Women undergoing instrumental delivery are known to be at higher risk of urinary retention, which can lead to long term complications such as voiding dysfunction Nulliparous women undergo a pronounced and sudden change in perineum due to stretching during delivery which may add to the perineal trauma from an episiotomy, increasing the risk of urinary retention. We aim to study the incidence and risk factors associated with postpartum urinary retention in women undergoing instrumental delivery.
Pregnant women who had instrumental delivery after 37 weeks of gestation, at JIPMER, Puducherry, India between January – June 2017 were included in the study. Postpartum urinary retention was defined as the inability to void spontaneously or ultrasonographic documentation of post-void residual volume of >150 mL, six hours after delivery. Demographic factors, clinical profile & follow up of these patients were noted. Multivariate logistic regression analysis was performed to assess the risk factors associated with urinary retention and presented as adjusted odds ratios (OR) with 95% confidence intervals (CI).
Postpartum urinary retention was noted in 124(20.6%) women undergoing instrumental delivery. Overt & covert urinary retention occurred in 2.3% and 18.3% respectively. After adjusting for other risk factors, nulliparity(adjusted OR=4.05, 95% CI 2.02- 8.12 compared to multiparity) and prolonged second stage (OR= 3.96, 95% CI 1.53-10.25) compared to suspected fetal compromise as indication for instrumental delivery was associated with increased risk of postpartum urinary retention. Interaction was noted between parity and episiotomy on the occurrence of postpartum urinary retention (p= 0.010). Among nulliparous women, those with episiotomy(adjusted OR = 6.10, 95% CI 2.65 – 14.04) have a higher odd of developing postpartum urinary retention compared to those without episiotomy.
Almost one out of five (20.6%) women undergoing instrumental delivery developed postpartum urinary retention. Among women undergoing instrumental delivery, episiotomy increased the chances of developing postpartum retention in nulliparous but not multiparous women. Prolonged second stage as indication for instrumental delivery also increased the chances of retention. Future studies are needed to define the cut- off for diagnosis & to evaluate the long-term effects of covert postpartum urinary retention, as well to study the effect of episiotomy on development of postpartum urinary retention in women undergoing instrumental delivery.
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