Prevalence and risk factors of overt postpartum urinary retention among primiparous women after vaginal delivery: a case-control study

Background Postpartum urinary retention (PUR) may lead to bladder neuromuscular damage and subsequently voiding dysfunction. However, the literature regarding the incidence of and risk factors for PUR remains unclear. Moreover, previously reported studies are limited to small sample sizes. Thus, this study aimed to assess the incidence of and risk factors for overt PUR after vaginal delivery. Methods This retrospective case-control study included all primiparas who delivered vaginally between July 1, 2017, and June 30, 2019, at our institution. The case group comprised 677 women diagnosed with overt PUR who required catheterisation after delivery. The control group comprised 677 women without overt PUR randomly selected in a 1:1 ratio matched for date of delivery and who delivered immediately after each woman with overt PUR to minimise the impact of variations over time in obstetric practice. Univariate and multivariate logistic regression analyses were performed to investigate the factors associated with overt PUR. Results Of the 12,609 women included in our study, 677 were diagnosed with overt PUR (incidence 5.37%). Univariate analysis identified epidural analgesia, episiotomy, perineal tears, instrument-assisted delivery, duration of labour stage, intrauterine operation, and vulvar oedema as risk factors for PUR. Multivariate logistic regression identified epidural analgesia (odds ratio [OR] = 1.41, 95% confidence interval [CI]: 1.11–1.79, P = 0.005), vulvar oedema (OR = 6.92, 95% CI: 4.65–10.31, P < 0.001), forceps delivery (OR = 8.42, 95% CI: 2.22–31.91, P = 0.002), episiotomy (OR = 1.37, 95% CI: 1.02–1.84, P = 0.035), and second-degree perineal tear (OR = 3.42, 95% CI: 2.37–4.94, P < 0.001) as significant independent risk factors for PUR. Conclusions PUR was highly associated with epidural analgesia, forceps delivery, vulvar oedema, episiotomy, and second-degree perineal tears. More attention should be paid to women at high risk to reduce the incidence of PUR.

Spontaneous isolated intraperitoneal rupture of urinary bladder after normal vaginal delivery presenting as puerperal sepsis

Spontaneous isolated intraperitoneal rupture of urinary bladder is a rare urological complication of normal delivery. This complication is usually related to prolonged labour, failure to empty bladder in second stage of labour, use of forceps/ ventouse, postpartum urinary retention, vaginal birth after caesarean section and usually presents immediately after delivery. We report the case of a patient with spontaneous isolated intraperitoneal rupture of urinary bladder after normal vaginal delivery in the absence of any risk factor. She presented on day 5 postpartum with features suggestive of puerperal sepsis with pyoperitoneum with acute kidney injury. Absence of unhealthy lochia and later, normal-looking uterus and adnexa during laparotomy led to the suspicion of alternate cause for seropurulent ascites. Further exploration revealed rent in the urinary bladder with necrosed margins. High index of suspicion of alternate diagnosis should be maintained if some of the clinical findings are not supportive of provisional initial diagnosis

RESEARCH ON POSTPARTUM URINARY RETENTUON AND SOME RELATED FACTORS IN VAGINAL DELIVERY IN DA NANG HOSPITAL FOR WOMEN AND CHIDREN

Objective: To determine the rate of urinary retention after vaginal delivery and evaluation some factorsrelated to urinary retention after vaginal delivery at Da Nang Hospital For Women And Chidren.Methods: Cross-sectional study describing 673 women giving birth vaginally, at Da Nang HospitalFor Women And Chidren from March 2018 to the end of September 2018. The pregnant womenin the research group will be examined, interviewed, and refer to the medical records to record thevariables according to the research questionnaire.Results: Women who are primigravida with postpartum urinary retention rate 6.6%, higher than2.4% for multigravida who have postpartum urinary retention. In infants with a weight of ≥ 3500grams, the prevalence of birth urinary retention was 16.7%, higher than that of women with babies<3500 grams with neonatal urinary retention (1.7%). The rate of postpartum urinary retention amongwomen who had a baby with a head circumference ≥ 36 cm was 24.3% higher than for women with ahead circumference <36 cm (3.6%). The rate of urinary retention in pregnant women: asisted vaginaldelivery was 50.0%; time of labor in stage 1 lasted ≥ 12 hours was 13.0%; the duration of second stagelabor was 16.4% prolonged, higher than the rate of urinary retention in the group of pregnant women:vaginal delivery (4.6%); period of labor for stage 1 <12 hours (2.1%); period of labor for stage 2 didnot last long (3.3%). In the group of women who did not exercise early after giving birth, the rate ofurinary retention was 37.5%, higher than this group of women with early movement after birth, 1.3%.Conclusion: The rate of urinary retention after vaginal delivery is 4.8%. Factors: giving birth incomparison, giving birth to a large baby with a gestational weight: ≥ 3500 grams, head circumference≥36 cm, asisted vaginal delivery, long stage 1 labor, long stage 2 labor, early postpartum inactivityincreases the risk of postpartum urinary retention

Intrapartum pudendal nerve block analgesia and risk of postpartum urinary retention: a cohort study

Introduction and hypothesis Pudendal nerve block analgesia (PNB) is used as pain relief in the final stage of childbirth. We hypothesized that PNB is associated with higher rates of postpartum urinary retention. Methods We performed a cohort study among primiparous women with a singleton, cephalic vaginal birth at Oslo University Hospital, Norway. Women receiving PNB were included in the exposed group, while the subsequent woman giving birth without PNB was included in the unexposed group. We compared the likelihood of postpartum urinary retention, defined as catheterization within 3 h after birth. Logistic regression analysis stratified by mode of delivery was performed adjusting for epidural analgesia, episiotomy and birth unit. Results Of the 1007 included women, 499 were exposed to PNB and 508 were unexposed. In adjusted analyses, women exposed to PNB did not differ in likelihood of postpartum urinary retention compared to women unexposed to PNB in either spontaneous (odds ratio[OR]: 0.82, 95% confidence interval [CI] 0.55–1.22) or instrumental (OR 1.45, 95% CI 0.89–2.39) births. Furthermore, no differences between the groups were observed with excessive residual urine volume or catheterization after > 3 h. Conclusions PBD was associated with neither risk of postpartum urinary retention nor excessive residual urine volume and is therefore unlikely to hamper future bladder function.

Association of Obstetric Risk Factors with Postpartum Urine Retention in Spontaneous Labor

Objective: To determine the relationship between obstetric risk factors and the incidence of postpartum urinary retention in spontaneous labour at RSUD Ulin Banjarmasin.Methods: This clinical study used an analytical observational design with a cross-sectional approach. The population of this study was patients with a diagnosis of postpartum urinary retention in spontaneous labour in the delivery ward and postpartum ward of Ulin Banjarmasin Hospital between January 2018-January 2020. The sample for this study was a part of the target population selected by purposive sampling, which fulfilled the inclusion and exclusion criteria. Data were analyzed using the Chi square test and multivariate analysis using binary logistics.Results: The results showed 35 samples of patients diagnosed with postpartum urinary retention in spontaneous labour and had met the inclusion and exclusion criteria. Characteristic data of the study samples found that most of the study subjects were more than 35 years old, 27 patients (77%), 21 patients (60%) of cases with primigravida parity, 26 patients (76%) with the duration of second stage labour more than equal to 1 hour. Episiotomy was performed in 30 patients (86%), 34 patients (97%) had a newborn birthweight of less than 4000 grams. There was a significant association between the risk factors for parity in primigravida (p-value 0.02), second stage labour duration in primigravida (p-value 0.01), and episiotomy (p-value 0.01), with postpartum urinary retention in spontaneous labour. In contrast, age (p-value 0.19), and birthweight (p-value 0.10) were not significantly associated with postpartum urinary retention in spontaneous labour.Conclusions: There were significant associations between obstetric risk factors (parity, duration of second stage labour, and episiotomy) with postpartum urinary retention in spontaneous labour. Whereas age and birth weight were not significantly associated with postpartum urinary retention in spontaneous labour.Keywords: obstetric risk, postpartum retention, spontaneous delivery. Abstrak Tujuan: Mengetahui hubungan faktor risiko obstetrik dengan kejadian retensio urin postpartum pada persalinan spontan di RSUD Ulin Banjarmasin.Metode: Penelitian ini merupakan penelitian klinis dengan rancangan observasional analitik dengan pendekatan potong lintang. Populasi dari penelitian ini adalah ibu postpartum yang didiagnosis dengan retensio urin postpartum pada persalinan spontan di kamar bersalin dan di ruangan nifas RSUD Ulin Banjarmasin periode Januari 2018-Agustus 2020. Data dianalisis bivariat menggunakan uji Chi square dan analisis multivariate dengan menggunakan binary logistik.Hasil: Didapati 35 sampel yang didiagnosis retensio urin postpartum pada persalinan spontan dan memenuhi kriteria inkulusi dan eksklusi. Data karakteristik sampel penelitian ditemukan usia terbanyak subyek penelitian berusia lebih dari 35 tahun sebanyak 27 pasien (77,14%), kasus dengan paritas primigravida sebanyak 21 pasien (60%), lama kala dua primigravida lebih dari sama dengan 1 jam sebanyak 26 pasien (76%). Tindakan episiotomi sebanyak 30 pasien (86%), berat bayi lahir terbanyak pada berat kurang dari 4.000 gram yaitu sebnyak 34 pasien (97%). Terdapat hubungan yang bermakna pada faktor risiko paritas pada primigravida dengan p value 0,02, lama kala dua dengan p value 0,01, dan tindakan episotomi dengan p value 0.01 dengan kejadian retensio urin postpartum sedangkan didapatkan hasil yang tidak bermakna pada risiko obstetrik usia dengan p value 0.19 dan berat bayi lahir dengan p value 0.10 pada kejadian retensio urin postpartum.Kesimpulan: Terdapat hubungan signifikan antara faktor risiko obstetrik (paritas, lama kala dua dan tindakan episotomi) dengan retensio urin postpartum persalinan spontan. Sedangkan umur dan berat badan lahir tidak berhubungan dengan retensio urin postpartum pada persalinan spontanKata kunci: persalinan spontan, risiko obstetrik, retensio postpartum.