presentation PUR

8/11/2019 presentation PUR

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POSTPARTUM URINARY

RETENTION (PUR)

DEPARTMENT OF OBSTETRICS AND GYNECOLOGY

RSU DOKTER SOEDARSO PONTIANAK

2014

Presented By : Tri Catur Sari (I11111048)

Dr. Manuel Hutapea, sp.OG (K) Onk


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1. http://www.rnceus.com/uro/norm2.htm


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Anatomic Changes During Pregnancy

The primary changeenlargement and dilation ofthe kidneys and urinary collecting system2

The kidneys lengthen by approximately 1 cm during

pregnancy as a result of greater interstitial volume as

well as distended renal vasculature2

The renal calyces, pelves, and ureters dilate during

pregnancy because of mechanical and hormonal

factors2

2. Beckmann CRB, Ling FW, Herbert WNP, Laube DW, Smith RP, Casanova R, Chuang A, Goepfert AR, Hueppchen NA, Weiss PM. Obstetrics and Gynecology. 7 thRevised

Edition. Philadhelphia: Wolter Kluwer Lippincott Wil liams and Wilkins; 2014.


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Mechanical compression of the ureters occurs as the

uterus enlarges and rests on the pelvic brim.

Compression of the bladder by the enlarged uterus

results in urinary frequency2

Progesterone causes relaxation of the smooth

muscle of the ureters and decreases bladder tone, so

the residual volume is increased. As the uterus

enlarges as pregnancy progresses, bladder capacity

decreases2

2. Beckmann CRB, Ling FW, Herbert WNP, Laube DW, Smith RP, Casanova R, Chuang A, Goepfert AR, Hueppchen NA, Weiss PM. Obstetrics and Gynecology. 7 thRevised

Edition. Philadhelphia: Wolter Kluwer Lippincott Wil liams and Wilkins; 2014.


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3. Lowdermilk DL. Perry SE. Maternity Nursing. 7thEdition. United State of America: Mosby Elsevier Incorporation; 2006. h. 208-230


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General Terminology Urinary retentionComplaint of the inability to

pass urine despite persistent effort4

Urinary Retention :5

1. Acute Urinary Retention(generally) as a painful,

palpable, or percussable bladder with the patientunable to pass any urine

2. Chronic Urinary RetentionNon-painful bladder ,which remains palpable or percussable after the

patient has passed urine

4. HaylenBT, de ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, Monga A, Petri E, Rizk DE, Sand PK, Schaer GN. An International Urogynecological Association

(IUGA)/International Incontinence Society (ICS) Joint Report on the Terminology for Female Pelvic Floor Dysfunction.Journal of the Association of Chartered Physiotherapists

in Womans Health2012; 110: 33-57.

5. AbramsP, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, van Kerrebroeck P, Victor A, Wein A. The Standardisation of Terminology of Lower Urinary Tract Function:Report from the Standardisation sub-Committee of the International Continence Society. Neurology and Urodynamics2002; 21: 167-178.
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Postpartum Urinary Retention

Absence of spontaneous micturition within 6 hoursof vaginal delivery; in case of Caesarian Section it is

defined as no spontaneous micturition within 6

hours after the removal of an in dwelling catheter

(>24 hours after delivery)6

The incidence of PUR after vaginal delivery is 10.9%,

and after Caesarian delivery is 24.1%7,8

6. SaultzJW, Toffler WL, Shackles JY. Postpartum Urinary Retention. The Journal of the American Board of Family Practice/American Board of Family Practice 1991; 4 (5): 341-

344.

7. KekreAN, Vijayanand S, Dasgupta R, Kekre N. Postpartum Urinary Retention after Vaginal Delivery. International Journal of Gynecology and Obstetrics2011; 112: 112-115.

8. LiangCC, Chang SD, Chang YL, Chen SH. Postpartum Urnary Retention after Cesarean Delivery. International Journal of Gynecology and Obstetrics2007; 99: 229-232.
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Risk Factors

Risk Factors of PUR :7-10

Parity

Prolonged labour

Assisted/instrumental delivery

Perineal injury

Caesarean section

Epidural and regional anaesthesia

7. KekreAN, Vijayanand S, Dasgupta R, Kekre N. Postpartum Urinary Retention after Vaginal Delivery. International Journal of Gynecology and Obstetrics2011; 112: 112-115.

8. LiangCC, Chang SD, Chang YL, Chen SH. Postpartum Urnary Retention after Cesarean Delivery . International Journal of Gynecology and Obstetrics 2007; 99: 229-232.

9. MulderFEM, Schoffelmeer MA, Hakvoort RA, Limpens J, Mol BWJ, van der Post JAM, Roovers JPWR. Risk Factors for Postpartum Urinary Retention: A Systematic Review

and meta-Analysis. BJOG: An International Journal of Obstetrics and Gynecology 2012; 119: 1440-1446.

10. MusselwhiteKL, Faris P, Moore K, Berci D, King KM. Use of Epidural Anesthesia and the Risk of Acute Postpartum Urinary Retention. American Journal of Obstetrics andGynecology 2007; 196: 472.e1-472.e5.
http://localhost/var/www/apps/conversion/tmp/scratch_9/PUR%20references/1-s2.0-S0020729210004960-main.pdfhttp://localhost/var/www/apps/conversion/tmp/scratch_9/PUR%20references/45.pdfhttp://localhost/var/www/apps/conversion/tmp/scratch_9/PUR%20references/j.1471-0528.2012.03459.x.pdf;jsessionid=F2BAA7A1CEC121A1514C514AF4DF6744.pdfhttp://localhost/var/www/apps/conversion/tmp/scratch_9/PUR%20references/GI0507426.pdfhttp://localhost/var/www/apps/conversion/tmp/scratch_9/PUR%20references/GI0507426.pdfhttp://localhost/var/www/apps/conversion/tmp/scratch_9/PUR%20references/j.1471-0528.2012.03459.x.pdf;jsessionid=F2BAA7A1CEC121A1514C514AF4DF6744.pdfhttp://localhost/var/www/apps/conversion/tmp/scratch_9/PUR%20references/45.pdfhttp://localhost/var/www/apps/conversion/tmp/scratch_9/PUR%20references/1-s2.0-S0020729210004960-main.pdf


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Types of PUR

- Overt retention

The inability to pass urine within 6hours of birth thus requiring catheterization, in

which volumes greater than normal bladder capacity

(400-600mL) are drained from the bladder11

- Covert retentionThe women is able to voidhowever fails to empty at least 50% of her normal

bladder capacity, or a post void residual volume of

greater than 150mL11

11. The RoyalWomens Hospital. Policy, Guideline, and Procedure Manual Bladder Management - Intrapartum and Postpartum. Melbourne; 2013.
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The Aim of Bladder Training

The aim :11

1. Decrease the time to go to the toilet

2. Increase the amount of urine that pass each time

3. Hold on for longer or put off emptying bladder

Postpartum Warning Sign

All women who unable to pass urine 6 hours

following delivery and women who are symptomatic

of voiding dysfunction12


12. KearneyAR, Cutner A. Review Postpartum Voiding Dysfunction. The Obstetricians and Gynecologist2008; 10: 71-74.
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Prevention In labour11

1. Encourage woman to void every 2 hours2. If the patient unable to void in 2 occasions,

catheterization threshold should be low, but if thebladder palpable and the patient cant void insert thecatheter immediately

3. Soft catheter is preferable (balloons filled with 5mlsterile water), if the women doesnt have an epiduraland catheterization, the purpose merely for emptyingthe bladder and in/out catheter should be considered

Postpartum11

Urine volumesof >100 mL should be voided 3x/24hours

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Management

Management of PUR :11

ALGORITHM

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presentation PUR

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