Compared to elective Cesarean, Vaginal delivery more likely to be associated with voiding dysfunction

Researchers have found in a new study that postpartum post-voiding residual volume is significantly higher than the pre-labour PVRV in women delivered vaginally. In addition, postpartum post-voiding residual volume was significantly higher in women delivered vaginally compared to elective Cesarean Delivery.

Labor is related with both voiding dysfunction and faecal incontinence of the pelvic floor. Following vaginal birth, between 1.7 and 43% of women have voiding problems. The likelihood of voiding dysfunction after an emergency caesarean birth is also a significant risk factor.

The first prospective research conducted by L. Salman ET Al. sought to determine the effect of vaginal vs elective CD delivery on PVRV by comparing PVRV levels before and after delivery. This prospective observational cohort research comprised nulliparous women who were admitted to the delivery room or had elective CD and had a singleton gestation at term. Pre-labour voiding function was examined using a bladder scan to determine the post-voiding residual volume PVRV. PVRV testing was performed at least 12 hours after birth and before to discharge. If the PVRV was more than 150 ml, it was deemed abnormal.

54 women were enrolled, 34 (63%) of whom delivered vaginally and 20 (37%) of whom had elective CD. In all women, postpartum PVRVs were significantly greater than pre-labour PVRVs. However, abnormal postpartum PVRV was much more prevalent in vaginal birth than in caesarean delivery (73.5 vs 45 percent, p.05. When postpartum PVRV was compared directly to method of birth, women who delivered vaginally had statistically significantly greater outcomes independent of pre-labor PVRV.

Because more than 90% of women in both groups had regional anaesthesia, this research eliminated the bias of regional anaesthesia as an independently associated risk for decreased postpartum PVRV. The study's primary weakness was the minimal number of participants in each group. The bladder scan used to diagnose PVRV may be a restriction, since an enlarged uterus during labour and the early postpartum period may affect the outcome of this test. Another disadvantage was that voiding dysfunction could not be assessed during the immediate postpartum period.

This research suggests that delivery has a detrimental effect on voiding function and that women who deliver vaginally are more prone to voiding dysfunction than those who deliver by elective CD. Nonetheless, substantial observational studies are necessary to corroborate these findings and to determine if this difference persists beyond the postpartum period.

• What information is currently available on this subject?

Delivery is linked to voiding disorder. While the majority of research on postpartum voiding dysfunction has focused on vaginal birth, little is known about the influence of delivery mode on voiding dysfunction (vaginal vs caesarean delivery (CD)).

• What value do the findings of this research add?

We discovered that the postpartum post-voiding residual volume is considerably greater than the pre-labor PVRV in vaginally delivered women in this research. Additionally, postpartum PVRV was considerably greater in vaginally delivered women than in elective CD patients.

• What do these results mean for clinical practise and/or future research?

This research suggests that women who deliver vaginally are more likely to have voiding dysfunction than those who deliver by elective CD. However, bigger observational studies are necessary to corroborate these findings and to determine if the difference persists beyond the postpartum period.

Reference –

Lina Salman, Anat Shmueli, Shachar Aharony, Anat Pardo, Rony Chen, Arnon Wiznitzer & Rinat Gabbay-Benziv (2022) Postpartum voiding dysfunction following vaginal versus caesarean delivery, Journal of Obstetrics and Gynaecology, 42:2, 256-260, DOI: 10.1080/01443615.2021.1907553