Authors' objectives: Identify and summarize evidence on urinary catheterization of labor and delivery patients having epidural anesthesia.

Authors' results and conclusions: ▪ Evidence comparing patients managed with and without bladder catheterization is weak. There is considerable imprecision in results, and high heterogeneity of results for some outcomes. Additionally, some of the evidence comes from trials done outside of high-resource health care systems: a source of indirectness in the evidence. ▪ Continuous catheterization possibly reduces urinary retention and increases UTI in patients undergoing Caesarean section when compared to no catheterization. The effect on length of stay is very uncertain. The GRADE of this evidence is very low. There are no studies comparing continuous catheterization to no catheterization during labor. ▪ There is little evidence comparing continuous catheterization to intermittent catheterization of labor and delivery patients with epidural anesthesia. There does not appear to be a significant difference in rates of urinary retention and UTI with continuous or intermittent catheterization, but there is considerable inconsistency in results. The evidence GRADE is very low. ▪ Earlier removal of urinary catheters after Caesarean section increases risk of urinary retention while decreasing risk of UTI. The magnitude of these effects is uncertain and the GRADE of the evidence is low. Evidence on the effects of earlier or later IUC removal in patients who have delivered vaginally is lacking, but guideline authors make note of the same trade-offs. Guideline recommendations on timing of IUC removal in both C-section and vaginal delivery patients vary. ▪ Several different factors contributing to risk of postpartum urinary retention have been identified in multivariate analyses. These factors could be used to develop decision criteria for catheterization of patients during epidural anesthesia.

Project Status: Completed

Year Published: 2024

URL for published report: https://www.med.upenn.edu/CEP/external-request-form.html

English language abstract: An English language summary is available

Publication Type: Rapid Review

Country: United States

Organisation Name: Penn Medicine Center for Evidence-based Practice

Contact Address: Penn Medicine Center for Evidence-based Practice, University of Pennsylvania Health System, 3600 Civic Center Blvd, 3rd Floor West, Philadelphia PA 19104

Contact Name: Nikhil Mull

Contact Email: cep@pennmedicine.upenn.edu

Copyright: <p>Center for Evidence-based Practice (CEP)</p>