Postpartum urinary retention after cesarean delivery.

OBJECTIVE: To investigate the incidence of postpartum urinary retention (PUR) after cesarean delivery and determine which obstetric factors contribute to this problem. METHOD: A prospective study recruited 605 pregnant women who had a cesarean delivery. Each patient's postvoid residual bladder volume (PVRBV) was estimated with an ultrasound scan after first micturition. The women were divided into 2 groups: PUR (PVRBV > or =150 mL) and normal. Patients' characteristics, obstetric parameters, and prevalence of lower urinary tract symptoms at 3 months postpartum were compared. RESULT: The overall incidence of PUR was 24.1%. The incidence of overt and covert PUR was 7.4% and 16.7%, respectively. Morphine-related postoperative analgesia, multiple pregnancy, and low body mass index were significantly associated with PUR. At 3-month follow-up, 5.0% of patients had obstructive voiding symptoms and 9.1% had irritative voiding symptoms. CONCLUSION: Our results revealed PUR was a common phenomenon in patients who had a cesarean delivery, and morphine-related postoperative analgesia was the main contributing factor.     

Risk factors for postpartum urinary retention after vaginal delivery at term without epidural anesthesia

Objective: We performed a retrospective case-control study of vaginal delivery at term without epidural anesthesia to identify clinical predictions of postpartum urinary retention (PUR).

Methods: We reviewed the obstetric records of all singleton vaginal deliveries at Japanese Red Cross, Katsushika Maternity Hospital form January 2016 through December 2017.

Results: There were 58 women (2.4%) complicated by PUR and 2391 women without PUR. A multivariate analysis revealed nulliparity, instrumental delivery, and episiotomy as independent risk factors for PUR (nulliparity: adjusted OR 2.39, 95%CI 1.2–4.8, p?=?0.01; instrumental delivery: 3.53, 95%CI 1.9–6.7, p?p?=?.04). While, urination (or urethral catheterization) within 1?hour before delivery revealed as independent prevention factor for PUR (adjusted OR 0.54, 95%CI 0.30–0.99, p?=?.048).

Conclusions: The risk factors identified in our institute seemed to approximately similar to those observed in the institutes capable of performing epidural anesthesia. In addition, urination just before delivery seemed to be an independent prevention factor for PUR.     

Risk factors for acute postpartum urinary retention after vaginal delivery: focus on episiotomy direction

Objective: This study aimed to investigate the independent factors for acute postpartum urinary retention (APUR) after vaginal delivery.

Methods: From January 2008 to December 2013, 98 patients with APUR after vaginal delivery without instrument use were compared with 108 control patients matched by age and medical history. Multivariate logistic regression analysis was performed to identify independent risk factors for APUR. Predictive accuracy for the multivariate model was assessed using the derived area under a receiver operating characteristics curve.

Results: Among maternal previous partial history, mean live birth history was lower in the APUR group (0.12 versus 0.31, p?=?0.017). Regional anesthesia use (76.5% versus 60.2%, p?=?0.036), mediolateral episiotomy (63.3% versus 31.5%, p?<?0.001) and labor time were significantly higher in the APUR group. Multivariate logistic regression analysis showed that mediolateral episiotomy, labor time and the presence of regional anesthesia were independent contributing factors for the development of APUR. This model’s predictive accuracy for APUR was 73.1%.

Conclusion: Prolonged labor time, regional anesthesia and mediolateral episiotomy were independent factors for APUR. Therefore, we considered median episiotomy to be the best approach during vaginal delivery avoiding APUR.     

Safety of vaginal birth after cesarean delivery.

OBJECTIVE: To compare the outcomes of labor induction in women with a history of 1 cesarean section (CS) who undergo trial of labor. METHODS: A prospective observational study of 702 pregnant women who had 1 previous CS was conducted at Women's Hospital, Hamad Medical Corporation, Doha, Qatar, between April 2003 and April 2004. Those with no history of vaginal delivery were assigned to one group and those with a history of vaginal delivery were assigned to another group, and the latter group was then divided into 2 subgroups according to the results of trial of labor. RESULTS: Of these 702 women with a history of 1 CS, 62.4% also had a history of vaginal delivery. After trial of labor, vaginal delivery occurred more often among women with no history of vaginal delivery (64.8%). Moreover, trial of labor resulted in a vaginal delivery more often in women who were delivered only once and by CS (87.7%) than in women who also had a history of vaginal delivery (79.2%). CONCLUSION: These findings indicate that women who have had a CS should strongly consider natural delivery for subsequent pregnancies.     

Stress urinary incontinence six months after first vaginal delivery

Objective

To determine the prevalence, severity and impact on quality of life of stress urinary incontinence (SUI) six months after the first vaginal delivery, as well as to investigate the risk factors associated with it.

Study design

We designed a prospective study that included 396 women who had their first vaginal delivery in the Hospital Donostia. Diagnosis and identification of the type of urinary incontinence were carried out considering the 2002 ICS definitions. Women were interviewed and examined twice, at term and six months after delivery. The severity of the symptoms was evaluated with the Incontinence Severity Index (ISI) and the impact on quality of life was evaluated with the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form. The statistical analysis included comparison of means (Student's t-test or analysis of variance) and proportions (Chi square and Fisher's exact tests). Multiple logistic regression analysis was performed using variables that were close to statistical significance.

Results

15.1% of the women reported SUI six months after their first vaginal delivery. The ISI was slight or moderate in the majority of the cases and the impact on quality of life was low. The presence of SUI in pregnant women at term was the only independent risk factor associated with SUI after delivery (OR: 3.71; 95% IC: 1.95–7.06). The type of vaginal delivery did not influence in SUI six months after the birth, not even in women who were continent during pregnancy.

Conclusions

Slight or moderate SUI was common after the first vaginal delivery and the impact on quality of life was low. Urinary incontinence during pregnancy was the only risk factor independently associated with the presence of SUI six months after the first vaginal delivery.     

The impact of pregnancy and vaginal delivery on urinary incontinence

Objective

To identify women who had urinary incontinence (UI) before, during, and after pregnancy, and to determine whether women with symptoms of UI during pregnancy were the same women who had urinary incontinence postpartum.

Methods

All primigravid women who delivered within 1 year (1999) at the Charité Hospital in Berlin received a questionnaire about UI at 5 different time points during pregnancy and the postpartum period.

Results

Of 610 eligible women, 411 (67.4%) completed the questionnaire. The prevalence of urinary incontinence increased significantly in the second half of pregnancy (26.3%, P < 0.001). Although the overall number of women who reported UI within 6 weeks after delivery (28.5%) was almost the same as the number reporting UI in the second half of pregnancy, approximately every second women changed from being continent to incontinent and vice versa.

Conclusion

The group of women who experienced UI postpartum was different from the group that experienced UI before delivery and vice versa. Pregnancy itself may influence pelvic floor function in a different way compared with vaginal delivery.     

Uterine massage to reduce postpartum hemorrhage after vaginal delivery

Objective

To determine the effectiveness of sustained uterine massage started before delivery of the placenta in reducing postpartum hemorrhage.

Methods

A randomized controlled trial conducted in Egypt and South Africa between September 2006 and February 2009. A total of 1964 pregnant women were randomly allocated to 1 of 3 treatment groups: intramuscular oxytocin, sustained uterine massage, or both treatments. Blood loss within 30 minutes of delivery was recorded.

Results

The incidence of blood loss of 300 mL or more within 30 minutes of delivery was significantly higher in the massage group than in the massage plus oxytocin (RR 1.88; 95% CI, 1.29-2.74 in Assiut, and RR 1.3; 95% CI, 1.00-1.68 in SA) and the oxytocin only group (RR 1.7; 95% CI, 1.11-2.61 in Assiut, and RR 2.24; 95% CI, 1.54-3.27 in SA). In both centers, use of additional uterotonics was significantly higher in the uterine massage group compared with the other 2 groups.

Conclusion

Uterine massage was less effective than oxytocin for reducing blood loss after delivery. When oxytocin was used, there was no additional benefit from uterine massage. The effectiveness of uterine massage in the absence of oxytocin was not studied. ACTRN: 12609000372280.     

产后压力性尿失禁相关因素及研究进展

压力性尿失禁（SUI）是妇科常见病，以育龄妇女和绝经期妇女多发。导致其发生的主要原因为妊娠和分娩对盆底组织的损伤。产后是女性的特殊时期，盆底经历分娩导致的损伤，尚未恢复，尿失禁的发病处于较高水平。为预防及减少产后SUI。必须对其病因进行研究。通过对可能引起的相关因素分析寻找导致产后SUI的高危因素，为预防其发生寻找可行途径。通过文献分析发现，产后早期盆底肌训练对SUI有明显预防和治疗作用，但存在宣教不足及产妇缺少相应指导的困难，需由社区保健人员或产科医师尽早给予指导实施。     

产后压力性尿失禁相关因素及研究进展

压力性尿失禁（SUI）是妇科常见病,以育龄妇女和绝经期妇女多发。导致其发生的主要原因为妊娠和分娩对盆底组织的损伤。产后是女性的特殊时期,盆底经历分娩导致的损伤,尚未恢复,尿失禁的发病处于较高水平。为预防及减少产后SUI,必须对其病因进行研究。通过对可能引起的相关因素分析寻找导致产后SUI的高危因素,为预防其发生寻找可行途径。通过文献分析发现,产后早期盆底肌训练对SUI有明显预防和治疗作用,但存在宣教不足及产妇缺少相应指导的困难,需由社区保健人员或产科医师尽早给予指导实施。     

Ethnic disparity in the success of vaginal birth after cesarean delivery

Objective.?To estimate whether maternal race/ethnicity is independently associated with successful vaginal birth after cesarean delivery (VBAC).

Study design.?A retrospective cohort study from January 1, 1997 to July 30, 2002 of women with singleton pregnancies and a previous cesarean delivery. The odds ratio (OR) for successful VBAC as a function of ethnicity was corrected for age >35 years, parity, weight gain, diabetes mellitus, hospital site, prenatal care provider, gestational age, induction, labor augmentation, epidural analgesia, and birth weight >4000 g.

Results.?Among 54 146 births, 8030 (14.8%) occurred in women with previous cesarean deliveries. The trials of labor rates were similar among Caucasian (46.6%), Hispanic (45.4%), and African American (46.0%) women. However, there was a significant difference among ethnic groups for VBAC success rates (79.3% vs. 79.3% vs. 70.0%, respectively). When compared to Caucasian women, the adjusted OR for VBAC success was 0.37 (95% confidence interval (CI) 0.27–0.50) for African American women and 0.63 (95% CI 0.51–0.79) for Hispanic women.

Conclusion.?African American and Hispanic women are significantly less likely than Caucasian women to achieve successful VBAC.     

剖宫产术后再次妊娠阴道分娩的安全性及影响因素分析

目的探讨剖宫产术后再次妊娠阴道分娩的安全性及其影响因素。 方法回顾性分析2017年1月至2018年10月在佛山市妇幼保健院住院分娩的剖宫产术后再次妊娠阴道试产孕妇的临床资料。按照是否成功经阴道分娩分成剖宫产后阴道分娩(vaginal birth after cesarean section, VBAC)组和剖宫产后阴道试产(trial of labor after cesarean,TOLAC)失败组,比较VBAC组和TOLAC失败组患者的妊娠结局,采用多因素Logistic回归分析方法分析VBAC的影响因素。 结果(1)2017年1月至2018年10月共纳入TOLAC研究的孕妇共323例,其中VBAC率为80.2%(259/323),TOLAC失败率为19.8%(64/323);子宫破裂发生率为0.62%(2/323),均为TOLAC失败组;两组患者均无子宫切除。(2)VBAC组和TOLAC失败组比较,VBAC组头盆评分(7.77±1.15)分,高于TOLAC失败组(7.16±0.70)分,(t＝4.891,P<0.001);TOLAC失败组产前阴道出血率6.3%(4/64),高于VBAC组1.2%(3/259),P＝0.033;两组的Bishop评分、羊水指数、羊水最深均没有统计学差异(P>0.05)。(3)TOLAC失败组产后出血≥500 ml的比例为51.6%(33/64),高于VBAC组的2.8%(7/259),( χ²＝105.500,P<0.001);TOLAC失败组子宫破裂率3.2%(2/64),高于VBAC组(0/259),( χ²＝8.144,P＝0.017);但两组间产后出血≥1000 ml的比例、输血率没有统计学差异(P>0.05)。(4)VBAC组的分娩孕周、新生儿出生体重、身长、头围和胸围均低于TOLAC失败组,1 min Apgar评分高于TOLAC失败组且具有统计学意义(P<0.05)。(5)多因素分析显示,孕妇的头盆评分(OR＝0.610, 95%CI：0.420～0.887,P＝0.010)、新生儿出生体重3500～3999 g(OR＝4.783, 95%CI：1.431～15.989,P＝0.011)和新生儿出生体重≥4000 g(OR＝16.042, 95%CI：1.306～196.983,P＝0.030)是VBAC的独立影响因素。 结论在严格的纳入排除标准、系统的产前评估和严密的产程管理下,TOLAC是安全可行的,VBAC成功率也较高。多因素分析显示,头盆评分和胎儿出生体重是VBAC的独立影响因素。     

Prophylactic phenoxybenzamine in the prevention of postoperative retention of urine after vaginal repair: a prospective randomized double-blind trial

To investigate the effect of prophylactic phenoxybenzamine on the bladder emptying after vaginal repair operations, 41 consecutive patients, who underwent the Manchester operation or an anterior + posterior repair because of genital descensus, were allocated at random to either prophylactic phenoxybenzamine (PBZ-group) or placebo treatment in the postoperative course. Prophylactic phenoxybenzamine was found to produce an improved emptying function of the bladder, leading to a statistically significant reduced number of acute urinary retentions (P = 0.029), decreased time until spontaneous voiding (P = 0.026) and reduced volume of residual urine (P = 0.018). Furthermore, a reduced incidence of urinary tract infections was found in the PBZ-group. Prophylactic phenoxybenzamine treatment is recommended as an alternative to routine bladder drainage in preventing urinary retention following vaginal repair operations for genital descensus.