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At least ten percent of patients have postpartum urinary retention or difficulty urinating after birth, which can cause incontinence and other urinary problems long-term. After getting an epidural placed, patients should be numb in their pelvic region. This numbness makes it difficult to feel the need to urinate, so patients need a urinary catheter placed to empty the bladder. Some patients have one catheter placed throughout their labor and others have a catheter placed to empty the bladder then removed every few hours. The investigators are studying whether placing a catheter once or catheterizing multiple times affects the rate of postpartum urinary problems and infection.
This is a randomized controlled trial to assess the effect of bladder catheterization method during labor with epidural anesthesia on the rate of postpartum urinary retention.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Intermittent catheterization | Active Comparator |
| |
| Continuous catheterization | Active Comparator |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Intermittent catheterization | Procedure | intermittent bladder catheterization every four hours, or shorter intervals if volume exceeds 500mL per expert recommendation |
|
| Measure | Description | Time Frame |
|---|---|---|
| Postpartum urinary retention | Urinary retention defined as overt inability to void at six hours after last bladder emptying postpartum or symptomatic incomplete emptying, or covert retention of >150cc urine in the bladder after voiding Collecting number of participants who experience this | Three days postpartum |
| Measure | Description | Time Frame |
|---|---|---|
| Postpartum urinary tract infection | Culture-proven urinary tract infection without pre-existing infection documented on admission for delivery Collecting number of participants who experience this | One week postpartum |
| Patient satisfaction |
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Inclusion Criteria:
Exclusion Criteria:
Patients will be excluded from UTI analyses if:
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| Name | Affiliation | Role |
|---|---|---|
| Anna Binstock, MD | UPMC Magee-Womens Hospital | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| UPMC Magee-Womens Hospital | Pittsburgh | Pennsylvania | 15217 | United States |
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Allocation will be determined based on a previously generated randomization scheme created by the NCI Clinical Trials Randomization Tool.
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While the patient, nursing team, and delivery providers will not be blinded to the catheterization method, the provider making the diagnosis of postpartum urinary retention will be blinded to the exposure group.
| Continuous catheterization | Procedure | One catheter is placed in the bladder until pushing |
|
Title: Patient satisfaction Minimum rating 1, maximum 5, with 5 corresponding to better outcome Each question will be interpreted alone rather than aggregated
| Immediately postpartum |
| Nurse satisfaction | Title: Nurse satisfaction Minimum rating 1, maximum 5, with 5 corresponding to better outcome Each question will be interpreted alone rather than aggregated | Immediately postpartum |
| Voiding function at 2 weeks | Urinary Distress Inventory-6 questionnaire answers, to be analyzed individually (0-4) and also summed, with higher total score indicating worse function from 0 to 24 | 2 weeks postpartum |
| Voiding function at 6 weeks | Urinary Distress Inventory-6 questionnaire answers, to be analyzed individually (0-4) and also summed, with higher total score indicating worse function from 0 to 24 | 6 weeks postpartum |
| Voiding function at 6 months | Urinary Distress Inventory-6 questionnaire answers, to be analyzed individually (0-4) and also summed, with higher total score indicating worse function from 0 to 24 | 6 months postpartum |
| Voiding function at one year | Urinary Distress Inventory-6 questionnaire answers, to be analyzed individually (0-4) and also summed, with higher total score indicating worse function from 0 to 24 | one year postpartum |
| ID | Term |
|---|---|
| D016055 | Urinary Retention |
| D014552 | Urinary Tract Infections |
| D004194 | Disease |
| ID | Term |
|---|---|
| D014555 | Urination Disorders |
| D014570 | Urologic Diseases |
| D052776 | Female Urogenital Diseases |
| D005261 | Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
| D052801 | Male Urogenital Diseases |
| D007239 | Infections |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| ID | Term |
|---|---|
| D057928 | Intermittent Urethral Catheterization |
| ID | Term |
|---|---|
| D014546 | Urinary Catheterization |
| D002404 | Catheterization |
| D013812 | Therapeutics |
| D008919 | Investigative Techniques |
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