| BackgroundAt present,there are many delay in nursing of intrapartum dominant urinary retention and postpartum dominant urinary retention.The incidence of dominant urinary retention is high,empirical indwelling catheter leads to increased risk of repeated removal and insertion of catheter,the clinical effects were not satisfactory.There are common risk factors between postpartum stress urinary incontinence and parturien women urinary retention,postpartum stress urinary incontinence is the consequence of delayed treatment for urinary retention of parturien women.the incidence of postpartum stress urinary incontinence was 25.7%,it which seriously affected the quality of life in the later period of parturien women has become an important problem of postpartum rehabilitation.Therefore,it is urgent to find a method and index for early prediction of micturition outcomes of dominant urinary retention to improve micturition outcomes.Objectives1.The bladder pressure and volume changes of the dominant urinary retention were investigated by the reverse simple bladder pressure measurement in parturien women,and the micturition outcomes of parturien women with dominant urinary retention was analyzed.2.Confirme the predictive value of bladder pressure and volume in micturition outcomes of dominant urinary retention,and provide a theoretical basis for the clinical to implement a low-cost early prevention strategy for abnormal micturition.Methods1.Monitor the bladder pressure and volume changes of dominant urinary retention of parturien women,and analyse of micturition outcomes of dominant urinary retention.780 cases of primipara of single fetus and full term who regular prenatal examinate,and dominant urinary retention occurred in hospital delivery in Obstetrics Department of two Three-level A-rate Hospitals from January 2017 to June 2019 were selected,The changes of bladder pressure and volume were prospectively explored by the reverse simple bladder pressure measurement.A subgroup analysis was performed on the termination of pregnancy by cesarean section,transvaginal delivery,and different stages of transvaginal delivery.After 3 months follow-up,the micturition outcomes were analyzed.2.Predict the micturition outcomes of dominant urinary retention with the bladder pressure and volume350 cases of primipara of single fetus and full term needed catheterization or indwelling catheterization due to dominant urinary retention delivery in Obstetrics Department of two Three-level A-rate Hospitals from October 2019-June 2020 were selected,the micturition outcomes were predicted by bladder pressure and volume.After 3 months follow-up,the prediction effect was analyzed.,to confirm the predictive value of bladder pressure and volume in micturition outcome of parturien women with dominant urinary retention.Results1.Changes of bladder pressure and volume,and the micturition outcome of dominant urinary retention of parturien womenThe change of bladder pressure and volume showed a skewed distribution.Intrapartum dominant urinary retention,vaginal delivery:non analgesia incubation period group,non analgesia active period group,analgesia incubation period group,analgesia active period group,trial delivery failure group,the median bladder volume was respectively 550.0,150.0,650.0,350.0,750.0 ml,and the median bladder pressure during uterine contraction was respectively 31.0,126.0,12.0,13.0,40.0 cmH2O.Postpartum dominant urinary retention,vaginal delivery non analgesia group,vaginal delivery analgesia group,strong uterine contraction drug group,planned cesarean section group,the median bladder volume was respectively 730.0,1 000.0,500.0,950.0 ml,and the corresponding median pressure was respectively 12.0,10.0,24.0,11.0 cmH2O.when micturition of postpartum dominant urinary retention is resumed,the median bladder volume was 320.0～350.0 ml,and the corresponding median pressure was 10.0 cmH2O.The bladder pressure of dominant urinary retention during leakage of urine was ≤26 cmH2O,and postpartum stress urinary incontinence occurred.There were 780 cases of dominant urinary retention,no loss during follow-up.There were 290 cases of intrapartum dominant urinary retention in vaginal delivery non analgesia group,among them,there were 13(4.5%)cases of intrapartum dominant urinary retention again,81(27.9%)cases of postpartum dominant urinary retention,55(19.0%)cases of postpartum stress urinary incontinence.There were 219 cases of intrapartum dominant urinary retention in vaginal delivery analgesia group,among them,there were 75(34.2%)cases of intrapartum dominant urinary retention again,90(41.1%)cases of postpartum dominant urinary retention,11(5.0%)cases of postpartum stress urinary incontinence.There were 130 cases of postpartum dominant urinary retention in vaginal delivery non analgesia group,among them,there were 38(29.2%)cases of postpartum dominant urinary retention again,45(34.6%)cases of recessive urinary retention,5(3.8%)cases of refractory urinary retention,31(23.8%)cases of postpartum stress urinary incontinence.There were 130 cases of postpartum dominant urinary retention in vaginal delivery analgesia group,among them,there were 35(26.9%)cases of postpartum dominant urinary retention again,69(53.1%)cases of recessive urinary retention,6(4.6%)cases of refractory urinary retention,41(31.5%)cases of postpartum stress urinary incontinence.There were 75 cases of postpartum dominant urinary retention in planned cesarean section group,among them,there were 5(6.7%)cases of recessive urinary retention,6(8.0%)cases of refractory urinary retention,8(10.7%)cases of postpartum stress urinary incontinence.2.Results of prediction of the micturition outcome of dominant urinary retention by bladder pressure and volumeBladder pressure and volume were used as predictors,There was no significant difference in homogeneity of application of prediction criteria(P>0.05).Predict effects of micturition outcomes of intrapartum dominant urinary retention:intrapartum dominant urinary retention again was 75.0%,postpartum dominant urinary retention was 74.1%,postpartum stress urinary incontinence was 100.0%in vaginal delivery non analgesia group;intrapartum dominant urinary retention again was 88.2%,postpartum dominant urinary retention was 85.4%in vaginal delivery analgesia group.Predict effects of micturition outcomes of postpartum dominant urinary retention:Urinary retention in each group was 100.0%;postpartum stress urinary incontinence was 45.5%in vaginal delivery non analgesia group;postpartum stress urinary incontinence cannot be predicted in the parturien women of vaginal delivery analgesia and planned cesarean section,because the bladder pressure at the time of urine leakage can’t be measured.Conclusion1.Changes of bladder pressure and volume showed different in termination of pregnancy by cesarean section,transvaginal delivery and different stages of transvaginal delivery,Changes of bladder pressure and volume showed the same when urination recovers postpartum dominant urinary retention.2.Dominant urinary retention can cause intrapartum dominant urinary retention again,and postpartum dominant urinary retention again,and recessive urinary retention,and refractory urinary retention,and can also cause postpartum stress urinary incontinence.3.It is feasible that bladder pressure and volume were used to predict the micturition outcome of dominant urinary retention of parturien women in advance during the period of hospitalization,it can provide a theoretical basis for the implementation of low-cost early prevention strategy of abnormal micturition,it is worth popularizing and applying in clinic. |
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