Wilson Barbara L, Passante Tammy, Rauschenbach Diane, Yang Rumei, Wong Bob
Barbara L. Wilson is an Associate Professor and Associate Dean of Academics, College of Nursing, University of Utah, Salt Lake City, UT. She can be reached via e-mail at
MCN Am J Matern Child Nurs. 2015 Jul-Aug;40(4):234-42; quiz E17-8. doi: 10.1097/NMC.0000000000000156.
Many labor nurses routinely include continuous urinary catheterization (CC) as part of their standard care for women who receive intrapartum epidural anesthesia, to prevent urinary retention, thought to delay fetal descent. Recent studies question use of CCs during labor, as they may predispose patients to urinary tract infections (UTIs), even though the catheters are in place for a relatively short period of time. The objective of this study was to determine the influence of CCs versus intermittent catheters (ICs) (only as needed) on the duration of second stage of labor and the incidence of postpartum UTIs.
Randomized controlled trial. English-speaking low-risk nulliparous women ≥37 weeks gestation with a single fetus in a vertex presentation who requested an epidural were eligible for participation. Prior to epidural placement, cervical status was documented, women were encouraged to void, and then women were randomized to receive either CC or IC as the method for urinary bladder management for the duration of the first stage of labor. Final sample size included 123 participants; 55 in the CC group and 68 in the IC group.
No differences were noted in length of second stage labor, and the overall incidence of UTIs in both groups was low. There was a significantly increased likelihood of cesarean birth in women who had CC (P < .01) when compared to women who had IC. The overall cesarean rate in the CC group was 27.3%, versus 10.3% in the IC group.
Intermittent catheterization only as needed appears to be best practice for bladder management for laboring women with an epidural. There was a significantly higher rate of cesarean birth among women in the CC group. The relationship between route of birth and use of continuous indwelling urinary catheters for women in labor with epidurals for pain relief needs more study.
许多产科护士通常将持续导尿（CC）作为接受产时硬膜外麻醉的女性标准护理的一部分，以预防尿潴留，认为尿潴留会延迟胎儿下降。最近的研究对分娩期间使用CC提出质疑，因为即使导尿管留置时间相对较短，它们也可能使患者易患尿路感染（UTI）。本研究的目的是确定CC与间歇性导尿（IC）（仅在需要时）对第二产程持续时间和产后UTI发生率的影响。
随机对照试验。孕周≥37周、单胎头先露、要求硬膜外麻醉的讲英语的低风险初产妇符合参与条件。在放置硬膜外麻醉前，记录宫颈情况，鼓励产妇排尿，然后将产妇随机分为接受CC或IC作为第一产程膀胱管理方法的两组。最终样本量包括123名参与者；CC组55名，IC组68名。
第二产程长度无差异，两组UTI的总体发生率较低。与接受IC的女性相比，接受CC的女性剖宫产的可能性显著增加（P <.01）。CC组的总体剖宫产率为27.3%，而IC组为10.3%。
仅在需要时进行间歇性导尿似乎是硬膜外麻醉产妇膀胱管理的最佳做法。CC组女性的剖宫产率显著更高。分娩方式与产时接受硬膜外镇痛的女性使用持续留置导尿管之间的关系需要更多研究。
