Hypothesis / aims of study
Postpartum urinary retention (PUR) is a recognized but often underdiagnosed condition that can significantly affect maternal recovery and contribute to prolonged hospitalization. It is defined as the inability to void within six hours after delivery or the need for catheterization to assist with voiding. PUR can lead to discomfort, complications such as urinary tract infections (UTIs), and increased risk of other bladder-related issues. The study aims to assess the incidence of PUR in postpartum women and evaluate the relationship between factors such as prior urinary tract infections (UTIs), catheterization, anesthesia, and assisted delivery methods.
Study design, materials and methods
A retrospective audit was conducted over three months, from October to December 2023, to review delivery records from a tertiary hospital. The primary focus of the study was the incidence of PUR, defined as delayed first voiding (more than six hours postpartum) or the requirement for catheterization. Key parameters were maternal demographics (age, obesity, prior UTI history), mode of delivery (spontaneous vaginal delivery [SVD], emergency/elective lower-segment cesarean section [LSCS], or vacuum-assisted delivery), anesthesia type, catheterization status, and postpartum voiding patterns.
Results
Results:
The cohort included over 150 postpartum women, aged between 20 and 39 years (mean: 31 years). Obesity was present in 35% of the cohort, and prior UTI history was reported in less than 5% of cases. The overall incidence of PUR, defined as delayed first voiding (>6 hours postpartum) or the need for catheterization, was 20%, with a notably higher prevalence among women who underwent LSCS and vacuum-assisted deliveries (Groutz et al., 2022).
Catheterization was used in 25% of the cases, especially among those who had epidural anesthesia or vacuum-assisted delivery. Prior UTI history did not significantly correlate with an increased risk of PUR, suggesting that other factors—particularly anesthesia type and mode of delivery—were more influential.
Regarding anesthesia, epidural anesthesia, used in 40% of spontaneous vaginal deliveries, was linked to higher PUR rates compared to spinal anesthesia used during LSCS. Vacuum-assisted deliveries showed the highest rate of delayed voiding (30%), frequently requiring temporary catheterization.
Interpretation of results
The results of this study suggest that PUR is most commonly associated with certain delivery methods and anesthesia choices. The higher incidence of PUR in women who received epidural anesthesia or underwent vacuum-assisted deliveries indicates that these factors may significantly impact the ability to void postpartum. Epidural anesthesia, in particular, appears to be a critical factor influencing bladder function, as it can interfere with bladder sensation and voiding reflexes, leading to delayed or impaired voiding.
Interestingly, prior UTI history, a potential risk factor for urinary complications, did not show a significant relationship with PUR incidence in this cohort. This suggests that while UTIs may pose other health risks, they do not independently contribute to postpartum urinary retention. Furthermore, the study revealed that catheterization, often used during epidural anesthesia or vacuum-assisted deliveries, does not independently increase the risk of PUR. This finding emphasizes the need for more judicious catheter use and better post-delivery monitoring, particularly for women with risk factors like epidural anesthesia or instrumental delivery.
Concluding message
This study underscores the importance of delivery-related factors, particularly anesthesia type and the use of vacuum-assisted deliveries, in the development of postpartum urinary retention. The lack of significant correlation between prior UTI history and PUR suggests that other factors should be considered when assessing risk. The findings advocate for improved monitoring protocols, careful use of catheters, and individualized patient care. Future research should focus on preventive strategies, such as early ambulation and targeted bladder management interventions, to reduce the incidence of PUR and improve maternal recovery outcomes.