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Several Risk Factors for Postpartum Urinary Retention Identified.

SAN DIEGO -- Regional anesthesia, instrumental delivery, mediolateral episiotomy, and primiparity were each associated with an increased risk of postpartum urinary retention after vaginal delivery in a retrospective study.

Careful follow-up of patients with these risk factors can help physicians spot postpartum urinary retention (PUR) early, Dr. Michael Carley said in an interview at the annual meeting of the Society for Obstetric Anesthesia and Perinatology.

Dr. Carley, who is with the Mayo Clinic, Rochester, Minn., conducted, a retrospective case-control study of 11,332 women who were delivered at the clinic between August 1992 and April 2000.

He found that 51 of these women experienced clinically overt PUR, defined, as an inability to void within 12 hours after delivery. The 51 case patients were similar to controls on the basis of maternal age, race, body mass index, parity, and fetal presentation, Dr. Carley said.

Case patients were significantly more likely than controls to have received regional anesthesia (98.0% vs. 68.8%), to have had an instrumental delivery (47.1% vs. 12.4%), to have had a mediolateral episiotomy (39.2% vs. 12.5%), and to be primiparous (66.7% vs. 40.0%).

The duration of epidural analgesia was significantly longer in the patients who experienced PUR, Dr. Carley said.

Those with postpartum urinary retention received an average of 536 minutes of analgesia, compared with an average of 335 minutes in the controls.

Injury from forceps may have caused direct bladder trauma, contributing to the higher incidence of PUR among the women who had instrumental deliveries, according to Dr. Carley.

PUR resolved in 80.4% of the women before they left the hospital.

In most cases, the problem was resolved by self-catheterization or an indwelling catheter.
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Publication:OB GYN News
Date:Jul 15, 2001
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