The risk factors of postpartum urinary retention after vaginal delivery: A systematic review.
Qiaomeng Li, Shening Zhu, Xiao Xiao
PMID 33195762WHAT IT FOUND
After vaginal delivery, episiotomy, instrumental birth, first baby, longer second stage, and epidural analgesia were associated with urinary retention.
Birth weight over 3,800 g was not.
Key findings
01Five obstetric factors were identified as independent risk factors for postpartum urinary retention: episiotomy, epidural analgesia, instrumental delivery, primiparity, and longer second stage of labor.
02Pooled analyses showed higher odds with instrumental delivery (OR 4.01, 95% CI 1.97-8.18, P < 0.001) and episiotomy (OR 2.99, 95% CI 1.31-6.79, P = 0.009).
03Fetal birth weight over 3,800 g was not an independent risk factor (mean difference 64.41, 95% CI -12.59 to 141.41, P = 0.10).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The included studies were observational, not randomized, so they show association rather than cause. Heterogeneity was high for episiotomy, epidural analgesia, instrumental delivery, and primiparity (I2 = 59% to 88%), and the review did not find its source with subgroup or sensitivity analysis. Only English studies published 2009 to 2019 were searched, and two included studies were low quality. The review pooled overt and covert retention together, while definitions and populations varied across studies. Some studies excluded epidural or had confounding factors, and risk factors may interact rather than act independently.
Declared interests
This study was funded by the Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University (FYB2018008). The review authors had no conflicts of interest.
The easy way to misread this
Do not read these pooled estimates as proof that episiotomy, instrumental birth, first baby, longer second stage, or epidural analgesia caused urinary retention. The review combined observational studies with high heterogeneity and did not test interventions to prevent retention.