Intermittent vs continuous catheterization for postpartum urinary retention: A multicenter randomized controlled trial

BACKGROUND

Postpartum urinary retention is a common complication in the immediate postpartum period. However, there is no consensus regarding optimal management.

OBJECTIVE

This study aimed to compare 2 catheterization strategies for the treatment of postpartum urinary retention.

STUDY DESIGN

A multicenter prospective randomized controlled trial was conducted at 4 university-affiliated medical centers between January 2020 and June 2022. Individuals with postpartum urinary retention (bladder volume of >150 mL) up to 6 hours after vaginal or cesarean delivery were randomly allocated to 1 of 2 protocols: intermittent catheterization every 6 hours, up to 4 times, or continuous catheterization with an indwelling urinary catheter for 24 hours. If postpartum urinary retention was not resolved after 24 hours, an indwelling catheter was inserted for an additional 24 hours in both groups. The primary endpoint was the mean time to postpartum urinary retention resolution. The secondary endpoints included postcatheter urinary tract infection rate and length of hospital stay. The satisfaction rate was estimated using the 30-Item Birth Satisfaction Scale questionnaire.

RESULTS

After randomization, 73 individuals were allocated to the intermittent catheterization group, and 74 individuals were allocated to the continuous catheterization group. The mean time to postpartum urinary retention resolution was significantly shorter in the intermittent catheterization group than in the continuous catheterization group (10.2±11.8 vs 26.5±9.0 hours; P<.001), with 75% and 93% resolution rates after 1 and 2 catheterizations, respectively. The number of individuals who achieved resolution at 24 hours was 72 (99%) in the intermittent catheterization group and 67 (91%) in the continuous catheterization group (P=.043). The satisfaction rate was higher in all categories in the intermittent catheterization group than in the continuous catheterization group (P<.001). No intercohort difference was found in the urinary tract infection rates (P=.89) or hospital stay length (P=.58).

CONCLUSION

Compared with indwelling catheterization, intermittent catheterization for urinary retention after delivery was associated with quicker postpartum urinary retention resolution and a higher satisfaction rate without increasing the complication rates.

Trends, seasonality and effect of ambient temperature on preterm delivery

PURPOSE

To identify trends in preterm delivery (PTD) as well as seasonality, temporal variation and the effect of heat stress on its incidence.

MATERIALS AND METHODS

In this retrospective population-based study, we included all deliveries taking place at the Soroka University Medical Center between the years 1988-2012. A time series database was built including meteorological factors and the number of spontaneous versus induced PTDs for each day. Data were analyzed using time-series analyses.

RESULTS

During the study period, 263 709 deliveries occurred, 7.9% of which were preterm. Spontaneous PTD rate steadily decreased, while induced PTD rate increased. A significant annual and seasonal variation was noted in PTD incidence. A significant higher incidence of spontaneous PTD was demonstrated during the summer period with an incidence rate ratio (IRR) of 4.1 (95%CI: 3.1-5.5; p < 0.001). This trend was not significant for induced PTD. A significant linear association was noted between the heat-stress index and the rates of spontaneous (IRR = 1.07, 95%CI: 1.05-1.10; p < 0.001) but not induced PTDs.

CONCLUSIONS

Spontaneous PTD is more common during the summer and its rate is declining steadily over the past decades. Increased outdoor temperature has a significant effect on the incidence of spontaneous, but not induced, PTD.