(1069) Intermittent versus continuous bladder catheterization in epiduralized laboring patients: a pilot randomized controlled trial

Intrapartum bladder overdistension can lead to postpartum urinary retention (PUR) as well as long-term voiding dysfunction and has not yet been assessed as the primary outcome of a trial. We performed a pilot randomized controlled trial to assess the feasibility of detecting PUR rates after intermittent versus continuous bladder catheterization in laboring patients with neuraxial anesthesia. 

Study Design:

Participants in labor with term singletons planning vaginal delivery were randomized to intermittent (IC) or continuous catheterization (CC) after epidural anesthesia initiation. Our primary efficacy outcome was urinary retention within three days postpartum. Secondarily, we assessed voiding dysfunction at 2 and 6 weeks via the UDI-6 questionnaire, positive urine cultures within 2 weeks, and patient and nurse satisfaction. We assessed feasibility of recruitment and retention, effectiveness of randomization, and fidelity to the protocol. This pilot enrolled 10% of the planned population based on detecting a 60% difference in published rates of PUR after IC and CC. Group comparisons of PUR and UTI were assessed with logistic regression in an intention-to-treat fashion.

Results:

59 (82%) of 72 patients approached were randomized with 73% retained for follow-up questionnaire. All patients’ outcome data were recorded appropriately. 10% of participants were catheterized at frequencies deviating from the protocol. Characteristics were similar between groups indicating effective randomization. The rate of PUR was 5% with no significant difference between CC vs. IC groups (OR 2.15, 95% CI 0.18-25.1). UTI rates were similar (OR 0.32, 95% CI 0.032-3.28), as were UDI-6 scores at 2 and 6 weeks postpartum. Nursing satisfaction was significantly higher for CC (97 vs. 60%, p< 0.001).

Conclusion:

Recruitment and retention of subjects for a randomized controlled trial comparing the effect of IC to CC on PUR is feasible. Reasons for protocol deviation were collected to guide future research. CC was better accepted by staff. A larger study may uncover a difference in PUR that would guide catheterization practices.