Delivery-related risk factors for covert postpartum urinary retention after vaginal delivery.
Delivery-related risk factors for covert postpartum urinary retention after vaginal delivery.
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DOI：
10.1007/s00192-015-2768-8
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发表时间：
2016-01
影响因子：
1.8
通讯作者：
Roovers JP
中科院分区：
文献类型：
--
作者：
Mulder FE;Oude Rengerink K;van der Post JA;Hakvoort RA;Roovers JP
产后尿潴留（PUR）是阴道分娩后膀胱功能障碍的常见后果。隐性 PUR 患者能够自发排尿，但排尿后残余膀胱容量 (PVRV) ≥150 mL。膀胱排空不完全可能会导致生命后期出现膀胱功能障碍。这项横断面研究的目的是确定阴道分娩后隐性 PUR 的独立分娩相关风险因素，以确定隐性 PUR 风险增加的女性。阴道分娩女性的 PVRV 在第一次自主排尿后使用便携式膀胱扫描设备进行测量。 PVRV 为 150 mL 或以上被定义为隐蔽 PUR。通过多元回归分析确定了隐性 PUR 的独立危险因素。在 745 名女性中，347 名 (47%) 被诊断患有隐性 PUR (PVRV ≥150 mL)，其中 197 名 (26%) 的 PVRV ≥250 mL（第 75 个百分位），50 名 (7%) 的 PVRV ≥500 mL（第 95 个百分位）。在多变量回归分析中，会阴切开术（OR 1.7，95% CI 1.02 – 2.71）、硬膜外镇痛（OR 2.08，95% CI 1.36 – 3.19）和出生体重（OR 1.03，95% CI 1.01 – 1.06）是隐性 PUR 的独立危险因素。分娩期间阿片类镇痛（OR 3.19，95% CI 1.46 – 6.98）、硬膜外镇痛（OR 3.54，95% CI 1.64 – 7.64）和会阴切开术（OR 3.72，95% CI 1.71 – 8.08）是PVRV≥500 mL的危险因素。会阴切开术、硬膜外镇痛和出生体重是隐性 PUR 的危险因素。我们建议，当获得有关异常 PVRV 临床后果的数据时，应重新评估当前隐性 PUR 的临界值。
Postpartum urinary retention (PUR) is a common consequence of bladder dysfunction after vaginal delivery. Patients with covert PUR are able to void spontaneously but have a postvoid residual bladder volume (PVRV) of ≥150 mL. Incomplete bladder emptying may predispose to bladder dysfunction at a later stage of life. The aim of this cross-sectional study was to identify independent delivery-related risk factors for covert PUR after vaginal delivery in order to identify women with an increased risk of covert PUR. The PVRV of women who delivered vaginally was measured after the first spontaneous micturition with a portable bladder-scanning device. A PVRV of 150 mL or more was defined as covert PUR. Independent risk factors for covert PUR were identified in multivariate regression analysis. Of 745 included women, 347 (47 %) were diagnosed with covert PUR (PVRV ≥150 mL), of whom 197 (26 %) had a PVRV ≥250 mL (75th percentile) and 50 (7 %) a PVRV ≥500 mL (95th percentile). In multivariate regression analysis, episiotomy (OR 1.7, 95 % CI 1.02 – 2.71), epidural analgesia (OR 2.08, 95 % CI 1.36 – 3.19) and birth weight (OR 1.03, 95 % CI 1.01 – 1.06) were independent risk factors for covert PUR. Opioid analgesia during labour (OR 3.19, 95 % CI 1.46 – 6.98), epidural analgesia (OR 3.54, 95 % CI 1.64 – 7.64) and episiotomy (OR 3.72, 95 % CI 1.71 – 8.08) were risk factors for PVRV ≥500 mL. Episiotomy, epidural analgesia and birth weight are risk factors for covert PUR. We suggest that the current cut-off values for covert PUR should be reevaluated when data on the clinical consequences of abnormal PVRV become available.