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Urinary retention

Urinary retention






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    Urinary retention Urinary retention Presentation Transcript

    • Management of Post Partum Urinary Retention
    • Background
      2 Types:
      Overt Retention
      The inability to void spontaneously within 6 hrs of vaginal birth or removal of an indwelling catheter (Yip et al.,2004)
      Covert retention
      Elevated post void residual volumes of >150ml no symptoms of retention
    • Causes
      Neurological damage associated with prolonged pressure against the pelvic floor and bladder (Carley et al., 2002)
      Pudendal, pelvic or hypogastric nerve injury (Yip et al., 2004)
      Pain inhibited detrusor function (Boston, 2006)
    • Risk factors
      Epidural analgesia
      Prolonged labour
      Instrumental birth
      Perineal oedema
      Periurethral trauma
      Previous history of retention
      (Yip et al.,2005; Boston, 2006; Carley et al.,2002)
    • Pudendal nerve stretch
      Pudendal nerve & pelvic floor structure geometry at beginning of 2nd Stage
      Simulated pudendalnerve & pelvic floor geometry at the end of 2nd stage in oblique view
      (Lien et al, 2005)
    • Symptoms of overt urinary retention
      Difficulty passing urine
      Slow or intemittent stream
      Straining to void
      Sense of incomplete emptying
      (Yip et al., 2005)
    • Symptoms of covert urinary retention
      No symptoms of overt urinary retention
      No urge to void
      Overflow incontinence
    • Management of overt urinary retention 1st treatment strategy
      Adequate Analgesia
      Adequate hydration
      Warm bath
      (Boston, 2006; Yip et al., 2005; Ching-Chung et al., 2002)
    • 2nd Treatment Strategy
      Indwelling catheter
      Urine catheter sample to be sent to the lab
      Volume 150-700ml – catheter 24hrs
      Volume >700ml – catheter 48hrs
      Removal of catheter wait 4hrs no passing urine go back to 1st treatment strategies
      After another 2 hrs no passing urine then reinsert the catheter
    • Management covert urinary retention 1st treatment
      4hrs post birth has the woman passed urine?
      No – 2hrly checks
      Encourage fluids
      Fluid balance chart
      Measure 1st passage of urine
      Send Mid Stream Urine sample
    • Management of covert urinary retention 2nd treatment strategy
      Volume between 200-700ml:
      Continue timing passage of urine
      No urge to pass urine after 24hrs or at >300ml:
      Insert indwelling catheter and measure residual volume
      <150ml continue timing passage of urine
      >150ml leave catheter in for 24hrs
      After 24hrs remove catheter repeat process
    • References
      Boston. L. (2006). Postpartum urinary retention. Journal of the Association of Charted Physiotherapists in Women’s Health, 98, 53-60.
      Carley, M.E., Carley, J.M., Vasdev, G., Lesnick, T.G., Webb, M.J., Ramin, K.D. & Lee, R.A. (2002). Factors that are associated with clinically overt postpartum urinary retention after vaginal delivery. American Journal of Obstetrics and Gynecology, 187, 430-433.
      Ching-Chung, L, Shuenn-Dhy, C, Ling-Hong, T., Ching-Chang, H., Chao-Lun, C. & Po-Jen, C. (2002). Postpartum urinary retention: assessment of contributing factors and long-term clinical impact. Australian and New Zealand Journal and Obstetrics and Gynecology, 42(4), 367-370.
      Lien, K. C., Morgan, D. M., Delancey, J. O., & Ashton-Miller, J. A. (2005). Pudendal nerve stretch during vaginal birth: a 3D computer simulation. Am J ObstetGynecol, 192(5), 1669-1676.
      Rizvi, R.M., Khan, Z.S. & Khan, Z. (2005). Diagnosis and management of postpartum urinary retention. International Journal of Gynecology and Obstetrics, 91, 71-72.
      Yip, S., Sahota, D. & Pang, M. (2005). Postpartum urinary retention. Obstetrics & Gynecology, 106(3), 602-606.
      Yip, S., Sahota, D., Pang, M. & Chang, A. (2004). Postpartum urinary retention. ActaObstetricia et GynecologicaScandinavica, 83, 881-891.