Introduction and hypothesis Postpartum urinary retention (PUR) may cause long-term urogenital tract morbidity. The incidence ranges from 0.18 to 14.6%, but the importance of prompt diagnosis and appropriate management is often underappreciated. The paucity of data on long-term outcome after PUR contributes to these drawbacks. The aim of this study was to assess long-term persistence of elevated PVR (post-void residual urine) volume after PUR. Pathophysiology, risk factors and management of PUR are reviewed. Methods In our tertiary referral urogynecology unit in the University Women’s Hospital of Bern, Switzerland, all patients who were referred for PUR were asked to participate in this study. PVR was measured sonographically every 2 days until day 15, then after 6, 12, 24 and 36 months and, if increased, the patients were instructed to perform clean intermittent self-catheterization. If retention persisted longer than the lactation period, multichannel urodynamics was performed. Results Sixty-two patients were included. The median PVR normalized at day 7. Long-term voiding disorders were found in 8.2%, 6.7%, and 4.9% after 1, 2, and 3 years respectively. Multichannel urodynamics confirmed in all patients with persisting retention an acontractile detrusor and de novo stress urinary incontinence in 4 cases. Quantile regression did not reveal any factor contributing to earlier recovery. Eighty-nine percent of the patients with PUR had operative vaginal deliveries, emphasizing the importance of this risk factor for PUR. Conclusions In most cases PUR resolves early, but voiding difficulties persist more often than previously thought, and for these patients the consequences are devastating. Obstetric awareness, early active management, and developing management strategies in the postpartum period might preclude lower urinary tract morbidity.

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Study question How did the coronavirus disease 2019 (COVID-19) pandemic affect live birth numbers in Europe? SUMMARY ANSWER In 14 European countries with validated data sets on live birth numbers during the ongoing COVID-19 pandemic, excess mortality was inversely correlated with live birth numbers. What is known already Since March 2020, in order to minimise spread of severe acute respiratory syndrome coronavirus 2 and reducing strain on the health care systems, many national authorities have imposed containments and restricted both indoor and outdoor recreational activities. Historical events, such as electricity blackouts, have repeatedly been shown to exert incremental effects on birth numbers. Study design, size, duration We evaluated the effect of the COVID-19 pandemic and the containments on reproduction and birth numbers in 14 European countries with complete and validated data sets, until March 2021. Participants/Materials, setting, methods The national demographic offices of 20 European countries were requested to provide the monthly birth numbers from 2015 to March 2021. Fourteen countries provided those data. Taking into account seasonal variations, the live birth numbers were compared with excess mortality at two different time intervals during the pandemic. Main results and the role of chance Nine months after the initiation of containments in many European countries, 11 of 14 European countries (78.5%) experienced a decline in live birth numbers, ranging between -0.5% and -11.4%. The decline in live birth numbers was most pronounced in eight European countries with the highest degree of excess mortality. From January to March 2021, live birth numbers continued to decline in five of eight European countries with high excess mortality, whereas live births started to recover in eight of 14 countries (57.1%). Limitations, reasons for caution The live birth numbers of some key European countries were not available. Wider implications of the findings The demographic changes linked to the COVID-19 pandemic may add to the overall socioeconomic consequences, most particularly in those countries with pre-existing reduced reproduction rates. Study Funding/COMPETING INTEREST(S) This study did not receive specific funding. The authors have no conflicts of interest to declare. Trial registration number Not applicable.

ZusammenfassungFrauen mit intaktem Uterus müssen bei der Anwendung eines systemisch wirksamen Östrogens zur Endometriumprotektion ein Gestagen erhalten. Gestagene lassen sich in verschiedene Wirkstoffgruppen einteilen, welche unterschiedliche Partialwirkungen haben. Dies bedeutet, dass es keinen Klasseneffekt der Gestagene gibt, sondern die Effekte auf Metabolismus sowie auf hormonsensible Gewebe wie Brust, Endometrium und Knochen variieren können. Mikronisiertes Progesteron und Dydrogesteron scheinen in Hinblick auf Herz-Kreislauf-System und Brust die sicherste Option zu sein. Ihre Effekte auf die Glukosehomöostase und den Lipidstoffwechsel sind neutral. Eine menopausale Hormontherapie, einschliesslich der Wahl des Gestagens, sollte immer entsprechend dem Risikoprofil und den Behandlungszielen der Patientin individualisiert werden.