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Identification of risk factors for postpartum urinary retention following vaginal deliveries: A retrospective case-control study

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Abstract

Objective

Postpartum urinary retention (PUR) is an uncommon complication of vaginal delivery, defined as a failure to void spontaneously in the six hours following vaginal birth. The objective of this study was to identify risk factors for PUR in order to provide prompt management.

Study Design

A retrospective, comparative, case-control study, including two groups of 96 patients who delivered vaginally, was conducted at the Women and Children’s University Hospital in Lyon, France. Patients were selected based on data extraction from the medical records of the obstetrics and gynecology department. The first group included patients with postpartum urinary retention and the second group, without PUR, was selected randomly, respecting 1:1 matching criteria, paired according to the year of delivery and patient’s age at delivery.

Results

Logistic regression analysis found that instrumental delivery (OR 13.42, 95%CI [3.34;53.86], p = 0.0002), absence of spontaneous voiding before leaving the delivery room (OR 6.14, 95%CI [2.56;14.73], p < 0.0001), no intact perineum (OR 3.29, 95%CI [1.10;9.90], p = 0.03) and vulvar edema or perineal hematoma (OR 8.05, 95%CI [1.59;40.67], p = 0.01) were independent risk factors associated with PUR.

Conclusion

The present study identified risk factors for PUR that should be taken into consideration as soon as delivery is over in order to implement appropriate management. Future studies are needed to assess the contribution of early systematic bladder scanning in patients with risk factors for early diagnosis of PUR.

Introduction

Postpartum urinary retention (PUR) is an uncommon complication of vaginal delivery. It is defined as the inability to completely void after giving birth and occurs with an incidence of 0.45% to 0.9% [1]. Yip et al. were the first to make a distinction between overt (symptomatic) and covert (asymptomatic) PUR [2]. They defined overt PUR as failure to spontaneously void within six hours of vaginal delivery or catheter removal post-cesarean section [3,4]. Overt PUR occurs with an incidence of 4.9% [3]. Covert PUR is defined as a post void residual bladder volume (PVRBV) superior to 150 ml, with no symptoms of urinary retention, and presents with an incidence of 9.7% [3,5]. Postpartum urinary retention can lead to urinary incontinence and detrusor atony, urinary tract infections, anuria, hydronephrosis, and even kidney failure [[6], [7], [8]]. Although the pathophysiology of postpartum acute urinary retention is still unclear, many hypotheses and risk factors have been described as involved, including physiological, neurological, and mechanical causes [4,5]. Several risk factors have been suggested, such as preexisting risk factors (history of urinary retention, nulliparity), and additional risk factors related to epidural analgesia, iatrogenic fluid overload, patient BMI, the baby’s birth weight, or vaginal delivery (labor duration, instrumental delivery, episiotomy, perineal edema) [[9], [10], [11]]. Screening for PUR does not occur during standard postpartum care. Therefore, early recognition of risk factors is important in order to provide immediate management and prevent potential damage of an enduring retention. The objective of the present study was to identify risk factors for PUR in order to be able to provide prompt management avoiding further complications.

Section snippets

Materials and methods

A retrospective, comparative, case-control study, including 2 groups of 96 patients who delivered vaginally between March 2011 and October 2015, was conducted in the obstetrics and gynecology department of the Women and Children’s University Hospital (Hôpital Femme Mère Enfant) in Lyon, France. This study was approved by the French ethics committee, registered in the clinical trials register (N° NCT03876756) and declared to the National Commission on Informatics and Liberty (CNIL, N° 17-020).

Results

Among the two groups of patients included in the study, the mean maternal age was 29.2 ± 4.8 years in the PUR group and 29.4 ± 4.9 years in the control group (p = 0.86). A total of 63 patients (65.6%) from the PUR group and 38 (40%) from the control group were primiparous (p = 0.0004). The mean labor duration was superior to 360 min for 58 patients (61%) in the PUR group vs. 38 patients (40.9%) from the control group (p = 0.006) (Table 2). Among patients with labor exceeding > 360 min, 71

Comment

During labor and in the postpartum period, the bladder is usually at risk for possible injuries and dysfunction creating the need for identifying specific risk factors for PUR. The present study showed that, following vaginal delivery, an increased risk of PUR was associated to instrumental delivery, the absence of spontaneous voiding before leaving the delivery room, the presence of vulvar edema, and a dose of local anesthetic superior to 50 mg.

Only vaginal operative delivery, which has been

Conclusion

The present study identified risk factors for PUR that should be taken into consideration as soon as delivery is over in order to implement appropriate management. Future studies are needed to assess the contribution of early systematic bladder scanning in patients with risk factors for early diagnosis of PUR.

Funding

None.

Author’s contribution

Gery Lamblin: Project development, Manuscript writing, Editing

Gautier Chene: Project development, Manuscript writing

Camille Aeberli: Data collection, Manuscript writing

Roxana Soare: Data collection, Manuscript writing

Stéphanie Moret: Management Data analysis

Lionel Bouvet: Methodologist analysis, Manuscript writing

Muriel Doret-Dion: Project development, Manuscript writing, Supervisor

Declaration of Competing Interest

None.

Acknowledgments

Thanks to Ms Mariane Gindre, a dedicated midwife working in our department, who put the basis of this study as part as her graduation thesis.

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