European Journal of Obstetrics & Gynecology and Reproductive Biology
Full length articleIdentification of risk factors for postpartum urinary retention following vaginal deliveries: A retrospective case-control study
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.
References (24)
- et al.
Four-year follow-up of women who were diagnosed to have postpartum urinary retention
Am J Obstet Gynecol
(2002) - et al.
A simulation study of the number of events per variable in logistic regression analysis
J Clin Epidemiol
(1996) - et al.
[Postpartum urinary retention]
Prog en Urol
(2011) - et al.
[Effects of anesthesia on postoperative micturition and urinary retention]
Ann Fr Anesth Reanim
(1995) - et al.
The effect of intermittent versus continuous bladder catheterization on labor duration and postpartum urinary retention and infection: a randomized trial
J Clin Anesth
(2008) - et al.
Is portable three-dimensional ultrasound a valid technique for measurement of postpartum urinary bladder volume?
Taiwan J Obstet Gynecol
(2014) - et al.
Prolonged second stage of labour, maternal infectious disease, urinary retention and other complications in the early postpartum period
BJOG
(2016) - et al.
Screening test model using duration of labor for the detection of postpartum urinary retention
Neurourol Urodyn
(2005) - et al.
Urinary retention in the post-partum period. The relationship between obstetric factors and the post-partum post-void residual bladder volume
Acta Obstet Gynecol Scand
(1997) - et al.
Use of epidural anesthesia and the risk of acute postpartum urinary retention
Am J Obstet Gynecol
(2007)
Postpartum urinary retention after vaginal delivery: assessment of risk factors in a case-control study
J Turkish Ger Gynecol Assoc.
Long-term renal dysfunction in patients with acute urinary retention
Scand J Urol Nephrol
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