Postpartum urinary retention after vaginal birth: incidence and associated risk factors among nulliparous women

Postpartum urinary retention (PUR) is a complication following childbirth that may result in bladder overdistension, urinary tract infections, and delayed postpartum recovery. Knowledge regarding clinically significant PUR is limited.

The aim of this study was to examine the incidence of postpartum urinary retention requiring an indwelling urinary catheter and to identify associated risk factors among nulliparous women following vaginal birth.

A retrospective cohort study was conducted in two Swedish birth units. The study included 1075 nulliparous women; singleton pregnancies, cephalic presentation, ≥37 gestational weeks who gave birth vaginally. PUR was defined as urinary retention requiring an indwelling urinary catheter. Data were extracted from medical records. Differences between women with and without PUR were analysed using descriptive statistics. Multivariable logistic regression analyses were performed to identify independent risk factors.

The incidence of PUR requiring an indwelling urinary catheter was 5.7%. Women with PUR were more likely to receive epidural analgesia (90.2% vs. 61.2%, p < 0.001), oxytocin augmentation (88.5% vs. 56.7%, p < 0.001), episiotomy (18.0% vs. 5.5%, p < 0.001), and instrumental birth (23.0% vs. 12.3%, p = 0.019). In adjusted analyses, epidural analgesia (aOR 4.01, 95% CI 1.63-9.90), augmentation (aOR 2.87, 95% CI 1.18-6.94), and episiotomy (aOR 3.16, 95% CI 1.43-7.02) remained associated with PUR.

PUR requiring an indwelling urinary catheter occurred in approximately one in twenty women after vaginal birth. Epidural analgesia, oxytocin augmentation, and episiotomy were associated with PUR. Early identification of women at increased risk may support targeted postpartum bladder surveillance and help prevent PUR and associated complications.