How the Method of Bladder Emptying After Epidural Placement in Labor Affects Postpartum Voiding

University of Pittsburgh564 enrolled

Overview

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.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

DOUBLE

Enrollment

564

Conditions

Urinary Retention Urinary Tract Infection (Diagnosis)Postpartum Acute Urinary Retention

Interventions

Intermittent catheterizationPROCEDURE

intermittent bladder catheterization every four hours, or shorter intervals if volume exceeds 500mL per expert recommendation

Continuous catheterizationPROCEDURE

One catheter is placed in the bladder until pushing

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Pregnant patients planning vaginal delivery presenting in labor or for induction of labor * Age 18 years and older * Live fetus * Receive epidural anesthesia Exclusion Criteria: * those under 18 years old * those with stillbirth * those with baseline overactive bladder symptoms, neurogenic bladder diagnoses, or otherwise using bladder catheterization during pregnancy Patients will be excluded from UTI analyses if: * they received antibiotics intrapartum * had bacteriuria diagnosed by a clean catch specimen showing \>100,000 CFU/mL of a single bacterial species, regardless of symptoms

Outcomes

Primary Outcomes

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

Time frame: Three days postpartum

Secondary Outcomes

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

Time frame: One week postpartum

Patient satisfaction

Title: Patient satisfaction Minimum rating 1, maximum 5, with 5 corresponding to better outcome Each question will be interpreted alone rather than aggregated

Time frame: 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

Time frame: 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

Time frame: 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

Time frame: 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

Time frame: 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

Time frame: one year postpartum

How the Method of Bladder Emptying After Epidural Placement in Labor Affects Postpartum Voiding

Overview

Conditions

Interventions

Eligibility

Locations (1)

Outcomes

Primary Outcomes

Secondary Outcomes

Central Contacts