title: Delivery-related risk factors for covert postpartum urinary retention after vaginal delivery.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. f.e.mulder@amc.uva.nl.
authors.forename: Femke E M
authors.initials: FE
authors.lastname: Mulder
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors.forename: Katrien
authors.initials: K
authors.lastname: Oude Rengerink
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors.forename: Joris A M
authors.initials: JA
authors.lastname: van der Post
authors.affiliation: Department of Obstetrics and Gynaecology, Spaarne Hospital, Hoofddorp, The Netherlands.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Hakvoort
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors.forename: Jan-Paul W R
authors.initials: JP
authors.lastname: Roovers
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011644:Puerperal Disorders / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors; D016055:Urinary Retention / Q000453:epidemiology / Q000209:etiology*; D055815:Young Adult
keywords: Incomplete voiding; Postpartum period; Postpartum urinary retention; Risk factors; Vaginal delivery; Voiding dysfunction