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The Risk Factors of Postpartum Urinary Retention for Women by Vaginal Birth: A Systematic Review and Meta-Analysis

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Abstract

Introduction and Hypothesis

Postpartum urinary retention is one of the most common complications in women during the immediate postpartum period. The objective was to systematically assess risk factors for postpartum urinary retention after vaginal delivery.

Methods

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses, we retrieved relevant studies from PubMed, Embase, Cochrane Library, Web of Science Core Collection, China National Knowledge Internet, Wangfang Database, and Chinese Biomedical Database for observational studies investigating the risk factors for postpartum urinary retention from inception to 11 November 2022. The Newcastle–Ottawa Scale and Joanna Briggs Institute's tool were used to assess the risk of bias. We conducted a meta-analysis using RevMan 5.3.

Results

In total, 3,074 articles were screened and data from 27 studies were used in the meta-analysis. Sixteen risk factors were identified, namely, labor augmentation (OR = 1.72, 95% CI = 1.17–2.51), primiparity (OR = 2.36, 95% CI = 1.64–3.38), manual fundal pressure (OR = 2.84, 95% CI = 1.00–8.11), perineal hematoma (OR = 7.28, 95% CI = 1.62–32.72), vulvar edema (OR = 7.99, 95% CI = 5.50–11.63), the total duration of labor (MD = 90.10, 95% CI = 49.11–131.08), the duration of the first stage of labor (MD = 33.97, 95% CI = 10.28–57.65), the duration of the second stage of labor (MD = 14.92, 95% CI = 11.79–18.05), the duration of the second stage of labor > 60 min (OR = 3.18, 95% CI = 1.32–7.67), mediolateral episiotomy (OR = 3.65, 95% CI = 1.70–7.83), severe perineal tear (OR = 3.21, 95% CI = 1.84–5.61), epidural analgesia (OR = 3.23, 95% CI = 1.50–6.96), forceps delivery (OR = 4.95, 95% CI = 2.88–8.51), vacuum delivery (OR = 2.44, 95% CI = 1.30–4.58), neonatal birth weight > 4,000 g (OR = 3.61, 95% CI = 1.96–6.65), and neonatal birth weight > 3,500 g (OR = 1.89, 95% CI = 1.12–3.19).

Conclusions

Our results demonstrated that labor augmentation, primiparity, manual fundal pressure, perineal hematoma, vulvar edema, the total duration of labor, the duration of the first stage of labor, the duration of the second stage of labor, the duration of the second stage of labor > 60 min, mediolateral episiotomy, severe perineal tear, epidural analgesia, forceps delivery, vacuum delivery, and neonatal birth weight > 4,000 g and > 3,500 g were risk factors for postpartum urinary retention in women with vaginal delivery. The specific ranges of the first and the second stages of labor causing postpartum urinary retention need to be clarified.

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Data Availability

The data are available from the corresponding author on reasonable request.

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Acknowledgements

The registration number is CRD42022368621.

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Contributions

X.Y.: methodology, formal analysis, data curation, writing original draft; D.Z.: methodology, formal analysis, data curation, writing original draft; W.W.: methodology; Y.X.: conceptualization, writing, reviewing, and editing.

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Correspondence to Yahong Xu.

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Appendix

Appendix

Search Method of PubMed

#1(((((((((((((((((((Postpartum Period[MeSH Terms]) OR (Postpartum Period[Title/Abstract])) OR (Period, Postpartum[Title/Abstract])) OR (Postpartum[Title/Abstract])) OR (Postpartum Women[Title/Abstract])) OR (Women, Postpartum[Title/Abstract])) OR (Puerperium[Title/Abstract])) OR (postnatal period[Title/Abstract])) OR (Delivery, Obstetric[MeSH Terms])) OR (Deliver*, Obstetric[Title/Abstract])) OR (Obstetric Deliver*[Title/Abstract])) OR (childbirth*[Title/Abstract])) OR (Parturition[MeSH Terms])) OR (Parturition*[Title/Abstract])) OR (Birth*[Title/Abstract])) OR (Labor, Obstetric[MeSH Terms])) OR (Labor, Obstetric[Title/Abstract])) OR (Obstetric Labor[Title/Abstract])) OR (Pregnancy[MeSH Terms])) OR (Pregnanc*[Title/Abstract]).

#2((((((((((urinary retention[MeSH Terms]) OR (urinary bladder[MeSH Terms])) OR (voiding difficulty[Title/Abstract])) OR (urinary retention[Title/Abstract])) OR (postpartum voiding dysfunction[Title/Abstract])) OR (urinary voiding dysfunction[Title/Abstract])) OR (postpartum urinary retention[Title/Abstract])) OR (voiding dysfunction[Title/Abstract])) OR (bladder care[Title/Abstract])) OR (obstetric bladder management[Title/Abstract])) OR (urinary bladder[Title/Abstract]).

#3 ((((((((((((((((((((((Risk[MeSH Terms]) OR (Risk[Title/Abstract])) OR (Risks[Title/Abstract])) OR (Relative Risk[Title/Abstract])) OR (Relative Risks[Title/Abstract])) OR (Risk, Relative[Title/Abstract])) OR (Risks, Relative[Title/Abstract])) OR (Risk Factors[MeSH Terms])) OR (Risk Factor*[Title/Abstract])) OR (Factor, Risk[Title/Abstract])) OR (Social Risk Factor*[Title/Abstract])) OR (Factor*, Social Risk[Title/Abstract])) OR (Risk Factor*, Social[Title/Abstract])) OR (Health Correlates[Title/Abstract])) OR (Correlates, Health[Title/Abstract])) OR (Population* at Risk[Title/Abstract])) OR (Risk Score*[Title/Abstract])) OR (Score, Risk[Title/Abstract])) OR (Risk Factor Score*[Title/Abstract])) OR (Score, Risk Factor[Title/Abstract])) OR (predictor*[Title/Abstract])) OR (Association[MeSH Terms])) OR (Association*[Title/Abstract]).

#4 #1 AND #2 AND #3.

Search Method of the Cochrane Library

#1 Postpartum Period OR Delivery, Obstetric OR Parturition OR Labor, Obstetric OR Pregnancy OR Postpartum Period OR Period,Postpartum OR Postpartum OR Postpartum Women OR Women,Postpartum OR Puerperium OR postnatal period OR Deliver*,Obstetric OR Obstetric Deliver* OR childbirth* OR Parturition* OR Birth* OR Labor,Obstetric OR Obstetric Labor OR Pregnanc*

#2 urinary retention[MeSH Terms] OR urinary bladder[MeSH Terms] OR voiding difficulty OR urinary retention OR postpartum voiding dysfunction OR urinary voiding dysfunction OR postpartum urinary retention OR voiding dysfunction OR bladder care OR obstetric bladder management OR urinary bladder.

#3 #1 AND #2.

Search Method of Embase

#1 'postpartum'/exp OR 'puerperium'/exp OR 'postnatal period'/exp OR 'obstetric delivery'/exp OR 'childbirth'/exp OR 'birth'/exp OR 'labor'/exp OR 'pregnancy'/exp OR 'postpartum period':ab,ti OR postpartum:ab,ti OR 'postpartum women':ab,ti OR puerperium:ab,ti OR 'postnatal period':ab,ti OR 'obstetric delivery':ab,ti OR childbirth:ab,ti OR birth:ab,ti OR parturition:ab,ti OR labour:ab,ti OR labor:ab,ti OR pregnancy:ab,ti.

#2'urinary retention'/exp OR 'impaired bladder emptying'/exp OR 'postpartum urinary retention'/exp OR 'voiding difficulty':ab,ti OR 'urinary retention':ab,ti OR 'postpartum voiding dysfunction':ab,ti OR 'urinary voiding dysfunction':ab,ti OR 'postpartum urinary retention':ab,ti OR 'voiding dysfunction':ab,ti OR 'bladder care':ab,ti OR 'obstetric bladder management':ab,ti OR 'urinary bladder':ab,ti.

#3 risk:ab,ti OR 'risk factor':ab,ti OR predictor:ab,ti OR association:ab,ti OR etiology:ab,ti OR correlate:ab,ti OR 'risk'/exp OR 'risk' OR 'risk factor'/exp OR 'risk factor' OR 'predictor variable'/exp OR 'predictor variable' OR 'etiology'/exp OR 'etiology'.

#4 #1 AND #2 AND #3.

Search Method of Web of Science Core Collection

#1 Postpartum Period (主题) or Period, Postpartum (主题) or Postpartum (主题) or Postpartum Women (主题) or Women, Postpartum (主题) or Puerperium (主题) or postnatal period (主题) or Deliver*, Obstetric (主题) or Obstetric Deliver* (主题) or childbirth* (主题) or Birth* (主题) or Parturition* (主题) or Labor, Obstetric (主题) or Obstetric Labor (主题) or Pregnanc* (主题).

#2 urinary retention (主题) or urinary bladder (主题) or voiding difficulty (主题) or postpartum voiding dysfunction (主题) or urinary voiding dysfunction (主题) or postpartum urinary retention (主题) or voiding dysfunction (主题) or bladder care (主题) or obstetric bladder management (主题) or urinary bladder (主题).

#3 Risk Factors (主题) or Factor, Risk (主题) or Risk Factor (主题) or Social Risk Factors (主题) or Factor, Social Risk (主题) or Factors, Social Risk (主题) or Factor, Social Risk (主题) or Risk Factors, Social (主题) or Social Risk Factor (主题) or Health Correlates (主题) or Correlates, Health (主题) or Population at Risk (主题) or Populations at Risk (主题) or Risk Scores (主题) or Risk Score (主题) or Score, Risk (主题) or Risk Factor Scores (主题) or Risk Factor Score (主题) or Score, Risk Factor (主题) or Risk (主题) or Risks (主题) or Relative Risk (主题) or Relative Risks (主题) or Risk, Relative (主题) or Risks, Relative (主题) or Association (主题) or predictor (主题) or Associations (主题) or Etiology (主题).

Search Method of the Chinese Biomedical Database

#1 (("产后期"[不加权:扩展]) OR "分娩"[不加权:扩展]) OR "剖宫产术"[不加权:扩展].

#2 "产褥期"[常用字段:智能] OR "产妇"[常用字段:智能] OR "阴道分娩"[常用字段:智能] OR "剖宫产"[常用字段:智能] OR "产后女性"[常用字段:智能].

#3 (#2) OR (#1).

#4 ("尿潴留"[不加权:扩展]) OR "排尿困难"[不加权:扩展].

#5 "尿潴留"[常用字段:智能] OR "排尿困难"[常用字段:智能] OR "产后尿潴留"[常用字段:智能] OR "膀胱护理"[常用字段:智能] OR "产后膀胱管理"[常用字段:智能].

#6 (#4) OR (#5).

#7 ("危险因素"[不加权:扩展]) OR "预测"[不加权:扩展].

#8 "危险因素"[常用字段:智能] OR "危险"[常用字段:智能] OR "预测"[常用字段:智能] OR "相关"[常用字段:智能].

#9 (#7) OR (#8).

#10 (#3) AND (#6) AND (#9).

Search Method of China National Knowledge Internet

#1 (主题 = 危险因素) OR (主题 = 预测) OR (主题 = 危险).

#2(主题 = 尿潴留) OR (主题 = 排尿困难) OR (主题 = 产后尿潴留) OR (主题 = 膀胱护理) OR (主题 = 产后膀胱管理).

#3 (主题 = 产后期) OR (主题 = 分娩) OR (主题 = 剖宫产) OR (主题 = 产褥期) OR (主题 = 产妇) OR (主题 = 阴道分娩) OR (主题 = 产后妇女).

#4 #1 AND #2 AND #3.

Search Method of the Wangfang Database

TI = '危险因素' or TI = '预测' or TI = '危险' or TI = '生态' or TI = '相关'.

TI = '尿潴留' or TI = '排尿困难' or TI = '产后尿潴留' or TI = '膀胱护理' or TI = '产后膀胱管理'.

TI = '产后期' or TI = '分娩' or TI = '剖宫产' or TI = '产褥期' or TI = '产妇' or TI = '阴道分娩' or TI = '产后妇女'.

(危险因素 + 预测 + 危险) * (尿潴留 + 排尿困难 + 产后尿潴留 + 膀胱护理 + 产后膀胱管理) * (产后期 + 分娩 + 剖宫产 + 产褥期 + 产妇 + 阴道分娩 + 产后妇女).

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Yin, X., Zhang, D., Wang, W. et al. The Risk Factors of Postpartum Urinary Retention for Women by Vaginal Birth: A Systematic Review and Meta-Analysis. Int Urogynecol J (2024). https://doi.org/10.1007/s00192-024-05853-w

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