Background: The overall risk of postpartum urinary retention (PUR) is between 0.05% and 37%. Being Asian increases the risk, while other factors include epidural analgesia, prolonged first and second stage of labour and previous history of PUR.
Subjects and Methods: This is a cohort study conducted at a tertiary hospital in Pahang State of Malaysia over one year duration. All postpartum women were included. The post void residual volume (PVRV) was measured after minimum 6 hours postpartum or when the subject complained of inability to pass urine. The PVRV of more than 150ml was considered as PUR. Data analysis was performed using SPSS version 20.
Results: Of 1000 included women, mean age was 28.44(5.68), parity of 2.0 and 75.8% had vaginal delivery. PUR was diagnosed in 42 (4.2%) women, of whom 4 (9.5%) were diagnosed with overt and 38 (90.5%) had covert PUR. Parity and perineal tear were significantly associated with PUR. Second degree perineal tear (including episiotomy) were independent risk factors associated with PUR (adjusted OR 3.19, CI 1.23 - 8.30).
Conclusion: Incidence of PUR in our population is low compared with others. Second degree perineal tear (including episiotomy) is a risk factor for PUR. PUR screening is not needed in our population.
Teo R, Punter J, Abrams K, Mayne C, Tincello D. Clinically overt postpartum urinary retention after vaginal delivery: a retrospective case-control study. Int Urogynecol J. 2007;18(5):521-24. doi 10.1007/s00192-006-0183-x.
Mesut P, Mehmet BS, Cigdem P, Ozan D, Cetin K, Mehmet SB. Postpartum urinary retention: evaluation of risk factors. Turk J Obstet Gynaecol. 2018; 15(2): 70-74. Doi 10.4274/tjod.43931.
Yip SK, Brieger G, Hin LY, Chung T. 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. 1997; 76(7):667-72.
Iosif S, Ingemarsson I, Ulmsten U. Urodynamic studies in normal pregnancy and in puerperium. Am J Obstet Gynecol. 1980;137(6):696-700.
Elliott RA, Castleden CM, Duffin HM. The effect of progesterone and oestrogen on rat detrusor muscle. Neurol Urodyn. 1992;11:345-6.
Groutz A, Levin I, Gold R, Pauzner D, Lessing JB, Gordon D. Protracted postpartum urinary retention: the importance of early diagnosis and timely intervention. Neurourol Urodyn. 2011;30(1):83–86. doi 10.1002/nau.20926.
Bates CP, Bradley WE, Glen ES, Griffiths D, Melchior H, Rowan D, et al. Third Report on the Standardization of Terminology of Lower Urinary Tract Function Procedures related to the evaluation of micturition: pressure-flow relationships. Residual urine. Produced by the International Continence Society, February 1977. Br J Urol. 1980;52(5):348–50. doi 10.1111/j.1464-410X.1980.tb03058.x
Kermans G, Wyndaele JJ, Thiery M, De Sy W. Puerperal urinary retention. Acta Urol Belg 1986;54(4):376–85
Liang CC, Chang SD, Chang YL, Chen SH, Chueh HY, Cheng PJ. Postpartum urinary retention after cesarean delivery. Int J Gynecol Obstet. 2007; 99(3): 229–232. doi 10.1016/j.ijgo.2007.05.037
Amrita C, Kamini T. Persistent postpartum urinary retention following vaginal delivery:a rare complication in obstetric practice. Int J Reprod ContraceptObstet Gynaecol. 2013;2(3):475-477. doi 10.5455/2320-1770.ijrcog20130951
Groutz A, Gordon D, Wolman I, Jaffa A, Kupferminc MJ, Lessing JB. Persistent postpartum urinary retention in contemporary obstetric practice: definition, prevalence and clinical implications. J Reprod Med. 2001;46(1):44-8
Zalina N, Norliza I, Razman MR, Hamizah I. Is portable three-dimensional ultrasound a valid technique for measurement of postpartum urinary bladder volume? Taiwan J Obstet Gynaecol. 2013;53(1):12–6. doi: 10.1016/j.tjog.2013.01.028
Zalina N, Abdul Rahman J, Dalia F and Rozihan I.Tanslation and validation of bahasa Malaysia version of Urogenital distress Inventory(UDI-6) and Incontinece Impact Quality of life Questionaires (IIQ-7), a cross sectional study (2014). Malaysian Journal of Medical Sciences,23 (3 May-June), pp57-63, ISSN 1394-195X E-ISSN 2180-4303
Liang CC, Lin YH, Chen TC, Chang SD. How antepartum and postpartum acute urinary retention affects the function and structure of the rat bladder. Int Urogynecol J. 2014;25(8):1105–1113. doi: 10.1007/s00192-013-2320-7
Mulder FE, Hakvoort RA, Schoffelmeer MA, Limpens J, Van der Post JA, Roovers JP. Postpartum urinary retention: a systematic review of adverse effects and management. Int Urogynecol J. 2014;25(12):1605–1612. doi 10.1007/s00192-014-2418-6
Kekre AN, Vijayanand S, Dasgupta R, Kekre N. Postpartum urinary retention after vaginal delivery. Int J Gynecol Obstet. 2011;112(2): 112–115. doi 10.1016/j.ijgo.2010.08.014
Snooks SJ, Swash M, Mathers SE, Henry MM. Effect of vaginal delivery on the pelvic floor: a 5 years follow-up. Br J Surg. 1990;77(12):1358–1360
Lien KC, Morgan DM, DeLancey JO, Ashton-Miller JA. Pudendal nerve stretch during vaginal birth: a 3D computer simulation. Am J Obstet Gynecol. 2005;192(5):1669–1676
Sajadi KP, Lin DL, Steward JE, Balog B, Dissaranan C, Zaszczurynski P, et al. Pudendal nerve stretch reduces external urethral sphincter activity in rats. J Urol. 2012;188(4):1389–1395
Tetzschner T, Sørensen M, Lose G, Christiansen J. Pudendal nerve recovery after a noninstrumented vaginal delivery. Int Urogynecol J Pelvic Floor Dysfunct. 1996;7(2):102-4
Tetzschner T, Sørensen M, Lose G, Christiansen J. Pudendal nerve function during pregnancy and after delivery. Int Urogynecol J Pelvic Floor Dysfunct. 1998;8(2):66-8
Ching-Chung L, Shuenn-Dhy C, Ling-Hong T, Ching-Chang H, Chao-Lun C, Po-Jen C. Postpartum urinary retention: assessment of contributing factors and long-term clinical impact. Aust N Z J Obstet Gynaecol. 2002;42(4):365-8
Carley ME, Carley JM, Vasdev G, Lesnick TG, Webb MJ, Ramin KD, et al. Factors that are associated with clinically overt postpartum urinary retention after vaginal delivery. Am J Obstet Gynecol. 2002;187(2):430–3.Groutz A, Gordon D, Wolman I, Jaffa A, Kupferminc MJ, Lessing JB. Persistent postpartum urinary retention in contemporary obstetric practice: definition, prevalence and clinical implications. J Reprod Med. 2001;46(1):44-8
This work is licensed under a Creative Commons Attribution 4.0 International License.