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DISCUSSION:

The risk of overt PUR in our study is extremely low (0.48%) compared to others [1,2,3].

There was no statistical difference of PUR in relation to the parity, mode of delivery, type of analgesic given, baby’s weight and time of voiding except for perineal injury.

In all patient with PUR, their post void residual volume returned to normal within 2 days therefore the maximum days of hospitalization was only two days.

During follow up of these groups, most of them were asymptomatic after discharge from hospital.

CONCLUSION

•The local incidence of overt and covert PUR are low.•Episiotomy increased risk of PUR•Covert and overt PUR are self limiting, specific treatment is unnecessary.

OVERT AND COVERT POST PARTUM URINARY RETENTION, RISK FACTORS AND COMPLICATIONS- ACOHORT STUDY

AT HOSPITAL TENGKU AMPUAN AFZAN (HTAA), KUANTAN, PAHANG, MALAYSIA

Objectives

Urinary retention is a frustrating complication in women during the immediate postpartum period. The risk of postpartum urinary retention ( PUR ) varies between 0.5 % - 14.1 % of deliveries. It is higher among Asian population with prolonged first and second stage of labor epidural analgesia and previous history of PUR. C.C Liang et al J Obstet Gynecol 2007;99:229-232

Main Objectives To determine the local incidence of PUR at Hospital Tengku Ampuan Afzan Kuantan ( HTAA ) Pahang.

Specific objectives• To identify the high risk group for PUR in the local population•To evaluate the risk factors of PUR •To determine the post void residual volume (PVRV ) that may associated with significant postpartum urinary retention that lead to long term urinary problem.

Methods

A cohort study on women who delivered at Hospital Tengku Ampuan Afzan, Kuantan , Pahang from 1st January to 30th December 2011. The study was approved by the hospital ethical committee and patient's informed consent obtained . The subjects were patients who were stable, not eclamptic, no severe post partum hemorrhage or medical illness that require routine bladder catheterization.

Patient were divided into three groups: ( 1 ) normal (PVRV < 150 ml) ( 2 ) covert (PVRV > 150 ml without associated urinary symptoms) ( 3 ) overt ( PVRV > 150 ml with symptoms of urinary retention).

All the patients were followed up at 1 month, 3 months and 6 month post delivery. A phone call made to the control groups to assess voiding dysfunction using the Urogenital Distress Inventory ( UDI – 6) and Incontinence Impact Questionnaire Short Form ( IIQ – 7). Those with symptoms of voiding dysfunction were seen in the outpatient Urogynecology clinic for confirmatory test ( bladder scan, urinalysis or urodynamic if indicated) as per schedule or till the problem resolved.

Data were analyzed using SPSS 18 , Kruskal – Wallis Test and Mann – Whitney test was used to evaluate the accuracy of the volume measurements and effect of the confounding factors. A P value of less than 0.05 is considered statistically significant

Results

There were 1000 women recruited in the study. This is a preliminary result on 414 women who had completed their follow up. The study subjects were mainly Malay ethnic group (89.3 % ), followed by others which included Orang Asli and foreigner ( 5.3 % ), Chinese (4.6 % ) and Indians ( 0.7 % )

AGE DISTRIBUTION OF THE SUBJECT

The majority of study population involved in this study belongs to a reproductive age group, 20 -<30 years ( 56.3 %) followed by age group 30 -< 40 year ( 34.3 % ), < 20 year ( 4.8 % ) and > 40 year ( 4.6 % ) respectively.

TYPES OF THE POST PARTUM URINARY RETENTION ( PUR ]

The majority of women ( 96.38 % ) had normal post voiding residual urine volume ( PVRV of < 150 ml). There were two cases ( 0.48 % ) of overt and 13 cases ( 3.14 % ) of covert PUR .

RISK FACTORS AFFECTING POST PARTUM URINARY RETENTION – PARITY (p = 0.22)

RISK FACTORS AFFECTING POST PARTUM URINARY RETENTION – MODE OF DELIVERY (p = 0.06)

RISK FACTORS AFFECTING POST PARTUM URINARY RETENTION – TYPES OF ANALGESIA (p = 0.11)

RISK FACTORS AFFECTING POST PARTUM URINARY RETENTION – BABY’S WEIGHT (p = 0.79)

FACTORS AFFECTING POST PARTUM URINARY RETENTION – DURATION BETWEEN MICTURATION AND URINE MEASUREMENT (p = 0.06)

RISK FACTORS AFFECTING POST PARTUM URINARY RETENTION – PERINEAL INJURY (p = 0.01)

References

1. C.C Liang, S.D. Chang, Y.L.Chang. Post partum urinary retention after caesarian delivery. Int J Obstet Gynecol 2007 ;99 :229 -232

2. Saultz JW, Toffler WL, Shackles JY. Post partum urinary retention.J Am Board Fam Pract 1991;4:341-344

3. Yip SK, Brieger G, Hin LY, Chung T. Urinary retention in the post partum period:the relationship between obstetric factors and the post partum post void residual bladder volume. Acta Obstet Gynecol Scand 1997 ;76 :667-672

Patients were followed up at 1 month, 3 month and 6 months

Covert PUR Overt PUR

Repeat bladder scan

PVRV < 150 ml PVRV > 150 ml

Discharge Follow up as schedule

Measure PVRV 6 hourlyDischarge if PVRV < 150 ml