiology and Resuscitation, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Lionel Bouvet
- Department of Anesthesia and Critical Care, Hospices Civils de Lyon, Lyon, France
| | | | - Admir Hadzic
- Department of Anesthesiology, Ziekenhuis Oost-Limburg, Genk, Belgium; Department of Anesthesiology & Algology, Faculty of Medicine, KULeuven, Leuven, Belgium
| | - Philippe E Gautier
- Department of Anesthesiology, Clinique Sainte-Anne Saint-Rémi - CHIREC, Anderlecht, Belgium
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Chen HT, Luo TZ, Jiang ZY, Dai SD, Xia HA, Yang S, Huang SY, Chen LP. Noninvasive external therapy of traditional Chinese medicine for preventing postpartum urinary retention in women with vaginal delivery: A network meta-analysis. Medicine (Baltimore) 2023; 102:e35399. [PMID: 37832117 PMCID: PMC10578683 DOI: 10.1097/md.0000000000035399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/05/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND To compare the effect of different noninvasive external therapies of traditional Chinese medicine (TCM) on the prevention of postpartum urinary retention (PUR) using a network meta-analysis (NMA). METHODS A search of the China National Knowledge Infrastructure, WanFangDate, VIP, China Biomedical Literature Database, PubMed, The Cochrane Library, Embase, and Web of Science databases were reviewed for related randomized controlled trials dated between database inception and December 31, 2022, on the prevention of PUR by noninvasive TCM. Two researchers independently screened the literature, extracted the data, and assessed the risk of bias in the included studies; then, a NMA was performed using Revman5.3 software, State13.1 software, and frequency methodology. RESULTS In total, 16 studies involving 3637 cases of parturients and 9 types of noninvasive TCM external treatments were incorporated into the NMA. The NMA results show that based on routine nursing, in terms of reducing the incidence of urinary retention, acupoint compressing combined with auricular acupressure is ranked first, followed by acupoint hot compress, acupoint massage combined with auricular acupressure, Yin-Yang therapy, acupoint massage, auricular acupressure, acupoint compressing, and routine nursing. In terms of urination time, acupoint compressing combined with auricular acupressure ranked first, followed by acupoint massage combined with auricular acupressure, acupoint electrical stimulation, acupoint compressing, TCM heating therapy, acupoint massage, auricular acupressure, and routine nursing. In terms of reducing residual urine volume after the first urination, acupoint compressing combined with auricular acupressure was ranked first, followed by auricular acupressure, acupoint compressing, acupoint massage, TCM heating therapy, and routine nursing. CONCLUSION Current evidence shows that acupoint compressing combined with auricular acupressure may be the best noninvasive TCM treatment for preventing PUR based on routine nursing; however, further high-quality clinical randomized controlled trials are needed for validation and support.
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Affiliation(s)
- Hua-Ting Chen
- The Third Clinical College of Guangzhou Medical University, The Nursing College of Guangzhou Medical University, Guangzhou, China
| | - Tai-Zhen Luo
- Department of Nursing, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zi-Yan Jiang
- Department of Obstetrics and Gynecology, Obstetrics, Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Si-Di Dai
- The Third Clinical College of Guangzhou Medical University, The Nursing College of Guangzhou Medical University, Guangzhou, China
| | - Hua-An Xia
- Department of Nursing, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shuai Yang
- Department of Obstetrics and Gynecology, Obstetrics, Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shi-Ying Huang
- Department of Cardiology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Li-Ping Chen
- Department of Nursing, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Nutaitis AC, Meckes NA, Madsen AM, Toal CT, Menhaji K, Carter-Brooks CM, Propst KA, Hickman LC. Postpartum urinary retention: an expert review. Am J Obstet Gynecol 2023; 228:14-21. [PMID: 35932877 DOI: 10.1016/j.ajog.2022.07.060] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/24/2022] [Accepted: 07/31/2022] [Indexed: 01/26/2023]
Abstract
Postpartum urinary retention is a relatively common condition that can have a marked impact on women in the immediate days following childbirth. If left untreated, postpartum urinary retention can lead to repetitive overdistention injury that may damage the detrusor muscle and the parasympathetic nerve fibers within the bladder wall. In rare circumstances, postpartum urinary retention may even lead to bladder rupture, which is a potentially life-threatening yet entirely preventable complication. Early diagnosis and timely intervention are necessary to decrease long-term consequences. There are 3 types of postpartum urinary retention: overt, covert, and persistent. Overt retention is associated with an inability to void, whereas covert retention is associated with incomplete bladder emptying. Persistent urinary retention continues beyond the third postpartum day and can persist for several weeks in rare cases. Recognition of risk factors and prompt diagnosis are important for proper management and prevention of negative sequelae. However, lack of knowledge by providers and patients alike creates barriers to accessing and receiving evidence-based care, and may further delay diagnosis for patients, especially those who experience covert postpartum urinary retention. Nationally accepted definitions and management algorithms for postpartum urinary retention are lacking, and development of such guidelines is essential for both patient care and research design. We propose intrapartum recommendations and a standardized postpartum bladder management protocol that will improve patient outcomes and contribute to the growing body of evidence-based practice in this field.
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Affiliation(s)
- Alexandra C Nutaitis
- Department of Obstetrics and Gynecology, Cleveland Clinic Akron General, Akron, OH
| | - Nicole A Meckes
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh Medical Center Magee-Womens Hospital, Pittsburgh, PA
| | - Annetta M Madsen
- Division of Urogynecology, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
| | - Coralee T Toal
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh Medical Center Magee-Womens Hospital, Pittsburgh, PA
| | - Kimia Menhaji
- Female Pelvic Medicine and Reconstructive Surgery, West Coast Ob/Gyn Inc, San Diego, CA; Division of Female Pelvic Medicine and Reconstructive surgery, Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Charelle M Carter-Brooks
- Department of Obstetrics and Gynecology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Katie A Propst
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL
| | - Lisa C Hickman
- Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH.
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Hosakoppal S, Brown O, Peaceman A. Postpartum urinary retention after the institution of a universal voiding protocol. J Matern Fetal Neonatal Med 2022; 35:10199-10205. [PMID: 36093850 PMCID: PMC9691574 DOI: 10.1080/14767058.2022.2122800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/23/2022] [Accepted: 07/29/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Postpartum urinary retention is a frequently occurring condition for which screening is not typically a standardized part of postpartum care. The aim of this study was to determine the incidence of and risk factors for postpartum urinary retention after the introduction of a universal postpartum voiding protocol. METHODS This was a single-center retrospective case-control study of women delivering in a 12-month period. Women with a documented diagnosis of postpartum urinary retention per the institution's voiding protocol were classified as cases, and a matched sample of those without urinary retention were controls. Demographic and obstetric characteristics were compared between both groups using univariate and multivariate analyses as a means to identify risk factors for postpartum urinary retention. RESULTS 8992 women were studied during the time period examined; 195 (2.2%) were identified to have postpartum urinary retention. On multivariate logistic regression analysis, operative vaginal delivery (aOR 2.98 95% CI 1.32-6.70) and second-degree or greater perineal laceration (aOR 2.83 CI 1.59-5.04) were significantly associated with postpartum urinary retention. CONCLUSIONS The incidence of postpartum urinary retention with a postpartum voiding protocol in place was low. Risk factors identified for urinary retention included operative vaginal delivery and second degree or greater perineal laceration. Awareness of these risk factors and implementation of standardized voiding protocols may aid with the early identification and prevention of postpartum urinary retention.
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Affiliation(s)
- Shweta Hosakoppal
- Northwestern University Feinberg School of Medicine. Chicago, Illinois, USA
| | - Oluwateniola Brown
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University. Chicago, Illinois, USA
| | - Alan Peaceman
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Northwestern University. Chicago, Illinois, USA
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Cui G, Zhang Y, Liu Z, Li X, Sha M, Jan N. Effect of Predictive Nursing Combined with Early Drinking Water Therapy on Patients with Urinary Retention after Vaginal Delivery. Computational and Mathematical Methods in Medicine 2022; 2022:1-5. [PMID: 35813411 PMCID: PMC9262503 DOI: 10.1155/2022/4204762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/10/2022] [Accepted: 05/13/2022] [Indexed: 11/17/2022]
Abstract
The aim of this study is to analyze the effect of predictive nursing combined with early drinking water therapy on patients with urinary retention after vaginal delivery. A total of 600 women who gave birth in our hospital from July 2019 to July 2020 were selected as the research objects. A double-blind method was adopted to divide them into a control group and observation group, 300 cases in each group. In the control group, routine nursing was given. In the observation group, (1) predictive nursing measures were used before surgery. (2) The postoperative observation group used early drinking water therapy; the incidence of urinary retention, the effective rate of urination, postpartum haemorrhage, and the treatment of urinary retention were compared between the two groups. In the observation group, the number of urinary retention was 17, and the incidence of urinary retention was 5.67%. The urination efficiency of the observation group was 98.33%; the urination efficiency of the control group was 86.33%; comparison results showed that
. The 24 h postpartum haemorrhage of the observation group was 1.33%; the 24 h postpartum haemorrhage of the control group was 2.66%. Uroschesis therapy was performed in 17 patients in the observation group and 44 patients in the control group.. The observation group had an 88.24 percent treatment rate, while the control group had a 72.73 percent treatment rate.
indicated that the difference was statistically significant.
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Dolezal P, Ostatnikova M, Balazovjechova B, Psenkova P, Zahumensky J. Covert postpartum urinary retention: causes and consequences (PAREZ study). Int Urogynecol J 2022. [PMID: 35716199 DOI: 10.1007/s00192-022-05278-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/03/2022] [Indexed: 11/17/2022]
Abstract
Introduction and hypothesis Increased post-voiding residual volume (PVRV), known as covert postpartum urinary retention (PUR), is an asymptomatic condition with unknown long-term adverse effects. The objectives were to determine the frequency of this phenomenon 3 days after delivery and to examine the associated risk factors and consequences of the increased residuum on women´s health 6 weeks postpartum. Methods We carried out a prospective observational study including a total of 926 primiparous women, giving birth to singletons. All participants underwent ultrasound determination of PVRV on day 3 postpartum. Then, risk factors were determined using logistic regression analysis. After 6 weeks, participants were invited to return for PVRV determination and to complete urogynecological and general health questionnaires. Using these data, the consequences of increased PVRV were determined. Results A total of n=90 women were diagnosed with abnormal PVRV. Mean age in the studied population was 30.4 years, BMI prior to delivery 27.8, weight of the newborn 3,420 g, and percentage of cesarean sections 15.9%. Gestational week (p=0.043), vaginal tear (p=0.032), and induction of labor (p=0.003) were risk factors for covert PUR. Puerperal incidence of urinary tract infection was 1.1% (6 out of 526) and of urinary incontinence 29.2% (155 out of 530), with no differences between the groups. In the second examination, covert PUR was no longer present, and the values of residual urine decreased for all patients in the case group. No statistically significant differences were observed in questionnaire scores in general health and wellbeing perceptions between the groups. Conclusions We have found a few significant obstetrical–pediatric risk factors for abnormal PVRVs. Data from the follow-up suggest that covert PUR has no impact on morbidity and quality of life 6 weeks postpartum. Therefore, abnormal PVRV is a self-limited phenomenon with a tendency toward self-correction. Our findings support those of previous studies that advocate against screening for asymptomatic retention in the postpartum period, despite some similar previous recommendations.
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O'Leary BD, Kelly L, Keane DP. Antenatal urinary retention: Risk factors, treatment, and effect on pelvic floor dysfunction. Eur J Obstet Gynecol Reprod Biol 2022; 271:15-19. [DOI: 10.1016/j.ejogrb.2022.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/24/2022] [Accepted: 01/28/2022] [Indexed: 11/04/2022]
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Geng X, Dong L, Sha M, Song X, Cui G. Effect of overall nursing combined with acupressure in preventing postpartum urinary retention. Am J Transl Res 2022; 14:1347-1353. [PMID: 35273737 PMCID: PMC8902544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/26/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES This study investigated the effects of overall nursing care combined with acupressure in preventing postpartum urinary retention. METHODS A total of 200 parturients with vaginal delivery in our hospital from March to October 2019 were enrolled and randomized to a control group and an observation group with 100 cases each. The control group received conventional nursing, while the observation group was also given "overall" nursing combined with acupressure. The two groups were compared in the incidence of urinary retention, time to the first urination, first urine volume, residual urine volume, pelvic floor muscle fiber contraction time, satisfaction, and treatment efficiency. RESULTS The two groups presented no significant difference in general information (P>0.05). Compared to the control group, the observation group showed a lower incidence of urinary retention and experienced an earlier time to first urination (both P<0.001). A significantly smaller residual urine volume was observed in the observation group as compared to controls at 4 h and 12 h after delivery (P<0.05). The observation group outperformed the control group in terms of pelvic floor muscle fiber contraction duration (P<0.001). Moreover, the observation group showed a treatment efficiency and nursing satisfaction superior to the control group (P<0.05). CONCLUSIONS Overall nursing care combined with acupressure can exert strong positive effects on the incidence of postpartum urinary retention, time to the first urination, and residual urine volume in parturients with vaginal delivery and improve their satisfaction.
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Affiliation(s)
- Xiaqing Geng
- Nursing Department, Shijiazhuang Fourth HospitalShijiazhuang 050000, Hebei Province, China
| | - Lifei Dong
- Department of Gynecology, Shijiazhuang Fourth HospitalShijiazhuang 050000, Hebei Province, China
| | - Manting Sha
- Obstetric Ward, Shijiazhuang Fourth HospitalShijiazhuang 050000, Hebei Province, China
| | - Xianfang Song
- Obstetric Ward, Shijiazhuang Fourth HospitalShijiazhuang 050000, Hebei Province, China
| | - Gaiying Cui
- Nursing Department, Shijiazhuang Fourth HospitalShijiazhuang 050000, Hebei Province, China
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Mohr S, Raio L, Gobrecht-Keller U, Imboden S, Mueller MD, Kuhn A. Postpartum urinary retention: what are the sequelae? A long-term study and review of the literature. Int Urogynecol J 2022. [PMID: 35129645 DOI: 10.1007/s00192-021-05074-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/18/2021] [Indexed: 10/31/2022]
Abstract
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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Gupta A, Pampapati V, Khare C, Murugesan R, Nayak D, Keepanasseril A. Postpartum urinary retention in women undergoing instrumental delivery: A cross-sectional analytical study. Acta Obstet Gynecol Scand 2020; 100:41-47. [PMID: 32652531 DOI: 10.1111/aogs.13954] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/30/2020] [Accepted: 07/04/2020] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Avantika Gupta
- Department of Obstetrics & Gynecology, Jawaharlal Institute of Medical Education & Research, Puducherry, India
| | - Veena Pampapati
- Department of Obstetrics & Gynecology, Jawaharlal Institute of Medical Education & Research, Puducherry, India
| | - Chetan Khare
- Department of Neonatology, All India Institute of Medical Sciences, Bhopal, India
| | - Rajeswari Murugesan
- Department of Biostatistics, Jawaharlal Institute of Medical Education & Research, Puducherry, India
| | - Deepthi Nayak
- Department of Obstetrics & Gynecology, Jawaharlal Institute of Medical Education & Research, Puducherry, India
| | - Anish Keepanasseril
- Department of Obstetrics & Gynecology, Jawaharlal Institute of Medical Education & Research, Puducherry, India
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Gonzalez-Díaz E, Biurrun GP. Levator ani muscle avulsion: a risk factor for persistent postpartum voiding dysfunction. Int Urogynecol J 2020; 31:2327-35. [PMID: 32728866 DOI: 10.1007/s00192-020-04412-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 06/23/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Persistent postpartum voiding dysfunction (P-PPVD) is defined as the inability to empty the bladder properly 72 h after delivery despite the use of intermittent urinary catheterization. Our aim was to find predictive factors for P-PPVD and to compare its urogynecologic outcomes with transient dysfunctions. MATERIALS AND METHODS A case-control study was performed in a university hospital center between January 2018 and April 2019. The case group included women diagnosed with P-PPVD after vaginal delivery, and the control group included women with PPVD that resolved before 72 h. Patients were followed up at 12 weeks and 12 months postpartum, including an ultrasound assessment of the levator ani muscle (LAM). RESULTS Of 2308 deliveries, 1894 (81%) were vaginal, 75 (3.85%) presented PPVD, and 1 lasted > 72 h (0.69% P-PPVD). LAM avulsion (OR 6.3, 95% CI 1.24-32.01) was the only independent risk factor for P-PPVD found. No significant differences in urogynecologic symptoms between transient and persistent PPVD were found in the short and the long term, except that women with P-PPVD had a lower prevalence of urinary incontinence at 12 weeks postpartum. CONCLUSIONS PPVD is a common, self-limited event, but in 17.3% of cases persists > 3 days. Levator ani muscle avulsion acts as an independent risk factor for P-PPVD. Early diagnosis and appropriate treatment of P-PPVD can help minimize any clinical implications for long-term urogynecologic disorders.
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Perú Biurrun G, Gonzalez-Díaz E, Fernández Fernández C, Fernández Corona A. Post Partum Urinary Retention and Related Risk Factors. Urology 2020; 143:97-102. [PMID: 32439549 DOI: 10.1016/j.urology.2020.03.061] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/09/2020] [Accepted: 03/24/2020] [Indexed: 10/24/2022]
Abstract
OBJETIVE To investigate the prevalence and potential risk factors for postpartum voiding dysfunction (PPVD). METHODS A retrospective observational study was performed in a university hospital center between January 2018 and April 2019. Women with PPVD criteria postpartum were diagnosed and treated. Gestational, delivery, and puerperium characteristics were compared between women with and without PPVD. RESULTS A total of 1894 out of 2308 deliveries (81%) were vaginal, 73 (9.85%) had PPVD and 13.7% were severe. Epidural analgesia (odds ratio [OR] 7.72, 95% confidence interval [CI],1.02-58.37), operative vaginal delivery (OR 2.23, 95% CI,1.01-4.93), birthweight >4000g (OR 3.7, 95%CI,1.4-9.73), and previous cesarean delivery (OR 6.54, 95% CI, 2.2-19.2) were independent risk factors for PPVD. CONCLUSION PPVD is a relatively common finding that complicates around 10% of vaginal deliveries. Epidural analgesia, birthweight, operative vaginal birth, and having a previous cesarean delivery are independent risk factors for PPVD. In order to prevent PPVD, more research on PPVD risk factors is needed.
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Affiliation(s)
- Gema Perú Biurrun
- Department of Obstetrics and Gynecology, Complejo Asistencial Universitario de León (CAULE), Spain
| | - Enrique Gonzalez-Díaz
- Pelvic Floor Unit, Department of Obstetrics and Gynecology, Complejo Asistencial Universitario de León (CAULE), Spain.
| | | | - Alfonso Fernández Corona
- Department of Obstetrics and Gynecology, Complejo Asistencial Universitario de León (CAULE), Spain
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Rantell A, Veit-Rubin N, Giarenis I, Khullar V, Abrams P, Cardozo L. Recommendations and future research initiative to optimize bladder management in pregnancy and childbirth International Consultation on Incontinence - Research society 2018. Neurourol Urodyn 2020; 38 Suppl 5:S104-S110. [PMID: 31821638 DOI: 10.1002/nau.24053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/19/2019] [Accepted: 05/19/2019] [Indexed: 11/05/2022]
Abstract
With increasing birth rates globally, obstetric bladder care and long term pelvic floor dysfunction continues to be a issue. This paper aims to provide an overview of the concerns in the antenatal, intrapartum an post partum periods and presents recommendation for the research requirements necessary and education to challenge current practice.
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Affiliation(s)
- Angie Rantell
- Department of Urogynaecology, King's College Hospital, London, UK
| | - Nikolaus Veit-Rubin
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Ilias Giarenis
- Department of Urogynaecology, Norfolk and Norwich Hospital, Norwich, UK
| | - Vik Khullar
- Department of Urogynaecology, Imperial College London, London, UK
| | - Paul Abrams
- Department of Urology, Bristol Urological Institute, Bristol, UK
| | - Linda Cardozo
- Department of Urogynaecology, King's College Hospital, London, UK
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Mulder FEM, van der Velde S, Pol F, Bos M, van Leeuwen JS, Dietz V, Hakvoort RA, Roovers JPWR. Accuracy of postvoid residual volumes after vaginal delivery: a prospective equivalence study to compare an automatic scanning device with transurethral catheterization. Int Urogynecol J 2018; 30:773-778. [PMID: 29951911 PMCID: PMC6491401 DOI: 10.1007/s00192-018-3700-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 06/12/2018] [Indexed: 11/28/2022]
Abstract
Introduction and hypothesis Abnormal postvoid residual volumes (PVRV) after delivery are common in daily clinical practice. By using an automatic scanning device, unnecessary catheterizations can be prevented. The aim of this study was to determine the accuracy of PVRV after vaginal delivery measured by an automatic scanning device through a comparison with transurethral catheterization. Materials and methods This prospective observational equivalence study was performed in patients who delivered vaginally between June 2012 and May 2017 in three teaching hospitals in The Netherlands. After the first spontaneous void after delivery, postvoid residual volume (PVRV) was measured with a portable automatic scanning device (BladderScan® BVI 9400). Directly afterward, it was measured by catheterization. Correlation between measurements was calculated using Spearman’s correlation coefficient and agreement plot. The primary outcome was to validate the correlation between the BladderScan® compared with the gold standard of transurethral catheterization. Results Data of 407 patients was used for final analysis. Median PVRV as measured by BladderScan® was 380 ml (± 261–0–999 ml) and by catheterization was 375 ml (± 315–1800 ml). Mean difference between measurements was −12.9 ml (± 178 ml). There was a very good correlation between methods (Spearman’s rho = 0.82, p < 0.001). Using a cut-ff value of >500 ml, specificity and sensitivity were 85.4 and 85.6%, respectively. Conclusions The BladderScan® (BVI 9400) measures PVRV precisely and reliably after vaginal delivery and should be preferred over catheterization.
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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.
| | - Sytske van der Velde
- Department of Obstetrics and Gynaecology, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Fraukje Pol
- Department of Obstetrics and Gynaecology, Catharina Ziekenhuis, Eindhoven, The Netherlands
| | - Marjolein Bos
- Department of Obstetrics and Gynaecology, Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | | | - Viviane Dietz
- Department of Obstetrics and Gynaecology, Catharina Ziekenhuis, Eindhoven, The Netherlands
| | - Robert A Hakvoort
- Department of Obstetrics and Gynaecology, Martini Hospital, Groningen, 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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