It is common obstetric knowledge full bladder cause secondary labour dystocia. But how much urine is necessary and which amount legalize a urinary catheterisation?
Full bladder in a female is 400-500 mls of urine. If the partogram shows slow progress due to ineffective uterine contraction and clinically if bladder is palpable on abdominal examination, and the woman in labour is unable to void, then its an indication for catheterisation.
Thanks Divya, I know this and practice it, but when does the amount of urine disturb the progress? It starts often earlier than 400 ml. But when? And are there any studies which can show a progress after catheterisation of 200ml? Or is it too much action with the risk of side effects? Sometimes there comes less than 100 ml urine and I can see no faster labour progression, but I used a invasive therapy.
Unless the bladder is full and distended, it does not obstruct labor. Unless you are in doubt it is better to avoid frequent catheterization, in order to avoid urinary tract infection.
Thanks Ulduz, I don't agree. I experienced a full bladder as major problem more than one time, often with more than 300 ml, but I absolutely agree avoiding frequent catheterization. If we say > 40ml/h urine is physiological, we will find min. 160 - 200ml after 4 hours, depending on woman's sweat and drinking behavior. Maybe that amount does not obstruct labour and warrant catheterization.
But we don't know, caused by lack of documentation or research about.
I only found this:
· Wilson BL et al. Bladder Management With Epidural Anesthesia During Labor: A Randomized Controlled Trial. MCN Am J Matern Child Nurs. 40(4):234-42. 2015
During active labour patient is encouraged to pass urine 1-2 hourly according to the local protocol. If the quantity passed is inadequate and and on clinical examination her contractions which were good have now slowed down then I would consider catheterisation. The amount may be just 100 -200 mls only. I might consider self -retaining catheter if I this problem is recurring and remove the catheter when she is fully dilated and ready to deliver.
I encourage all women to urinate often during the pushing phase of labor. The reason is that delivering over a bladder with urine in it can cause long term urinary incontinence after birth, sometimes permanently.
Because i remind women to pee often, i rarely see a full bladder, unless the woman has been laboring for a long time before she called me. It is my opinion, that if there is only 200 cc there, it is likely she will be able to pee without catheterization. Only where there is more than that, then the bladder entrance can be closed by the pressure of the head.
I have never seen a full bladder DECREASE uterine contractions and am curious if that is something you have seen. I never saw that in all my experience. Is that true? The contractions continue but the baby cannot be delivered because there is no room for it to come out. It is obvious that the woman has to be catheterized, because there are lots of contractions, no progress and a big full bladder above the public bone. I dont think the amount is particularly relevant. You ask the woman to try to pee. If she cant, you catheterize her.