Postpartum urinary retention (PPRT) affects between 2 and 3% of deliveries resulting in increased hospital costs and the potential for long term morbidity including need for prolonged catheter placement, intermittent self-catheterization, and future bladder dysfunction. PPRT is avoidable with medical staff awareness and intervention before bladder distention injuries occur. The project aim is to identify risk factors in patients who develop PPRT and determine the average postpartum diuresis.
This is a retrospective cohort study involving postpartum patients at Naval Medical Center San Diego. The study group was patients that delivered between 01JAN2017 and 01JAN2018 who had PPRT. Patients delivering between 01MAY2017 and 30MAY2017 were analyzed as the control group. Data collected included demographic information, delivery type, parity, length of second stage, infant weight, obstetric laceration, anesthesia type, comorbid conditions (hypertension, diabetes, obesity, postpartum hemorrhage), time to first void/bladder drainage and the volume.
58 patients were identified as having suffered PPRT. In the study group, the average time to noting bladder over distention was 3.88 hrs with an average volume of 1142cc (353cc/hr). The control group included 244 patients with average time to void of 2.92 hrs and an average volume of 454cc (194cc/hr). Common risk factors for PPRT included primiparity, operative delivery (12.3% of PPRT versus 2.9% of controls), prolonged second stage of labor, and neuraxial analgesia.
PPRT is an avoidable morbidity among obstetric patients. Identifying average diuresis rates and common risks factors as noted in this study will help better hone postpartum voiding trial protocols.