DISCUSSION:

1. OVERT AND COVERT POST PARTUM URINARY RETENTION, RISK FACTORS AND COMPLICATIONS- ACOHORT STUDY AT HOSPITAL TENGKU AMPUAN AFZAN (HTAA), KUANTAN, PAHANG, MALAYSIA • Hasliza Zakaria2,3, ZalinaNusee 1,2, JamaluddinAbRahman 4, Hamizah Ismail 1,2, Dalia Farouk 1,2, Suhaiza Abdullah 1,2, MokhtarAwang 1,2 • 1. Obstetrics & Gynaecology Department, Kuliyyah of Medicine, International Islamic University Malaysia • 2. Obstetrics & Gynaecology Department, Hospital TengkuAmpuanAfzan, Kuantan, Malaysia • 3. Obstetrics & Gynaecology Department, UniversitiKebangsaan Malaysia • 4.Community Medicine Department, Kuliyyah of Medicine, International Islamic University Malaysia Methods Results Objectives • DISCUSSION: • The risk of overt PUR in our study is extremely low (0.48%) compared to others [1,2,3]. • There was no statistical difference of PUR in relation to the parity, mode of delivery, type of analgesic given, baby’s weight and time of voiding except for perineal injury. • In all patient with PUR, their post void residual volume returned to normal within 2 days therefore the maximum days of hospitalization was only two days. • During follow up of these groups, most of them were asymptomatic after discharge from hospital. • CONCLUSION • The local incidence of overt and covert PUR are low. • Episiotomy increased risk of PUR • Covert and overt PUR are self limiting, specific treatment is • unnecessary. • Urinary retention is a frustrating complication in women during the immediate postpartum period. The risk of postpartum urinary retention ( PUR ) varies between 0.5 % - 14.1 % of deliveries. It is higher among Asian population with prolonged first and second stage of labor epidural analgesia and previous history of PUR. • C.C Liang et al J Obstet Gynecol 2007;99:229-232 • Main Objectives • To determine the local incidence of PUR at Hospital Tengku Ampuan Afzan Kuantan ( HTAA ) Pahang. • Specific objectives • To identify the high risk group for PUR in the local • population • To evaluate the risk factors of PUR • To determine the post void residual volume (PVRV )that • may associated with significant postpartum urinary • retention that lead to long term urinary problem. A cohort study on women who delivered at Hospital Tengku Ampuan Afzan, Kuantan , Pahang from 1st January to 30th December 2011. The study was approved by the hospital ethical committee and patient's informed consent obtained . The subjects were patients who were stable, not eclamptic, no severe post partum hemorrhage or medical illness that require routine bladder catheterization. Patient were divided into three groups: ( 1 ) normal (PVRV < 150 ml) ( 2 ) covert (PVRV > 150 ml without associated urinary symptoms) ( 3 ) overt ( PVRV > 150 ml with symptoms of urinary retention). All the patients were followed up at 1 month, 3 months and 6 month post delivery. A phone call made to the control groups to assess voiding dysfunction using the Urogenital Distress Inventory ( UDI – 6) and Incontinence Impact Questionnaire Short Form ( IIQ – 7). Those with symptoms of voiding dysfunction were seen in the outpatient Urogynecology clinic for confirmatory test ( bladder scan, urinalysis or urodynamic if indicated) as per schedule or till the problem resolved. Data were analyzed using SPSS 18 , Kruskal – Wallis Test and Mann – Whitney test was used to evaluate the accuracy of the volume measurements and effect of the confounding factors. A P value of less than 0.05 is considered statistically significant There were 1000 women recruited in the study. This is a preliminary result on 414 women who had completed their follow up. The study subjects were mainly Malay ethnic group (89.3 % ), followed by others which included Orang Asli and foreigner ( 5.3 % ), Chinese (4.6 % ) and Indians ( 0.7 % ) AGE DISTRIBUTION OF THE SUBJECT The majority of study population involved in this study belongs to a reproductive age group, 20 -<30 years ( 56.3 %) followed by age group 30 -< 40 year ( 34.3 % ), < 20 year ( 4.8 % ) and > 40 year ( 4.6 % ) respectively. TYPES OF THE POST PARTUM URINARY RETENTION ( PUR ] The majority of women ( 96.38 % ) had normal post voiding residual urine volume ( PVRV of < 150 ml). There were two cases ( 0.48 % ) of overt and 13 cases ( 3.14 % ) of covert PUR . RISK FACTORS AFFECTING POST PARTUM URINARY RETENTION – PARITY (p = 0.22) RISK FACTORS AFFECTING POST PARTUM URINARY RETENTION – MODE OF DELIVERY (p = 0.06) RISK FACTORS AFFECTING POST PARTUM URINARY RETENTION – TYPES OF ANALGESIA (p = 0.11) RISK FACTORS AFFECTING POST PARTUM URINARY RETENTION – BABY’S WEIGHT (p = 0.79) FACTORS AFFECTING POST PARTUM URINARY RETENTION – DURATION BETWEEN MICTURATION AND URINE MEASUREMENT (p = 0.06) RISK FACTORS AFFECTING POST PARTUM URINARY RETENTION – PERINEAL INJURY (p = 0.01) Patients were followed up at 1 month, 3 month and 6 months References C.C Liang, S.D. Chang, Y.L.Chang. Post partum urinary retention after caesarian delivery. Int J ObstetGynecol 2007 ;99 :229 -232 Saultz JW, Toffler WL, Shackles JY. Post partum urinary retention.J Am Board FamPract 1991;4:341-344 Yip SK, Brieger G, Hin LY, Chung T. Urinary retention in the post partum period:the relationship between obstetric factors and the post partum post void residual bladder volume. ActaObstetGynecol Scand 1997 ;76 :667-672 Covert PUR Overt PUR Repeat bladder scan PVRV < 150 ml PVRV > 150 ml Measure PVRV 6 hourly Discharge if PVRV < 150 ml Discharge Follow up as schedule