Covert postpartum urinary retention, is there a place for routine bladder ultrasound in postpartum care?

Postpartum urinary retention (PUR) is defined as inability to void after six hours from delivery or having abnormal post-void residual volume after delivery (PVRV). Overt PUR is easily detectable condition but covert PUR usually remains undiagnosed. We aim to investigate the incidence of covert PUR and identify the risk factors. A retrospective analysis of the postpartum women was undertaken between January-July 2016. PVRV of the patients either delivered vaginally or cesarean section were assessed with ultrasound after first micturition. All the ultrasound scans were made by experienced gynecologist. PVRV of more than 150 mL was defined as covert PUR. Maternal age, parity, BMI, type of delivery, episiotomy, first urination time, fetal head circumference, labor augmentation and fetal birth weight were investigated as possible risk factors for covert PUR. The characteristics of the patients with or without covert PUR were compared. Of the 450 women included, 67 (17.49%) were diagnosed as covert PUR. Birth weight (p= 0.001), head circumference (p=0.043), vaginal delivery (p=0.001) and need for episiotomy (p=0.003) were statistically different between patients with PVRV under 150 mL and above 150 mL. Fetal head circumference appeared as the only independent risk factor for covert PUR (95% CI for OR=1.11-1.127, p=0.04). Although covert PUR is a common problem after delivery, risk factors and treatment have not been established. Until risk factors are identified clearly with larger studies, postpartum routine PVRV evaluation may be beneficial for preventing long-term voiding dysfunction problems.

Download Full-text

Postpartum Urinary Retention after Vaginal Delivery

Indonesian Journal of Obstetrics and Gynecology ◽

10.32771/inajog.v7i2.833 ◽

2019 ◽

pp. 141-145 ◽

Cited By ~ 1

Author(s):

Bonifacius B Erlangga ◽

Rudy A Lengkong ◽

John Wantania

Keyword(s):

Risk Factors ◽

Birth Weight ◽

Urinary Retention ◽

Vaginal Delivery ◽

Perineal Laceration ◽

Stage Duration ◽

Second Stage ◽

Postpartum Urinary Retention ◽

Assisted Delivery ◽

Fetal Birth Weight

Abstract Objective:To determine the incidence of postpartum urinary retention (PUR) after vaginal delivery and to specify any obstetric risk factors that contributing PUR. Methods: Case control study. Six hours after vaginal delivery, urethral catheterization was implemented for estimation of post void residual bladder and diagnosis PUR. Patient data, including age, gestational age, body mass index, parity, mode of delivery, labor duration, perineal laceration or episiotomy, and fetal birth weight, were compared between women with and those without PUR to determine which obstetric factors that develops PUR. Results: Of the 365 participants recruited, 38 (10,67%) had PUR: 33 (9,27%) with covert PUR and 5 (1,4%) with overt PUR. Women with perineal laceration or episiotomy (p<0,05), instrument-assisted delivery (p<0,05), first stage duration of labor more than 12 hours (p<0,05), second stage duration of labor more than one hour in multipara (p=0,041), and fetal birth weight more than 3800 grams (p<0,05) more prone to develop PUR. Conclusion: The incidence of PUR were associated with several obstetric risk factors: perineal laceration or episiotomy, instrument-assisted delivery, first stage duration of labor more than twelve hours, second stage duration of labor more than one hour in multipara, and fetal birth weight more than 3800 grams. Key words: vaginal delivery, postpartum urinary retention, risk factor Abstrak Tujuan:Mengetahui angka kejadian retensi urine di kota Manado dan mengetahui faktor risiko obstetri yang berperan dalam terjadinya retensi urine pascasalin pervaginam. Metode:Penelitian kasus kontrol. Dilakukan pemeriksaan residu urine 6 jam pascasalin pervaginam untuk mengetahui kejadian retensi urine. Data pasien yang diambil berupa usia, usia gestasi, indeks massa tubuh, paritas, jenis persalinan, durasi kala I, durasi kala II, laserasi perineum / episiotomi, dan berat badan lahir bayi kemudian dibandingkan antara yang menderita retensi urine dan tanpa retensi urine pasca salin untuk mengetahui faktor risiko obstetri yang berperan. Hasil:Dari 365 sampel penelitian, 38 (10,67%) menderita retensi urine: 33 (9,27%) retensi urine asimptomatis dan 5 (1,4%) retensi urine simptomatis. Pasien dengan laserasi perineum / episiotomi (p<0,05), persalinan dengan bantuan instrumen (p<0,05), durasi persalinan kala I ³ 12 jam (p<0,05), persalinan kala II ³ 1 jam pada multipara (p=0,041), dan berat badan lahir bayi ³ 3800 gram (p<0,05) memiliki risiko lebih tingi menderita retensi urine pascasalin pervaginam. Kesimpulan:Kejadian retensi urine pascasalin pervaginam berhubungan dengan beberapa faktor risiko obstetri yaitu laserasi perineum / episiotomi, persalinan dengan bantuan instrumen, durasi persalinan kala I ³ 12 jam, persalinan kala II ³ 1 jam pada multipara, dan berat badan lahir bayi ³ 3800 gram. Kata kunci: persalinan pervaginam, retensi urine, faktor risik

Download Full-text

Faculty Opinions recommendation of Risk factors for postpartum urinary retention: a systematic review and meta-analysis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717954870.793461500 ◽

2012 ◽

Author(s):

Howard Goldman

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Urinary Retention ◽

Meta Analysis ◽

Postpartum Urinary Retention

Download Full-text

Prevalence and risk factors for postpartum urinary retention after vaginal delivery in Japan: A case‐control study

Japan Journal of Nursing Science ◽

10.1111/jjns.12293 ◽

2020 ◽

Vol 17 (2) ◽

Author(s):

Izumi Kawasoe ◽

Yaeko Kataoka

Keyword(s):

Risk Factors ◽

Urinary Retention ◽

Vaginal Delivery ◽

Case Control Study ◽

Case Control ◽

Postpartum Urinary Retention ◽

Control Study

Download Full-text

Accuracy of ultrasonic fetal weight estimation using head and abdominal circumference and femur length

Medicinski pregled ◽

10.2298/mpns0512548m ◽

2005 ◽

Vol 58 (11-12) ◽

pp. 548-552 ◽

Cited By ~ 1

Author(s):

Ljiljana Mladenovic-Segedi ◽

Dimitrije Segedi

Keyword(s):

Birth Weight ◽

Head Circumference ◽

Fetal Weight ◽

Abdominal Circumference ◽

Weight Estimation ◽

Fetal Head ◽

Total Body Mass ◽

Femur Length ◽

Fetal Weight Estimation ◽

Gynecology And Obstetrics

Introduction Former investigations have shown that the accuracy of fetal weight estimation is significantly higher if several ultrasonic fe?tal parameters are measured, because the total body mass depends on the size of fetal head, abdominal circumference and femur length. The aim of this investigation was to establish the best regression model, that is a number of combinations of fetal parameters providing the most accurate fetal weight estimation in utero in our population. Material and methods This prospective study was carried out at the Gynecology and Obstetrics Clinic of the Clinical Center Novi Sad. It included 270 pregnant women with singleton pregnancies within 72 hours of delivery who underwent ultrasound measurements of the biparietal diameter (BPD), head circumference (HC), ab?dominal circumference (AC) and femur length (FL). Results In regard to fetal weight estimation formulas, the deviation was lowest using regression models that simultaneously analyzed four fetal parameters (0.55%) with SD ?7.61%. In these models the estimates of fetal weights were within ?5% of actual birth weight in 48.89%, and within ?10% of actual birth weight in 81.48%. Good results were also obtained using AC, FL measurements (0.92% ? 8.20) as well as using AC, HC, FL measurements (-1.45% ? 7.81). In our sample the combination of AC and FL model gave better results in fetal weight estimation (0.92 ? 8.20%) than the one using BPD and AC (2.97 ? 8.83%). Furthermore, the model using parameters AC, HC and FL showed a lower error in accuracy (-1.45 ? 7.81%) than the model using BPD, AC and FL (2.51 ? 7.82%). Conclusion This investigation has confirmed that the accuracy of fetal weight estimation increases with the number of measured ultra?sonic fetal parameters. In our population the greatest accuracy was obtained using BPD, HC, AC and FL model. In cases when fast estimation of fetal weight is needed, AC, HC, FL model may be appropriate, but if fetal head circumference cannot be measured (amnion rupture and/or fetal head already in the pelvis) the AC, FL model should be used.

Download Full-text