ORAL BETHANECHOL IN POSTPARTUM URINARY RETENTION

Abstract

Purpose: Postpartum urinary retention (PUR) is one of common complication observed in obstetric units. Many risk factors have been identified for PUR which includes primiparity, epidural analgesia, cesarean delivery, perineal lacerations, operative vaginal delivery, and catheterization during labor, and prolonged second-stage labor. Most commonly used mode of management is catheterization which can be sometime extended to one week duration. Oral Bethanechol is FDA approved cholinergic drug for usage of PUR. Due to lack of sufficient data and studies it is not widely used in market. So we decided to study whether usage of Bethanechol is effective in management of PUR.

Study design:  Vaginally delivered patients with PUR who were managed by unit I with Bethanechol and catheter and by unit II with only catheter were observed retrospectively from medical data records between 1^st dec 2021 to 30^th nov 2023. Their treatment and its improvement in PUR were noted and studied for analysis in terms of number of days with catheterization and hospital stay.

Result: Out of total 1062 vaginal deliveries, total 49 vaginal delivered patients with history of PUR were analyzed for study. 23 patients (46.9 %) were managed by unit I with Bethanechol and catheter whereas 26(53.1%) were managed by unit II wit only catheterization. We have observed 59.2% patients were Primigravida whereas 40.8% patients were multigravida. Mean age of women with PUR was 26.5years and means period of gestation was 38 weeks 5 days with standard deviation of 1.25. Mean newborn birth weight was 3.25kg. In the "Bethanecol and Catheter" group, 21 participants (56.8%) required catheterization once, 2 participants (18.2%) required it twice, and none required it thrice. In the "Catheter" group, 16 participants (43.2%) required catheterization once, 9 participants (81.8%) required it twice, and 1 participant (100%) required it thrice. The Chi-square test (Fisher's exact) was used to assess the difference between the groups, and the p-value of 0.027 suggests a statistically significant difference in the number of times catheterization was required between the two groups.

Conclusion: Postpartum urinary retention is a very common condition, which is associated with the labor process. Bethanechol was found be effective in reducing the requirement of re-catheterization in PUR. Also Bethanechol is effective especially in the early phases of PUR. Thus, it is important to institute treatment with Bethanechol in cases of complete or partial urinary retention.