Postpartum urinary

RetentionEpidemiologyOne of the common complications that occur after childbirth, either vaginal delivery or sectio Caesarea is postpartum urinary retention. In 1998, dr. Kartono et al of the Faculty of medicine-RSCM Jakarta launched the data that there is a 17.1% incidence of urinary retention in women giving birth who had a catheter installed for six hours and 7.1% for the set for 24 hours postoperatively sectio Caesarea. SK Yip (Hong Kong, 1997) have reported a 14.6% rate for cases of urinary retention postpartum vaginal.Dr. Pribakti B. Gastric University of FK Mangkurat / Ulin Hospital Banjarmasin noted, that during the year 2002-2003 there were eleven cases of urinary retention postpartum 2850 cases (0.38%) recorded in Ulin Hospital Banjarmasin, with details of the four cases were among the 26-30 age group year and the highest parity is the parity of the (six cases). In addition, eight cases occurred in patients with vaginal deliveries, two cases in the vacuum extraction, and one case in sectio Caesarea. Other data come from Andolf et al (1.5%) and Kavin G. et al (0.7%).DefinitionUrinary retention is the inability to urinate according to Stanton for 24 hours in need catheters, because it can not spend more than 50% of urinary bladder capacity. Dr. Basuki of FK Unbraw Purnomo said that urinary retention is the inability of bladder (bladder) to remove the urine that have exceeded their limits. On maternal urinary activity should have been able to do six hours after birth (parturition). But after six hours if unable to urinate, it is said to postpartum urinary retention.The opinions of Psyhyrembel states that postpartum urinary retention is the inability to urinate normally 24 hours after childbirth (puerperal ischuria). The other literature defines postpartum urinary retention as a process of spontaneous voiding after catheter settled released, or be able to urinate spontaneously but residual urine over 150 ml.Postpartum urinary retention if not addressed promptly can lead to cystitis, uremi, sepsis, and even spontaneous rupture of urinary vesicles.PathophysiologyDuring pregnancy an increase in the elasticity of the urinary tract, in part due to the effects of the hormone progesterone that decrease detrusor muscle tone. In the third month of pregnancy, the detrusor muscle and lose tonusnya urinary vesicles capacity increases slowly. As a result, pregnant women usually feel like to urinate when the urinary vesicles containing 250-400 ml of urine. When a pregnant woman standing, the enlarged uterus pressing urinary vesicles. The pressure is doubled when the 38 weeks of gestation. The emphasis is getting bigger when the baby will be born, allowing the intrapartum trauma of the urethra and urinary vesicles and cause obstruction. This pressure disappears after the baby is born, causing urinary vesicles are no longer limited by the capacity of the uterus. As a result, the urinary vesicles become hypotonic and tend to last a while.EtiologyThe cause of postpartum urinary retention there were all kinds, including the

effect of epidural anasthesia, intrapartum trauma, urethral sphincter reflex seizures, hypotonia during pregnancy and childbirth, inflammation, psychogenic, and old ageDiagnosisSymptoms of postpartum urinary retention can be determined by examining the patient, which can be classified as follows:A. Subjective examination, which examine complaints submitted by patients who are explored through a systematic history. Usually obtained from a subjective examination of complaints such as suprapubic pain, straining to urinate because the flavor and taste of the bladder is full.2. Objective examination, which is conducting a physical examination of patients to seek objective data about the patient. From an objective examination with palpation or percussion method, usually found in areas suprasimfisis mass because the bladder is filled from a retention of urine.3. Investigations, which is conducting laboratory tests, radiology or imaging (imaging), uroflometri, or urodinamika, electromyography, endourology, and laparoscopy. In the laboratory tests most commonly used catheters and uroflowmetri, which is to measure the volume and residual urine in the bladder. It can also be used cystourethrografi to view radiographs of the bladder and urethra. According to dr. Basuki Purnomo, the maximum volume of normal adult bladder ranged from 300-450 ml with a residual volume of approximately 200 ml. If the results obtained catheterization volume / residual urine has been approached / exceeded the normal limit, then the patient was experiencing urinary retention.