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.

High dose vs. low dose oxytocin for labor augmentation: a systematic review and meta-analysis of randomized controlled trials

ObjectivesTo compare the safety and efficacy between high dose and low dose oxytocin administration for labor augmentation.MethodsWe searched for the available studies during March 2020 in PubMed, Cochrane Library, Scopus, and ISI Web of science. All randomized clinical trials (RCTs) that assessed safety and efficacy of high dose vs. low dose oxytocin for labor augmentation were considered. The extracted data were entered into RevMan software. Dichotomous and continuous data were pooled as odds ratio (OR) and mean difference (MD) respectively, with the corresponding 95% confidence intervals (CI). Our main outcomes were cesarean delivery rate, spontaneous vaginal delivery rate, uterine hyperstimulation and tachysystole, and labor duration from oxytocin infusion.ResultsEight RCTs with 3,154 patients were included. High dose oxytocin did not reduce cesarean delivery rate compared to low dose oxytocin (OR=0.76, 95% CI [0.52, 1.10], p=0.15). After solving the reported heterogeneity, high dose oxytocin did not increase the rate of spontaneous vaginal deliveries vs. low dose oxytocin (OR=1.06, 95% CI [0.84, 1.32], p=0.64). Low dose oxytocin was linked to a significant decline in uterine hyperstimulation and tachysystole (p>0.001). A reduction in labor duration was found in high dose oxytocin group over low oxytocin regimen (MD=−1.02 h, 95% CI [−1.77, −0.27], p=0.008).ConclusionsWe found no advantages for high dose oxytocin over low dose oxytocin in labor augmentation except in reducing labor duration. Low dose oxytocin is safer as it decreases the incidence of uterine hyperstimulation and tachysystole. More trials are needed to confirm our findings.

Understanding Technology in Birth Care from the Experiences of Taiwanese Obstetricians

Childbirth in Taiwan is characterized by the use of intensive technological and surgical interventions. Taiwanese cesarean rates are among the highest in the world, fetal monitoring is standard, and interventions such as episiotomy and labor augmentation are routinized practices during childbirth. In this Research Note, I describe the sociopolitical context that has given rise to this situation. More specifically, based on ethnographic research concerning birth care, I explore the ways obstetricians navigate this context and highlight the values and considerations that produce and shape “care” on the ground. I argue that understanding how interventionist birth care has come about, and how it is sustained as obstetricians manage care in daily practice, is vital to inform ongoing feminist activism for women’s self-determination and the de-medicalization of childbirth in Taiwan.

A decade’s experience in primipara, term, singleton, vertex parturients with a sustained low rate of CD

BackgroundCesarean delivery (CD) in primiparas with a term singleton vertex fetus (PTSV) is a sentinel event for the future mode of delivery and determinant of repeat CD risk. We aimed to evaluate the risk factors for primary CD in a population with a decade of sustained low rate of intrapartum CD.MethodsThis was a retrospective single-center cohort study between 2005 and 2014. The primary outcome of the study was the mode of delivery. PTSV who attempted vaginal delivery were identified and categorized according to the mode of delivery: vaginal delivery vs. CD. Risk factors for intrapartum CD adjusted odds ratio (aOR) [95% confidence interval (CI)] in multivariate analysis were reported.ResultsDuring the study, 121,483 deliveries were registered; 26,301 (21.6%) PTSV were admitted in labor, of which 1944 (7.4%) had an intrapartum CD. Significantly in multivariate analysis, this group had a unique risk profile as compared to those who delivered vaginally; non modifiable risks included advanced maternal age: 3.06 (2.16–4.33), P < 0.001; prior multiple (≥3) miscarriages: 1.94 (1.04–3.62), P = 0.04; low (<6) modified admission cervical score: 2.41 (2.07–2.82), P < 0.001; low birth weight (BW): 1.42 (1.00–2.01), P = 0.05 or macrosomia: 2.38 (1.77–3.21), P < 0.001; modifiable risks included induction of labor: 1.79 (1.51–2.13), P < 0.001 and oxytocin labor augmentation: 8.36 (6.84–10.22), P < 0.001.ConclusionIn a population of PTSV with a sustained low risk for intrapartum cesarean maintained by a strict labor management, induction of labor remains a significant and sole potentially modifiable risk factor for CD.