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

Abstract

Objective: 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. Material and Methods: 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. Results: 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). Conclusions: 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.

Keywords

• voiding dysfunction
• vaginal delivery
• urinary retension

References

1. Referans 1. Yip SK, Brieger G, Hin LY, Chung T (1997) 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 76:667–672
2. Referans 2. Buchanan J, Beckmann M (2014) Postpartum voiding dysfunction: identifying the risk factors. Aust N Z J Obstet Gynaecol 54:41–45
3. Referans 3. Kekre AN, Vijayanand S, Dasgupta R, Kekre N (2011) Postpartum urinary retention after vaginal delivery. Int J Gynaecol Obstet 112:112–115
4. Referans 4. Hee P, Lose G, Beier-Holgersen R, Engdahl E, Falkenlove P (1992),Postpartum voiding in the primiparous after vaginal delivery. Int Urogynecol J 3:95–99
5. Referans 5. Zaki MM, Pandit M, Jackson S. (2004) National survey for intrapartum and postpartum bladder care: assessing the need for guidelines. BJOG,;111:874- 6 . Referans. 6. Mesut Polat, Mehmet Baki Şentürk,Çiğdem Pulatoğlu, Ozan Doğan, Çetin Kılıççı,Mehmet Şükrü Budak (2018), Postpartum urinary retention: Evaluation of risk factors, Turk J Obstet Gynecol.; 15(2): 70–74. Jun 21. d
6. Referans 7. Andolf E, Iosif CS, Jorgensen C, Rydhstrom H.,(1994)Insidious urinary retention after vaginal delivery: prevalence and symptoms at follow-up in a population-based study. Gynecol Obstet Invest;38:51–3.
7. Referans 8. Groutz A, Hadi E, Wolf Y et al. (2004) Early postpartum voiding dysfunction: incidence and correlation with obstetric parameters. J Reprod Med; 49: 960–964.
8. Referans 9. Mulder FE, Schoffelmeer MA, Hakvoort RA, Limpens J, Mol BW, van der Post JA, et al. (2012) Risk factors for postpartum urinary retention: a systematic review and meta-analysis. BJOG ;119:1440-6.

9. Referans 10. Mustonen S, Ala-Houhala IO, Tammela TL.(2001) Long-term renal dysfunction in patients with acute urinary retention. Scand J Urol Nephrol;35:44-8. , Referans 11. Bross S, Schumacher S, Scheepe JR, Zendler S, Braun PM, Alken P, Junemann K (1999) Effects of acute urinary bladder overdistension on bladder response during sacral neurostimulation. Eur Urol 36:354–359
10. Referans 12. Lewis JM, Yalla SV, Stanitski KE, Sullivan MP (2012) Spectrum of urodynamic abnormalities and renal function changes in adult men with non- neurogenic urinary retention. Neurourol Urodyn 31:544–548
11. Referans. 13. Poston GJ, Joseph AE, Riddle PR.(1983) The accuracy of ultrasound in the measurement of changes in bladder volume. Br J Urol;55:361-3.
12. Referans 14. Glavind K, Bjork J (2003) Incidence and treatment of urinary retention postpartum. Int Urogynecol J Pelvic Floor Dysfunct 14:119–121
13. Referans 15. Rizvi RM, Khan ZS, Khan Z (2005) Diagnosis and management of postpartum urinary retention. Int J Gynaecol Obstet 91:71–72
14. Referans 16. Carley ME, Carley JM, Vasder G, Lesnick TG, Webb MJ, Ramin KD. (2002) Factors that are associated with clinically overt postpartum urinary retention after vaginal delivery. Am J Obstet Gynecol;187:430-3.
15. Referans 17. Liang CC, Chang SD, Chang YL, Chen SH, Chueh HY, Cheng PJ.Postpartum urinary retention after cesarean delivery. Int J GynaecolObstet 2007;99:229- 32.
16. Referans 18. Cavkaytar S, Kokanalı MK, Baylas A, Topçu HO, Laleli B, Taşçı Y. (2014 )Postpartum urinary retention after vaginal delivery: Assessment of risk factors in a case-control study, J Turk Ger Gynecol Assoc. Aug 8;15(3):140-3. doi: 10.5152/jtgga.2014.13102. eCollection 2014.
17. Referans 19. Lim JL.(2010) Post-partum voiding dysfunction and urinary retention. Aust N Z J Obstet Gynaecol; 50: 502–505.
18. Referans 20. Femke E. M. Mulder & Robert A. Hakvoort & Jan-Peter de Bruin & Erica W. Janszen & Joris A. M. van der Post & Jan-Paul W. R. Roovers (2018)), Long- term micturition problems of asymptomatic postpartum urinary retention: a prospective case–control study,Int Urogynecol J 29:481–488 DOI 10.1007/s00192-017-3457-6
19. Referans 21. F. E. M. Mulder & R. A. Hakvoort & M. A. Schoffelmeer &J. Limpens & J. A. M. Van der Post & J. P. W. R. Roovers, (2014)) Postpartum urinary retention: a systematic review of adverse effects and management, Int Urogynecol J 25:1605–1612 DOI 10.1007/s00192-014-2418-6
20. Referans 22. Routine Postnatal Care of Women and their Babies. National Institute for Health and Clinical Excellence Guideline 37. London;2006.
21. Referans 23. World Health Organization. World Health Organization Technical Consultation on Postpartum and Postnatal Care. Geneva: World Health Organization; 2010.
22. Referans 24. Postpartum Care Management Guideline, Turkish Ministry Of Health, Ankara, 2014