Department of Obstetrics and Gynecology, Cleveland Clinic Akron General, Akron, OH.
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh Medical Center Magee-Womens Hospital, Pittsburgh, PA.
Am J Obstet Gynecol. 2023 Jan;228(1):14-21. doi: 10.1016/j.ajog.2022.07.060. Epub 2022 Aug 3.
Postpartum urinary retention is a relatively common condition that can have a marked impact on women in the immediate days following childbirth. If left untreated, postpartum urinary retention can lead to repetitive overdistention injury that may damage the detrusor muscle and the parasympathetic nerve fibers within the bladder wall. In rare circumstances, postpartum urinary retention may even lead to bladder rupture, which is a potentially life-threatening yet entirely preventable complication. Early diagnosis and timely intervention are necessary to decrease long-term consequences. There are 3 types of postpartum urinary retention: overt, covert, and persistent. Overt retention is associated with an inability to void, whereas covert retention is associated with incomplete bladder emptying. Persistent urinary retention continues beyond the third postpartum day and can persist for several weeks in rare cases. Recognition of risk factors and prompt diagnosis are important for proper management and prevention of negative sequelae. However, lack of knowledge by providers and patients alike creates barriers to accessing and receiving evidence-based care, and may further delay diagnosis for patients, especially those who experience covert postpartum urinary retention. Nationally accepted definitions and management algorithms for postpartum urinary retention are lacking, and development of such guidelines is essential for both patient care and research design. We propose intrapartum recommendations and a standardized postpartum bladder management protocol that will improve patient outcomes and contribute to the growing body of evidence-based practice in this field.
产后尿潴留是一种相对常见的情况，会对分娩后几天的女性产生明显影响。如果不治疗，产后尿潴留可能会导致反复过度膨胀损伤，从而损害膀胱逼尿肌和膀胱壁内的副交感神经纤维。在极少数情况下，产后尿潴留甚至可能导致膀胱破裂，这是一种潜在的危及生命但完全可以预防的并发症。早期诊断和及时干预对于减少长期后果至关重要。产后尿潴留有 3 种类型：显性、隐性和持续性。显性尿潴留与无法排尿有关，而隐性尿潴留与膀胱排空不完全有关。持续性尿潴留持续超过产后第 3 天，在极少数情况下可持续数周。认识到风险因素并及时诊断对于适当的管理和预防不良后果非常重要。然而，提供者和患者都缺乏知识，这为获得和接受基于证据的护理造成了障碍，并可能进一步延迟患者的诊断，尤其是那些经历隐性产后尿潴留的患者。缺乏全国认可的产后尿潴留定义和管理算法，制定此类指南对于患者护理和研究设计都是必不可少的。我们提出了分娩期建议和标准化的产后膀胱管理方案，这将改善患者的结局，并为该领域不断增长的循证实践提供依据。
