Protracted postpartum urinary retention: the importance of early diagnosis and timely intervention

Abstract

Aims: To evaluate the prevalence and obstetric risk factors of protracted postpartum urinary retention, beyond the third postpartum day.

Methods: Thirty thousand seven hundred fifty-seven consecutive women delivered in Lis maternity hospital during June 2006 to June 2009. The term "protracted postpartum urinary retention" was defined as the absence of adequate voiding beyond the third postpartum day. Study group comprised 55 women who developed protracted postpartum urinary retention. Control group comprised 110 women, matched by age and parity, who delivered at the same day but did not develop urinary retention.

Results: Fifty-five (0.18%) women (41 primipara, 14 multipara) developed protracted postpartum urinary retention. On multivariate logistic regression analysis, only duration of the second stage of labor and vacuum deliveries was found to be significant independent risk factors. Thirty-six (65%) women achieved normal voiding within 4-14 days postpartum, and 19 (35%) others within 15-28 days. Higher postvoid residual urinary volume at 72 hr after delivery was associated with increased risk for late recovery. Forty-eight (87%) patients were available for 3-39 months follow-up. Of these, five (10.4%) had stress urinary incontinence, and four (8.3%) had overactive bladder symptoms. Three (6.3%) others had subjective voiding difficulties; however, urodynamic evaluation failed to reveal any voiding phase abnormalities.

Conclusions: Protracted postpartum urinary retention is uncommon in modern obstetric practice. The duration of the second stage of labor and vacuum deliveries were found to be significant independent risk factors. With early diagnosis and timely intervention, complete resolution is expected within 28 days postpartum with no extraordinary long-term consequences.