Received: 4 May 2020 | Revised: 30 June 2020
DOI: 10.1111/aogs.13954
ORIGINAL RESEARCH ARTICLE
Postpartum urinary retention in women undergoing
instrumental delivery: A cross-sectional analytical study
Avantika Gupta1 | Veena Pampapati1 | Chetan Khare2 | Rajeswari Murugesan3 |
Deepthi Nayak1 | Anish Keepanasseril1
1
Department of Obstetrics & Gynecology,
Jawaharlal Institute of Medical Education &
Research, Puducherry, India
2
Department of Neonatology, All India
Institute of Medical Sciences, Bhopal, India
3
Department of Biostatistics, Jawaharlal
Institute of Medical Education & Research,
Puducherry, India
Correspondence
Avantika Gupta, Department of Obstetrics
& Gynecology, Jawaharlal Institute of Post-
graduate Medical Education & Research
(JIPMER), Dhanvantri Nagar, Puducherry
605006, India.
Email: dravantikagupta@gmail.com
Abbreviations: CI, confidence interval; LR, likelihood ratio; OR, odds ratio; PUR, postpartum urinary retention; PVRBV, post-void residual bladder volume.
© 2020 Nordic Federation of Societies of Obstetrics and Gynecology
Acta Obstet Gynecol Scand. 2020;00:1–7. 
| Accepted: 4 July 2020
Abstract
Introduction: Women undergoing instrumental delivery are known to be at higher
risk of urinary retention, which can lead to long-term complications such as voiding
dysfunction. Nulliparous women undergo a pronounced and sudden change in the
perineum due to stretching during delivery, which may add to the perineal trauma
from an episiotomy, increasing the risk of urinary retention. We aim to study the
incidence and risk factors associated with postpartum urinary retention in women
undergoing instrumental delivery.
Material and methods: Pregnant women who had an instrumental delivery after
37 weeks of gestation at JIPMER, Puducherry, India, between January 2017 and
June 2017 were included in the study. Postpartum urinary retention was defined as
the inability to void spontaneously or ultrasonographic documentation of post-void
residual volume of >150 mL, 6 hours after delivery. Demographic factors, clinical
profile and follow up of these patients were noted. Multivariate logistic regression
analysis was performed to assess the risk factors associated with urinary retention
and was presented as adjusted odds ratios (OR) with 95% confidence intervals (CI).
Results: Postpartum urinary retention was noted in 124 (20.6%) women undergo-
ing instrumental delivery. Overt and covert urinary retention occurred in 2.3%
and 18.3%, respectively. After adjusting for other risk factors, nulliparity (adjusted
OR = 4.05, 95% CI 2.02-8.12 compared with multiparity) and prolonged second stage
(OR = 3.96, 95% CI 1.53-10.25) compared with suspected fetal compromise as an
indication for instrumental delivery was associated with increased risk of postpar-
tum urinary retention. Interaction was noted between parity and episiotomy on the
occurrence of postpartum urinary retention (P = .010). Among nulliparous women,
those with episiotomy (adjusted OR = 6.10, 95% CI 2.65-14.04) have higher odds of
developing postpartum urinary retention compared with those without episiotomy.
Conclusions: Approximately one of five (20.6%) women undergoing instrumental de-
livery developed postpartum urinary retention. Among women undergoing instrumen-
tal delivery, episiotomy increased the chances of developing postpartum retention
in nulliparous but not multiparous women. Prolonged second stage as an indication
wileyonlinelibrary.com/journal/aogs | 1
2 | GUPTA et al.

for instrumental delivery also increased the chances of retention. Future studies are
needed to define the cutoff for diagnosis and to evaluate the long-term effects of cov-
ert postpartum urinary retention, as well to study the effect of episiotomy on develop-
ment of postpartum urinary retention in women undergoing instrumental delivery.

KEYWORDS

covert retention, instrumental delivery, overt retention, postpartum urinary retention, post-
void residual bladder volume, prolonged second stage

1 | I NTRO D U C TI O N
The anatomical and physiological changes during pregnancy, as well
as the trauma during the process of childbirth, predispose women to
postpartum urinary retention (PUR). PUR can be “overt”, with an ina-
bility to void completely within 6 hours of delivery, or “covert”, when
the post-void residual bladder volume is >150 mL.1,2 Insensitivity
of the bladder muscle due to the hormonal changes, added to the
bladder edema and the injury to the pelvic nerve plexus (leading to
neuropraxia) from compression of the presenting part, increases the
chances of PUR after delivery.1,3 With early identification and treat-
ment, most cases with PUR will recover. In case of delay, it can result
in bladder under-activity, retention, recurrent urinary tract infec-
tions and prolonged voiding dysfunction.3
The majority of earlier studies reported the incidence and risk
factors in women undergoing vaginal delivery, including a subset of
women who had an instrumental delivery.2,4-8 The extra mechanical
strength of up to 200 Newton (equivalent to 20.4 kg) used during
instrumental delivery can lead to injury and stretching of the peri-
neal musculature and nerves.9 This makes those women undergoing
instrumental delivery more prone to PUR than those undergoing
spontaneous vaginal delivery. In nulliparous women, who have a less
distensible perineum compared with multiparous women, longer du-
ration of the second stage and the pressure exerted by the fetus on
the pelvis may cause more stretching, leading to injury to perineal
musculature and neuropraxia and hence an increased risk of PUR.2,10
Perineal trauma, local edema and pain secondary to episiotomy can
also lead to PUR by causing a reflex urethral spasm.10 The episiotomy
is more likely to be given in a nulliparous woman, so those nulliparous
women who receive episiotomy during the instrumental delivery may
be at increased risk of PUR. The objective of this study was to calcu-
late the incidence of PUR in women undergoing instrumental delivery
and to identify the risk factors associated with it. We also assessed
the possible interaction of episiotomy and parity on the development
of PUR among women who undergo instrumental delivery.
2 | M ATE R I A L A N D M E TH O DS
This study was carried out in the Department of Obstetrics and
Gynecology, Women and Children’s Hospital, attached to the
Jawaharlal Institute of Postgraduate Medical Education & Research,
Key message
Among those undergoing instrumental delivery, nullipa-
rous women who receive episiotomy and those who have
it performed for prolonged second stage of labor are more
prone to develop postpartum urinary retention.
Puducherry, India, between January 2017 and June 2017. Those
women who had instrumental delivery after 37 weeks of gesta-
tion with either vacuum using Bird metal cup, outlet forceps, low
forceps, or vacuum followed by a forceps delivery, were included
in the study. The use of instruments (low forceps, outlet forceps
or vacuum cup) was based on the fulfillment of ACOG criteria for
performing instrumental delivery, which was conducted by either a
registrar or an obstetric consultant in the labor ward.11 The obstetri-
cian conducting the delivery, based on his/her assessment, makes
the decision to perform episiotomy during the delivery. As epidural
analgesia could be a confounding factor, both for PUR as well as for
prolonged labor leading to instrumentation, we restricted the inclu-
sion of those women who underwent instrumental delivery without
the use of epidural analgesia.1 Those women who require indwelling
catheterization for indications such as urine output monitoring or
after a repair of anal sphincter injury were excluded from the study.
Written informed consent was received from all the participants in-
cluded in the study.
Demographic factors such as age and body mass index, and ob-
stetric factors such as parity, the onset of labor (spontaneous/in-
duced), birthweight of the baby, duration of labor, duration of the
second stage, presence or absence of episiotomy and the type of
instrument were noted from the case record. Body mass index was
calculated using pre-pregnancy bodyweight or weight in the first tri-
mester if the former was not available. The total duration of labor
was measured from the onset of true labor pain to the delivery of
the baby. The second stage of labor was defined as full dilation of
the cervix to the delivery of the baby. The prolonged second stage
was defined as duration more than 2 hours in nulliparous women and
1 hour in multiparous women.11
As per hospital policy, postpartum women after instrumental
delivery were encouraged to pass urine within 2 hours of delivery.
GUPTA et al.
Those women who were unable to void spontaneously within 6 hours
of delivery, despite all efforts, were catheterized with Foley’s self-re-
taining catheter and the volume of urine drained was taken as post-
void residual bladder volume (PVRBV). Antibiotics were started only
in the presence of bacterial growth, based on the sensitivity report
following urine culture examination.
Asymptomatic women who had an instrumental delivery, in-
cluded in the study, underwent a transabdominal ultrasound scan
within 6 hours of delivery, using the Voluson E8 Expert machine
(General Electric Medical Systems, Austria). PVRBV was measured
by ultrasound within 15 minutes of voiding, using the formula for
estimation of ellipsoid volume: (volume = π/6 × D1×D2 × D3, where
D1 is the widest diameter in transverse section, D2 is the anteropos-
terior diameter in longitudinal section and D3 is the cephalo-caudal
diameter in longitudinal section, all in centimeters). To avoid interob-
server variation, all scans were done by the first author (A.G.) of this
study.
“Postpartum urinary retention” (PUR) was defined as the inabil-
ity to void spontaneously (overt PUR) or a PVRBV of >150 mL on
transabdominal ultrasound within 6 hours of instrumental delivery
(covert PUR).1,2 All women with covert PUR underwent daily ul-
trasound for estimation of PVRBV until postpartum day 4 or until
PVRBV was <150 mL. If PVRBV was >150 mL on day 4, it was
repeated on day 7. All women with overt PUR and those with co-
vert PUR having a PVRBV >500 mL were catheterized for the next
48 hours, as per hospital policy. After 48 hours, the catheter was
removed and PVRBV was measured again. Persistent PUR was de-
fined as persistence of the inability to void spontaneously or PVRBV
measuring >150 mL even 48 hours after removal of the catheter.
These women were either trained in intermittent self-catheteriza-
tion, in consultation with the urologist, or a self-retaining catheter
was kept in place for the next 3-5 days and the women followed up
with the urologist after discharge from hospital. The resolution of
urinary retention was defined as the ability to void spontaneously
with PVRBV <150 mL.
2.1 | Sample size
The sample size was calculated using a prevalence of 16% from the
previous study and a relative precision of 20%; a minimum of 504
postpartum women undergoing instrumental delivery were there-
fore needed to be enrolled.4 Hence, 600 women were included in
the study. Subjects were divided into two groups: women with PUR
and those without PUR.
2.2 | Statistical analyses
Categorical variables are presented as frequency or percentages
and continuous variables as mean with standard deviation or median
with ranges. Fisher’s exact test or chi-square test was used for cat-
egorical variables. Student’s t test or Wilcoxon rank-sum test were
| 3
used respectively for continuous variables based on whether there
was a Gaussian distribution. Multivariate logistic regression analysis
was performed to assess the independent association of the vari-
ous risk factors with the development of PUR. The factors included
in this analysis were those which were clinically significant (such
as type of instrument and indication for the instrument) or had a
P value of <.2 in univariate logistic regression. Two models were
compared: (with the effective modification of parity with episiotomy
and without such interaction. Interaction between these factors was
tested with likelihood ratio tests. A two-tailed P value of <.05 was
taken as statistically significant. The analysis was performed using
STATA 13.1 software (StataCorp 13.1).
2.3 | Ethical approval
This study was done as per the ethical standards set by the Institute
Scientific Advisory and Ethical Committee for human studies, fol-
lowing the 1964 Declaration of Helsinki and its later versions. The
study was approved by the Institute Ethics Committee for human
studies (Approval number: JIP/IEC/SC/2013/3/393; dated 5 June
2013).
3 | R E S U LT S
During the study period, the incidence of instrumental delivery was
12.3% (1070/8643). Figure S1 shows the flow chart explaining the
inclusion and exclusion of those who underwent instrumental de-
livery in the study. Among 600 women who were recruited, 124
(20.6%) had PUR. The incidence of overt PUR was 2.3% (n = 14) and
of covert PUR 18.3% (n = 110). The baseline characteristics of the
participants are given in Table 1.
After adjusting for other risk factors on multivariate analysis, nul-
liparity (adjusted OR = 4.05, 95% confidence interval [CI] 2.02-8.12)
compared with multiparity and those who had instrumental delivery
for prolonged second stage compared with other indications were
associated with an increased risk of PUR (Table 2). Episiotomy (ad-
justed OR = 1.04, 95% CI 0.44-2.49) was not found be associated
with PUR after adjusting for other variables (Table 2). The likelihood
ratio test to assess the interaction between parity with episiotomy
on the occurrence of PUR showed evidence of an interaction (LR
χ2 = 6.56, P = .010). Nulliparous women who had an episiotomy (ad-
justed OR = 6.10, 95% CI 2.65-14.04) while undergoing instrumental
delivery, had higher odds than those without episiotomy for the de-
velopment of PUR (Table 3).
Clinical details of women who had overt PUR are shown in
Table S1. PUR resolved after 48 hours of bladder catheterization in 12
of 14 women with overt PUR, but the two other women developed
persistent PUR. One of these women recovered following re-cathe-
terization for the next 72 hours, but the other woman continued to
have persistent PUR. She was a primiparous lady delivered by low for-
ceps along with an episiotomy and had an initial PVRBV of 1500 mL.
4 | GUPTA et al.

TA B L E 1 Comparison of frequencies
Postpartum urinary retention
P for various risk factors in women with and
Variable Total (n = 600) Yes (n = 124) No (n = 476) value without urinary retention
a
Age in years 24.1 ± 3.0 24.3 ± 2.8 24.1 ± 3.1 .546
2a
BMI in kg/m 22.3 ± 1.7 22.5 ± 1.8 22.2 ± 1.6 .133
Parityc
Nulliparous 475 (79.2%) 111 (89.5%) 364 (76.5%) .001
Multiparity 125 (20.8%) 13 (10.5%) 112 (23.5%)
Onset of laborc
Induced 215 (35.8%) 45 (36.3%) 170 (35.7%) .905
Spontaneous 385 (34.2%) 79 (63.7%) 306 (64.3%)
Total duration of 15.6 ± 4.3 16.0 ± 5.3 15.4 ± 4.0 .193
labora
Duration of second 50.0 (10-150) 45 (10-150) 60 (10-150) .456
stage (min)b
Birth weight, gc 2851.3 ± 428.1 2825.0 ± 402.6 2858.2 ± 434.6 .442
c
Episiotomy 555 (92.5%) 115 (92.7%) 440 (92.4%) .909
Type of instrumentc
Vacuum 455 (75.8%) 89 (71.8%) 366 (76.9%) .365
Outlet forceps 62 (10.3%) 18 (14.5%) 44 (9.2%)
Low forceps 62 (10.3%) 12 (9.7%) 50 (10.5%)
Vacuum followed 21 (3.5%) 5 (4.0%) 16 (3.4%)
by forceps
Indicationc
Suspected fetal 373 (62.2%) 72 (58.0%) 301 (63.2%) .345
compromise
Prolonged 2nd 185 (30.8%) 40 (32.3%) 145 (30.5%)
stage
Maternal 42 (7.0%) 12 (9.7%) 30 (6.3%)
exhaustion
Analgesiac
Morphine 88 (14.6%) 19 (15.3%) 69 (14.5%) .817
Tramadol 512 (85.4%) 105 (84.7%) 407 (85.5%)

P < .05.
Abbreviations: BMI, body mass index.
a
Mean ± SD.
b
Median with range.
c
Frequency with percentages.

After two failed trials of catheterization, she was taught intermittent
self-catheterization by the urologist and required it for 20 days. At
the 3-month follow-up, she was asymptomatic and did not have void-
ing dysfunction. Follow up of patients with covert PUR is shown in
Figure 1. Three of these women had PVRBV of >500 mL and were
catheterized for 48 hours, after which the PUR resolved. By 7 days of
instrumental delivery, covert PUR had resolved in all the patients.
4 | D I S CU S S I O N
The incidence of PUR in the present study was 20.6%, which
is slightly higher than the previous reports which defined PUR
following vaginal deliveries using the same criteria, where it ranged
from 9.15% to 16.7% in the subset of participants undergoing in-
strumental delivery.4,6,7 Most professionals recommend using an in-
ability to void within 6 hours after delivery as the criterion to define
overt PUR; the definition of the covert PUR is still debatable.1
Covert PUR is diagnosed when a postpartum woman presents
with significant residual urine in the bladder after spontaneous
voiding. The majority of the studies used the cutoff for this post
residual bladder volume proposed by Yip et al, that is, PVRBV of
>150 mL (detected by ultrasonography or by catheterization after
spontaneous micturition) to define covert PUR. 2,4,6,7 The incidence
of covert PUR was 18.3% in the present study compared with a
wide range of 10.6-47% from previous studies which used the same
GUPTA et al. | 5

cutoff to define covert PUR in a subset of women undergoing instru- mental delivery.1,7,12 For consistent comparisons between previous
studies, we also chose a definition of 150 mL for covert PUR.
Recently, Mulder et al suggested raising the cutoff to >500 mL, mea-
TA B L E 2 Comparison of frequencies for various risk factors in sured by ultrasonography, after spontaneous micturition to define
women with and without urinary retention
covert PUR, following his study which assessed the clinical impact
Variable Unadjusted OR Adjusted OR of covert PUR.13 As injury from the perineal stretching and traction

Age in yearsa 1.02 (0.96-1.09) 1.02 (0.95-1.09) force during delivery may be greater in women undergoing instru-
2a mental delivery than a spontaneous vaginal delivery, the resulting
BMI in kg/m 1.09 (0.97-1.23) 1.09 (0.97-1.23)
neuropraxia or edema can result in a decrease in the bladder emp-
Parityc
tying in the immediate postnatal period. Due to this, using a cutoff
Nulliparous 2.63 (1.42-4.85) 4.05 (2.02-8.12)
of PVRBV similar to those undergoing spontaneous vaginal delivery
Multiparity 1.0 1.0
can lead to overdiagnosis, increasing the incidence of covert PUR.
Onset of laborc
Future studies assessing the short- and long-term impact of PVRBV
Induced 0.98 (0.65-1.47) 1.10 (0.71-1.72) are required to identify an optimal cutoff to define covert PUR in
Spontaneous 1.0 1.0 women undergoing instrumental delivery.
Total duration of 1.03 (0.98-1.08) 1.03 (0.98-1.09) In a meta-analysis including 13 studies, epidural analgesia (OR
labora
7.7), episiotomy (OR 4.8), instrumental delivery (OR 4.5) and nullipar-
Duration of second 0.99 (0.99-1.00) 0.99 (0.98-1.00) ity (OR 2.4) were found to be risk factors for overt urinary retention
stage (min)b
in women undergoing vaginal delivery.1 Episiotomy can lead to in-
Birthweightc 0.99 (0.99-1.00) 0.99 (0.99-1.00)
creased edema in the perineal region and can result in damage to the
Episiotomyc 1.05 (0.49-2.23) 1.04 (0.44-2.49) perineal nerve innervation, leading to PUR. In the present study, epi-
Type of instrumentc siotomy was not found to be associated with PUR, similar to reports
Vacuum 1.0 1.0 by Polat et al10 and Musselwhite et al.14 Meta-analysis by Mulder
Outlet forceps 1.68 (0.93-3.05) 1.85 (0.99-3.44) et al1 showed episiotomy to be associated with PUR (OR = 4.8) but it
Low forceps 0.99 (0.50-1.93) 0.82 (0.41-1.64) was not associated with covert PUR following vaginal delivery. The
Vacuum followed 1.29 (0.46-3.60) 1.65 (0.57-4.80) effect of episiotomy on PUR as noted in the meta-analysis may be
by forceps due more to other factors that led to performing episiotomy (such as
Indicationc instrumental delivery, prolonged second stage, nulliparous women
Suspected fetal 1.0 1.0 with good perineal tone) which might have resulted in neuropraxia
compromise or edema from tissue injury from these factors than to the proce-
Prolonged second 1.15 (0.75-1.78) 3.96 dure itself. Even though most organizations currently recommend a
stage (1.53-10.25) restrictive use of episiotomy,11,15 some suggest that its use in opera-
Maternal 1.67 (0.81-3.42) 1.30 (0.57-2.94) tive vaginal deliveries may reduce the risk of obstetric anal sphincter
exhaustion
injuries.16 Being restricted to a population in a setting which episi-
Analgesiac otomy is more often performed for women undergoing instrumental
Morphine 1.0 1.0 delivery, it is difficult to interpret the independent effect of episiot-
Tramadol 1.07 (0.62-1.85) 0.95 (0.52-1.73) omy on PUR. Future studies, involving a larger group of women un-
P < .05. dergoing instrumental delivery with or without episiotomy is needed
Abbreviations: BMI, body mass index. to evaluate its effect on the development of PUR.
a
Mean ± SD. Nulliparous women (OR 4.05) were at higher odds than mul-
b
Median with range. tiparous women of developing PUR. Interaction was evident be-
c
Frequency with percentages. tween parity and episiotomy; the odds of developing were found

TA B L E 3 Showing the modification of the effect of parity on postpartum urinary retention (PUR) among women undergoing instrumental
delivery by episiotomy

Without episiotomy Episiotomy

Odds ratio for postpartum urinary retention
With/without With/without within strata of parity (episiotomy vs no
PUR OR (95% CI) PUR OR (95% CI) episiotomy)

Multiparity 5/14 1.0 8/98 0.26 (0.07-1.01) 0.26 (0.07-1.01)

Nulliparity 4/22 0.66 (0.14-3.06) 107/342 2.26 (0.70-7.28) 6.10 (2.65-14.04)

Abbreviations: Odds ratio (OR) adjusted for age, body mass index, analgesia, onset of labor, birthweight, indication of instrumental delivery and type
of instrument.
6 |
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F I G U R E 1 Follow up of patients with covert retention (n = 110). On day 7, all patients had a PVRBV <150 mL. Three patients who
had a PVRBV >500 mL on day 0 were catheterized for 48 h, after which the PVRBV was <150 mL [Colour figure can be viewed at
wileyonlinelibrary.com]
to be 6.10 times greater in PUR nulliparous women with episiot-
omy than in nulliparous women undergoing instrumental delivery
without episiotomy (Table 3). The increased risk of PUR in nullipa-
rous women may be due to the damage to the pelvic nerve plexus
during vaginal birth from the sudden and pronounced change in
pelvic anatomy, which, when added to the changes/injury from
performing episiotomy for instrumental delivery, increases the
risk of developing PUR.
Epidural analgesia can lead to prolongation of the second stage
and it was also found to be one of the risk factors for urinary reten-
tion.1,4,5,14 We avoided the confounding effect of epidural analgesia
by restricting the study population to women who did not receive it
in the peripartum period. There are conflicting results in the liter-
ature concerning the duration of labor and birthweight as risk fac-
tors of urinary retention which was not found to be associated with
1,2,5,7,8,12,17,18
PUR. Median duration of the second stage was longer in
the those who did not have PUR than those who had PUR, which can
be due to a higher number of women having prolonged second stage
skewing the median value; however, the difference was not found to
be significant on analysis.
Covert PUR usually resolves by postpartum day 4 and almost
completely by day 7, as seen in the present study. 2,12 A 1-year follow
up of women with covert PUR defined as PVRBV >150 mL by Mulder
et al, did not find any difference in voiding difficulty or the devel-
opment of lower urinary tract symptoms.13 In the present study,
PUR resolved within 5 days of delivery in women who had overt
PUR. Even a single episode of overdistension can lead to long-lasting
19,20
voiding difficulties and recurrent urinary tract infections. In the
overstretched bladder, the intercellular junctions or nexuses are in-
terrupted, which is responsible for excitation transmission from one
muscle cell to another and can sometimes lead to long-term voiding
20
dysfunction. The Royal College of Obstetrics and Gynaecology
Study Group Report on incontinence recommends that no woman
should be allowed to go longer than 6 hours without voiding or cath-
eterization after delivery. 21
GUPTA et al.
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The biggest strength of this study is the inclusion of a homo-
geneous population of a large number of women who had instru-
mental delivery. All the previous studies had included women who
had a vaginal delivery, including a subset of women who delivered
with an instrument. We also excluded women who received epi-
dural analgesia to avoid its confounding effect. To reduce interob-
server variability, ultrasound for PVRBV was carried out by only
one person.
There are certain limitations, too, in the study. One recent study
found peripartum catheterization to be a risk factor for PUR in vagi-
nal deliveries.10 The frequency of catheterization during labor can be
one of the confounding factors in our study, which was not studied.
Nulliparous women and those with prolonged second stage who
undergo instrumental delivery should be closely monitored and also
encouraged to pass urine with 6 hours. After voiding, because of
the increased risk of covert PUR, an ultrasonographic estimation of
PVRBV can be done and, if diagnosed, may necessitate follow up
till resolution. Further studies are required to establish a cutoff for
defining covert UR which is clinically more relevant in women under-
going instrumental delivery, and also to assess its long-term compli-
cations such voiding dysfunction and on renal function.
5 | CO N C LU S I O N
Approximately one in five (20.6%) women undergoing instrumental
delivery developed PUR, 2.3% having overt PUR and 18.3% covert
PUR. Among women undergoing instrumental delivery, episiotomy
increased the chances of postpartum urinary retention in nullipa-
rous women but not multiparous women. Those who have an instru-
mental delivery performed for prolonged second stage of labor are
more prone to develop PUR. Future studies are needed to define the
cutoff for diagnosis and to evaluate the long-term effects of covert
PUR, as well to study the effect of episiotomy on development of
PUR in women undergoing instrumental delivery.
GUPTA et al.
C O N FL I C T O F I N T E R E S T
None.
ORCID
Veena Pampapati https://orcid.org/0000-0002-0832-8321
Deepthi Nayak https://orcid.org/0000-0001-5802-8354
Anish Keepanasseril https://orcid.org/0000-0002-4881-0382
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S U P P O R T I N G I N FO R M AT I O N
Additional supporting information may be found online in the
Supporting Information section.
How to cite this article: Gupta A, Pampapati V, Khare C,
Murugesan R, Nayak D, Keepanasseril A. Postpartum urinary
retention in women undergoing instrumental delivery: A
cross-sectional analytic study. Acta Obstet Gynecol Scand.
2020;00:1–7. https://doi.org/10.1111/aogs.$AID$