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Meta-Analysis
. 2014 Apr 11;2014(4):CD010322.
doi: 10.1002/14651858.CD010322.pub2.

Indwelling bladder catheterisation as part of intraoperative and postoperative care for caesarean section

Hany Abdel-Aleem  1 , Mohamad Fathallah Aboelnasr, Tameem M Jayousi, Fawzia A Habib
Affiliations
Meta-Analysis

Indwelling bladder catheterisation as part of intraoperative and postoperative care for caesarean section

Hany Abdel-Aleem et al. Cochrane Database Syst Rev. .

Abstract

Background: Caesarean section (CS) is the most common obstetric surgical procedure, with more than one-third of pregnant women having lower-segment CS. Bladder evacuation is carried out as a preoperative procedure prior to CS. Emerging evidence suggests that omitting the use of urinary catheters during and after CS could reduce the associated increased risk of urinary tract infections (UTIs), catheter-associated pain/discomfort to the woman, and could lead to earlier ambulation and a shorter stay in hospital.

Objectives: To assess the effectiveness and safety of indwelling bladder catheterisation for intraoperative and postoperative care in women undergoing CS.

Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 December 2013) and reference lists of retrieved studies.

Selection criteria: Randomised controlled trials (RCTs) comparing indwelling bladder catheter versus no catheter or bladder drainage in women undergoing CS (planned or emergency), regardless of the type of anaesthesia used. Quasi-randomised trials, cluster-randomised trials were not eligible for inclusion. Studies presented as abstracts were eligible for inclusion providing there was sufficient information to assess the study design and outcomes.

Data collection and analysis: Two review authors independently assessed studies for eligibility and trial quality, and extracted data. Data were checked for accuracy.

Main results: The search retrieved 16 studies (from 17 reports). Ten studies were excluded and one study is awaiting assessment. We included five studies involving 1065 women (1090 recruited). The five included studies were at moderate risk of bias.Data relating to one of our primary outcomes (UTI) was reported in four studies but did not meet our definition of UTI (as prespecified in our protocol). The included studies did not report on our other primary outcome - intraoperative bladder injury (this outcome was not prespecified in our protocol). Two secondary outcomes were not reported in the included studies: need for postoperative analgesia and women's satisfaction. The included studies did provide limited data relating to this review's secondary outcomes. Indwelling bladder catheter versus no catheter - three studies (840 women) Indwelling bladder catheterisation was associated with a reduced incidence of bladder distension (non-prespecified outcome) at the end of the operation (risk ratio (RR) 0.02, 95% confidence interval (CI) 0.00 to 0.35; one study, 420 women) and fewer cases of retention of urine (RR 0.06, 95% CI 0.01 to 0.47; two studies, 420 women) or need for catheterisation (RR 0.03, 95% CI 0.01 to 0.16; three studies 840 participants). In contrast, indwelling bladder catheterisation was associated with a longer time to first voiding (mean difference (MD) 16.81 hours, 95% CI 16.32 to 17.30; one study, 420 women) and more pain or discomfort due to catheterisation (and/or at first voiding) (average RR 10.47, 95% CI 4.71 to 23.25, two studies, 420 women) although high levels of heterogeneity were observed. Similarly, compared to women in the 'no catheter' group, indwelling bladder catheterisation was associated with a longer time to ambulation (MD 4.34 hours, 95% CI 1.37 to 7.31, three studies, 840 women) and a longer stay in hospital (MD 0.62 days, 95% CI 0.15 to 1.10, three studies, 840 women). However, high levels of heterogeneity were observed for these two outcomes and the results should be interpreted with caution.There was no difference in postpartum haemorrhage (PPH) due to uterine atony. There was also no difference in the incidence of UTI (as defined by trialists) between the indwelling bladder catheterisation and no catheterisation groups (two studies, 570 women). However, high levels of heterogeneity were observed for this non-prespecified outcome and results should be considered in this context. Indwelling bladder catheter versus bladder drainage - two studies (225 women)Two studies (225 women) compared the use of an indwelling bladder catheter versus bladder drainage. There was no difference between groups in terms of retention of urine following CS, length of hospital stay or the non-prespecified outcome of UTI (as defined by the trialist).There is some evidence (from one small study involving 50 women), that the need for catheterisation was reduced in the group of women with an indwelling bladder catheter (RR 0.04, 95% CI 0.00 to 0.70) compared to women in the bladder drainage group. Evidence from another small study (involving 175 women) suggests that women who had an indwelling bladder catheter had a longer time to ambulation (MD 0.90, 95% CI 0.25 to 1.55) compared to women who received bladder drainage.

Authors' conclusions: This review includes limited evidence from five RCTs of moderate quality. The review's primary outcomes (bladder injury during operation and UTI), were either not reported or reported in a way not suitable for our analysis. The evidence in this review is based on some secondary outcomes, with heterogeneity present in some of the analyses. There is insufficient evidence to assess the routine use of indwelling bladder catheters in women undergoing CS. There is a need for more rigorous RCTs, with adequate sample sizes, standardised criteria for the diagnosis of UTI and other common outcomes.

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Conflict of interest statement

None known.

Figures

1
1
Study flow diagram.
2
2
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Indwelling bladder catheter versus no catheter, Outcome 1 Distension of the bladder at the end of operation.
1.2
1.2. Analysis
Comparison 1 Indwelling bladder catheter versus no catheter, Outcome 2 Retention of urine.
1.3
1.3. Analysis
Comparison 1 Indwelling bladder catheter versus no catheter, Outcome 3 Need for catheterisation.
1.4
1.4. Analysis
Comparison 1 Indwelling bladder catheter versus no catheter, Outcome 4 UTI – as defined by trialists.
1.5
1.5. Analysis
Comparison 1 Indwelling bladder catheter versus no catheter, Outcome 5 Postpartum haemorrhage due to uterine atony.
1.6
1.6. Analysis
Comparison 1 Indwelling bladder catheter versus no catheter, Outcome 6 Pain/discomfort due to catheterisation (and/or at first voiding).
1.7
1.7. Analysis
Comparison 1 Indwelling bladder catheter versus no catheter, Outcome 7 Time to patient ambulation (hours).
1.8
1.8. Analysis
Comparison 1 Indwelling bladder catheter versus no catheter, Outcome 8 Length of hospital stay (days).
1.9
1.9. Analysis
Comparison 1 Indwelling bladder catheter versus no catheter, Outcome 9 Time of first voiding after CS (hours).
2.1
2.1. Analysis
Comparison 2 Indwelling bladder catheter versus bladder drainage, Outcome 1 Retention of urine.
2.2
2.2. Analysis
Comparison 2 Indwelling bladder catheter versus bladder drainage, Outcome 2 Need for catheterisation.
2.3
2.3. Analysis
Comparison 2 Indwelling bladder catheter versus bladder drainage, Outcome 3 UTI – as defined by trialists.
2.4
2.4. Analysis
Comparison 2 Indwelling bladder catheter versus bladder drainage, Outcome 4 Time to patient ambulation (hours).
2.5
2.5. Analysis
Comparison 2 Indwelling bladder catheter versus bladder drainage, Outcome 5 Length of hospital stay (days).
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  • doi: 10.1002/14651858.CD010322

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References

References to studies included in this review

Acharya 2012 {published data only}
    1. Acharya S, Uprety DK, Pokharel HP, Amatya R, Rai R. Cesarean section without urethral catheterization: a randomized control trial. Kathmandu University Medical Journal 2012;10(38):18‐22. - PubMed
Ghoreishi 2003 {published data only}
    1. Ghoreishi J. Indwelling urinary catheters in cesarean delivery. International Journal of Gynecology & Obstetrics 2003;83:267‐70. - PubMed
Kerr‐Wilson 1986 {published data only}
    1. Kerr‐Wilson RHJ, McNally S. Bladder drainage for caesarean section under epidural analgesia. British Journal of Obstetrics and Gynaecology 1986;93:28‐30. - PubMed
Nasr 2009 {published data only}
    1. Nasr AM, Bigawy AF, Abdelamid AE, Al‐Khulaidi S, Al‐Inany HG, Sayed EH. Evaluation of the use vs nonuse of urinary catheterization during cesarean delivery: a prospective, multicenter, randomized controlled trial. Journal of Perinatology 2009;29(6):416‐21. - PubMed
Onile 2008 {published data only}
    1. Onile TG, Kuti O, Orji EO, Ogunniyi SO. A prospective randomized clinical trial of urethral catheter removal following elective cesarean delivery. International Journal of Gynecology & Obstetrics 2008;102(3):267‐70. - PubMed

References to studies excluded from this review

Ahmad 2012 {published data only}
    1. Ahmad A, Mahendran D, James M, Fox R. A pilot study to assess the feasibility of a randomised control trial to investigate not catheterising women prior to caesarean section delivery. BJOG: an international journal of obstetrics and gynaecology 2013;120(Suppl s1):472.
    1. Ahmad AM, James M, Mahendran D. Is routine urinary catheterisation required for caesarean delivery? A pilot study. International Journal of Gynecology and Obstetrics 2012;119(Suppl 3):S691.
Dal 2013 {published data only}
    1. Dal U, Korucu AE, Eroglu K, Karatas B, Yalcin A. Sacral region massage as an alternative to the urinary catheter used to prevent urinary retention after cesarean delivery. Balkan Medical Journal 2013;30(1):58‐63. - PMC - PubMed
Dunn 2000 {published data only}
    1. Dunn TS, Forshner D, Stamm C. Foley catheterization in the postoperative patient. Obstetrics & Gynecology 2000;95(4 Suppl):30S.
Millet 2012 {published data only}
    1. Millet L, Shaha S, Bartholomew ML. Bacteriuria in laboring women with epidural analgesia: continuous vs intermittent bladder catheterization. American Journal of Obstetrics and Gynecology 2012;206(Suppl 1):S33. - PubMed
Naguimbing‐Cuaresma 2007 {published data only}
    1. Naguimbing‐Cuaresma AE, Habana AE. Early removal of urinary catheter in cesarean delivery in a tertiary training hospital. Philippine Journal of Obstetrics & Gynecology 2007;31(2):69‐74.
Paterson‐Brown 1997 {published data only}
    1. Paterson‐Brown S. A prospective, clinical, randomised, controlled study to compare early versus late urinary catheter removal after elective caesarean section under epidural anaesthesia. National Research Register (www.nrr.nhs.uk) (accessed 5 June 2007) 1997.
Saijan 2006 {published data only}
    1. Saijan GR, Prajna H. Catheterisation v/s non‐catheterisation in patients undergoing c‐section [abstract]. 49th All India Congress of Obstetrics and Gynaecology; 2006 January 6‐9; Cochin, Kerala State, India. 2006:103.
Symonds 1967 {published data only}
    1. Symonds EM. Role of trauma and catheterization in puerperal urinary tract infection. Journal of Obstetrics and Gynaecology of the British Commonwealth 1967;74:294‐8. - PubMed
Tangtrakul 1994 {published data only}
    1. Tangtrakul S, Taechaiya S, Suthutvoravut S, Linasmita V. Postcesarean section urinary tract infection: a comparison between intermittent and indwelling catheterization. Journal of the Medical Association of Thailand 1994;77(5):244‐7. - PubMed
Zhou 2012 {published data only}
    1. Zhou B, Lin Z, Huang Y. Effect of extubation time of indwelling urinary catheters on postoperative recovery after cesarean section. Nan Fang Yi Ke Da Xue Xue Bao = Journal of Southern Medical University 2012;32(8):1221‐2. - PubMed

References to studies awaiting assessment

Kolusari 2007 {published data only}
    1. Kolusari A, Zeteroglu S, Sahin HG, Ramazan S, Kamaci M. Should we use urinary catheter routinely at cesarean delivery? [Sezaryen operasyonlarinda idrar sondasi rutin olarak uygulanmali mi?]. Jinekoloji ve Obstetrik Dergisi 2007;21(3):150‐3.

Additional references

Betran 2007
    1. Betrán AP, Merialdi M, Lauer JA, Bing‐Shun W, Thomas J, Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatric and Perinatal Epidemiology 2007;21(2):98‐113. - PubMed
Dupuis 2011
    1. Dupuis O. Postpartum haemorrhage and postpartum urinary retention: could voiding be the best way of avoiding postpartum haemorrhage?. BJOG: an international journal of obstetrics and gynaecology 2011;118:1023–4. - PubMed
Festin 2009
    1. Festin MR, Laopaiboon M, Pattanittum P, Ewens MR, Henderson‐Smart DJ, Crowther CA, et al. Caesarean section in four South East Asian countries: reasons for, rates, associated care practices and health outcomes. BMC Pregnancy Childbirth 2009;9:9‐17. - PMC - PubMed
Ford 2008
    1. Ford J, Grewal J, Mikolajczyk R, Meikle S, Zhang J. Primary cesarean delivery among parous women in the United States, 1990 – 2003. Obstetrics and Gynecology 2008;112(6):1235–41. - PMC - PubMed
Hamilton 2011
    1. Hamilton BE, Martin JA, Ventura SJ. Births: Preliminary data for 2010. National Vital Statistics. Reports Vol. 60 No. 2. Division of Vital Statistics 2011;60(2):4.
Higgins 2011
    1. Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Khawaja 2009
    1. Khawaja M, Choueiry N, Jurdi R. Hospital‐based caesarean section in the Arab region: an overview. East Mediterranean Health Journal 2009;15(2):458‐69. - PMC - PubMed
Klevens 2007
    1. Klevens RM, Edwards JR, Richards CL Jr, Horan TC, Gaynes RP, Pollock DA, et al. Estimating health care‐associated infections and deaths in U.S. hospitals. Public Health Reports 2007;122(2):160‐6. - PMC - PubMed
Li 2011
    1. Li L, Wen J, Wang L, Li YP, Li Y. Is routine indwelling catheterisation of the bladder for caesarean section necessary? A systematic review. BJOG: an international journal of obstetrics and gynaecology 2011;118(4):400‐9. - PubMed
Liedberg H 1989
    1. Liedberg H. Catheter induced urethral inflammatory reaction and urinary tract infection. An experimental and clinical study. Scandinavian Journal of Urology and Nephrology. Supplementum 1989;124:1‐43. - PubMed
Raees 2012
    1. Raees M, Yasmeen S, Jabeen S, Utman N, Karim R. Maternal morbidity associated with emergency versus elective caesarean section. Journal of Postgraduate Medical Institute 2012;27(1):55‐62.
RevMan 2012 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.1. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2012.
Senanayake 2005
    1. Senanayake H. Elective cesarean section without urethral catheterization. Journal of Obstetrics and Gynaecology Research 2005;31(1):32‐7. - PubMed
Smaill 2010
    1. Smaill FM, Gyte GML. Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section. Cochrane Database of Systematic Reviews 2010, Issue 1. [DOI: 10.1002/14651858.CD007482.pub2] - DOI - PMC - PubMed
Stavrou 2011
    1. Stavrou EP, Ford JB, Shand AW, Morris JM, Roberts CL. Epidemiology and trends for caesarean section births in New South Wales, Australia: a population‐based study. BMC Pregnancy Childbirth 2011;11:8. - PMC - PubMed
Tuuli 2012
    1. Tuuli MG, Odibo AO, Fogertey P, Roehl K, Stamilio D, Macones GA. Utility of the bladder flap at cesarean delivery: a randomized controlled trial. Obstetrics and Gynecology 2012;119:815‐21. - PubMed
Wee 2005
    1. Wee MY, Brown H, Reynolds F. The National Institute of Clinical Excellence (NICE) guide‐lines for caesarean sections:implications for the anaesthetist. International Journal of Obstetric Anesthesia 2005;14:147‐58. - PubMed
Yong 2011
    1. Yong S. Routine indwelling catheterisation in caesarean section—there is still a role. BJOG: an international journal of obstetrics and gynaecology 2011;118:1022–3. - PubMed