Implementation of a Postpartum Urinary Retention Protocol

INTRODUCTION: Postpartum urinary retention (PUR) is estimated to affect up to 18% of deliveries and is associated with factors such as nulliparity, operative vaginal delivery, prolonged second stage of labor, and operative vaginal delivery. Although these risk factors are well-described in the literature, limited guidance exists to support clear and consistent PUR diagnosis and management. OBJECTIVE: We sought to describe the prevalence of postpartum urinary retention (PUR) and identify factors associated with postpartum urinary retention after implementation of a standardized bladder management protocol. We hypothesized that PUR prevalence would increase after implementation as a result of increased patient surveillance. METHODS: This is a retrospective analysis of patients who experienced PUR at a single center between January 2019 and May 2024, comparing PUR prevalence and postpartum bladder management before (pre-) and after (post-) bladder management protocol implementation in November 2023. Cases were identified using Current Procedural Terminology and International Classification of Diseases codes, and inclusion criteria were confirmed with chart review. PUR was defined as (1) a voided volume of <150 mL and postvoid residual (PVR) >400 mL within 6 hours of delivery, (2) an inability to void spontaneously within 6 hours of delivery, or (3) a PVR >400 mL any time postpartum as measured by either bladder scan or straight catheterization. The primary outcome was PUR prevalence. Clinical and demographic variables were analyzed using chi-square (Fisher's exact) and Student t-tests (Mann-Whitney U) as appropriate. RESULTS: Among 4260 deliveries, 33 (∼1%) were complicated by PUR after bladder management protocol implementation. The mean age and body mass index ± standard deviation were 31.5 ± 5.2 years and 30.5 ± 5.7 kg/m2, respectively. The majority of patients were White (67%) and were nulliparous (61%). When comparing cases pre- and post-protocol implementation, there were no statistically significant differences in maternal or neonatal characteristics between groups. Patients who delivered after bladder management protocol implementation were less likely to receive epidural anesthesia (58% vs 65%, p<0.01) and less likely to undergo operative vaginal delivery (9% vs 25%, p=0.03) than patients who delivered before implementation. CONCLUSIONS: PUR prevalence remained low (<1%) after implementing a bladder management protocol to improve PUR diagnosis and standardize management. Additional studies are needed to examine the impact of this bladder management protocol in larger, more diverse other populations (Tables 1 and 2).