Prevalence and outcome of postpartum urinary retention at an Australian hospital.

OBJECTIVE

Postpartum urinary retention is thought to be a potentially significant complication of childbirth. A universal postpartum void review process has been in place since 2008 at this tertiary obstetric hospital to screen for voiding dysfunction. Procedure compliance audits were undertaken on implementation but local prevalence and clinical outcomes of both acute and persistent postpartum urinary retention had not been documented for our cohort to date.

DESIGN

A clinical audit was undertaken to review the medical files for all women who birthed between January 1st 2016-March 31st 2016 (n = 1108 cases) to determine the prevalence of acute postpartum urinary retention. Medical files of persistent postpartum urinary retention cases occurring in 2016 requiring follow up were individually reviewed.

MEASUREMENT AND FINDINGS

An overall 3.8% baseline prevalence of acute postpartum urinary retention was observed retrospectively (n = 42/1108) in a 3 month period, with 28.6% of these experiencing significant bladder over distension (n = 12/42). Following urinary catheterisation, and often a period of bladder rest, 100% of women who failed their first void review were able to successfully void on catheter removal. There were 3 cases of persistent postpartum urinary retention over 12 months, representing an overall prevalence of 0.07% (n = 3/4353).

KEY CONCLUSIONS

The existing postpartum void review process appears to be a reliable framework for the early detection and management of postpartum urinary retention, but could be further enhanced by objectively confirming effective bladder emptying and function.

IMPLICATIONS FOR PRACTICE

In spite of a universal void review framework for postnatal void review, urinary retention and bladder overdistension still occurs. Staff education to encourage compliance with the framework and to facilitate timely clinical reasoning and decision making may improve prevalence rates.