Delivery-related risk factors for covert postpartum urinary retention after vaginal delivery

Mulder, Frits I.; Rengerink, Katrien Oude; Post, Joris A. M. van der; Hakvoort, R. A.; Roovers, Jan‐Paul W. R.

doi:10.1007/s00192-015-2768-8

Cited by 62 publications

(81 citation statements)

References 28 publications

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“…However, as bladder volumes during pregnancy and postpartum can reach and exceed 1,000 mL, it is a reasonable assumption that limiting PVRVs to 150 mL after delivery is clinically irrelevant. As over 15% of our patients had PVRV ≥500 mL, comparable with previous studies [18, 19], we believe that the cutoff value to detect a potential pathological condition should be increased. We therefore suggest that the new definition of covert PUR should be: “covert or asymptomatic postpartum urinary retention (PUR) includes post void residual volume (PVRV) ≥ 500 mL after the first spontaneous void following (vaginal) delivery, measured by ultrasound or catheter”.…”

Section: Discussionsupporting

confidence: 89%

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Long-term micturition problems of asymptomatic postpartum urinary retention: a prospective case–control study

et al. 2017

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Introduction and hypothesisCovert (asymptomatic) postpartum urinary retention (PUR) is defined as post-void residual volume (PVRV) ≥150 mL. Although often supposed to be a common and harmless phenomenon, no data are available on the potential long-term micturition problems of increased PVRV after vaginal delivery.MethodsAfter the first spontaneous void post-vaginal delivery, PVRV was measured using a portable scanning device. Micturition symptoms were compared using validated questionnaires between women with PVRV < 150 mL and those with PVRV ≥150 mL until 1 year after delivery. Women with PVRV ≥ 150 mL were followed until complete bladder emptying was achieved.ResultsData of 105 patients with PVRV < 150 mL and 119 with PVRV ≥ 150 mL were available for analysis. 75% of all patients included had PVRV ≥ 250 mL. More primiparous patients had PVRV ≥ 150 mL (p < 0.02). 92% of women with PVRV ≥ 150 mL after delivery were able to adequately empty their bladder within 4 days. One year after delivery, no statistically significant differences were found.ConclusionsCovert PUR according to the definition of PVRV ≥ 150 mL, is a common and transient phenomenon that does not result in more lower urinary tract symptoms 1 year after delivery. Although the current definition is not useful in identifying postpartum women with a pathological condition, we suggest that the definition of covert PUR should be change to: “PVRV≥500 mL after the first spontaneous void after (vaginal) delivery.” This cut-off value is the value at which some women do need more time to normalise emptying of the bladder. The exact clinical implications of covert PUR need to be further studied in this subcategory of women.

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Section: Discussionsupporting

confidence: 89%

“…These cut-off values were based on a previous study in which the median PVRV of an unselected cohort of 745 patients was 140 mL and the 75th and 95th percentile were 250 mL and 540 mL respectively [18]. As the currently used cut-off value, i.e.…”

Section: Methodsmentioning

confidence: 99%

Long-term micturition problems of asymptomatic postpartum urinary retention: a prospective case–control study

et al. 2017

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“…Decrease in the adrenergic and cholinergic innervation of the bladder has been observed after induced urinary retention and bladder overdistension in rats (31,59). Whether women suffer neuroanatomic changes in the bladder with labor is unknown, although it is possible, since urinary retention is a well-known condition after childbirth, with epidural analgesia, prolonged labor, episiotomy, and high birth weight as risk factors (28,37,38). The epidural analgesia commonly used to avoid pain during labor causes bladder hypotonia and eliminates the normal sensation to void, leading to bladder overdistension (62), which may damage the detrusor and consequently induce long-term voiding difficulties (64).…”

Section: 56)mentioning

confidence: 99%

Neuroanatomic and behavioral correlates of urinary dysfunction induced by vaginal distension in rats

Palacios-Galicia

Juárez

Morán

et al. 2016

American Journal of Physiology-Renal Physiology

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-The aim of the present study was to use a model of simulated human childbirth in rats to determine the damage to genitourinary structures and behavioral signs of urinary dysfunction induced by vaginal distension (VD) in female rats. In experiment 1, the length of the genitourinary tract and the nerves associated with it were measured immediately after simulated human delivery induced by VD or sham (SH) procedures. Electroneurograms of the dorsal nerve of the clitoris (DNC) were also recorded. In experiment 2, histological characteristics of the bladder and major pelvic ganglion of VD and SH rats were evaluated. In experiment 3, urinary parameters were determined in conscious animals during 6 h of dark and 6 h of light before and 3 days after VD or SH procedures. VD significantly increased distal vagina width (P Ͻ 0.001) and the length of the motor branch of the sacral plexus (P Ͻ 0.05), DNC (P Ͻ 0.05), and vesical nerves (P Ͻ 0.01) and decreased DNC frequency and amplitude of firing. VD occluded the pelvic urethra, inducing urinary retention, hematomas in the bladder, and thinness of the epithelial (P Ͻ 0.05) and detrusor (P Ͻ 0.01) layers of the bladder. Major pelvic ganglion parameters were not modified after VD. Rats dripped urine in unusual places to void, without the stereotyped behavior of micturition after VD. The neuroanatomic injuries after VD occur alongside behavioral signs of urinary incontinence as determined by a new behavioral tool for assessing micturition in conscious animals. external urethral sphincter; dorsal nerve of the clitoris; major pelvic ganglion; micturition MICTURITION consists of two phases: storage and urine expulsion. During storage, the detrusor is relaxed while the bladder neck and urethra are activated, preventing involuntary bladder emptying (11). Extrinsic elements such as the levator ani muscle also contribute to the maintenance of continence (3). When the bladder reaches its threshold volume, spinal and supraspinal reflexes are triggered to induce bladder contraction and urethral relaxation, and urine flows through the urethra (11). Damage to the lower urinary tract and/or its innervation can induce urinary dysfunction (3,29,41).Urinary dysfunction affects the health of many women (60). Stress urinary incontinence has been described as involuntary loss of urine during effort and is the most prevalent urinary disorder related to vaginal childbirth, which is known to injure the pudendal nerve and denervate the external urethral sphincter (EUS) (3, 15, 57).Maternal pelvic viscera and nerve damage results from the difficulty of human childbirth due the large fetal head and brain relative to the maternal pelvis size. Neonates at birth have heads that are close to the size of the maternal birth canal through which they must pass during the second stage of parturition (48). Births of fetuses over 4 kg or fetal malposition often prolong parturition (30), retaining the fetus in the pelvic cavity, the main anatomic resistance to fetal expulsion. Prolonged second stage of parturition...

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“…Clinically it is manifested as weak dribble of urine or completely blocked urinary tract, accompanied by abdominal distention and pain (symptomatic PUR) [1]; or patients are able to void spontaneously but have a postvoid residual bladder volume (PVRV) of ≥150 mL (symptomatic PUR) [2]. Reported prevalence for overt symptomatic PUR ranges from 0.3% to 4.7% [3, 4].…”

Section: Introductionmentioning

confidence: 99%

Acupuncture Compared with Intramuscular Injection of Neostigmine for Postpartum Urinary Retention: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials

Wang

Gong

et al. 2018

Evidence-Based Complementary and Alternative Medicine

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Objective To compare the effectiveness and safety of acupuncture versus intramuscular injection of neostigmine. Methods Databases including CNKI, VIP, WanFang, SinoMed, PubMed, Cochrane Library, and clinicaltrials.gov database were retrieved for relevant literature, with the retrieval deadline being November 2017. Two reviewers independently screened, selected, and extracted data and validated the results. The methodological quality was evaluated with the “Risk of Bias” tool, and the meta-analysis was performed by using the RevMan 5.3.5 software. Results Totally 953 patients with postpartum urinary retention from 15 randomized controlled trials entered the meta-analysis. 12 articles compared the clinical cure rate of acupuncture alone versus intramuscular injection of neostigmine and found the cure rate in the acupuncture group was 2 times that in the neostigmine group (RR, 1.91; 95% CI: 1.66–2.19). 15 articles compared the clinical effectiveness rate of acupuncture alone with that of intramuscular injection of neostigmine and found the clinical effectiveness rate was 28% higher in the acupuncture group than in the neostigmine group (RR: 1.28; 95% CI: 1.16–1.42). No adverse event was reported in the acupuncture group. Conclusion Acupuncture alone is more effective in treating postpartum urinary retention than intramuscular injection of neostigmine, with good safety profile. Therefore, it is a feasible and valuable technique in clinical settings.

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Delivery-related risk factors for covert postpartum urinary retention after vaginal delivery

Cited by 62 publications

References 28 publications

Long-term micturition problems of asymptomatic postpartum urinary retention: a prospective case–control study

Long-term micturition problems of asymptomatic postpartum urinary retention: a prospective case–control study

Neuroanatomic and behavioral correlates of urinary dysfunction induced by vaginal distension in rats

Acupuncture Compared with Intramuscular Injection of Neostigmine for Postpartum Urinary Retention: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials

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