Effect of intermittent versus continuous bladder catheterization on duration of the second stage of labor among nulliparous women with an epidural: a randomized controlled trial.

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Abstract

INTRODUCTION AND HYPOTHESIS

Catheterization type among women laboring with epidural analgesia who develop bladder retention has been reported to affect labor duration and mode of delivery. We aimed to compare the effect of continuous bladder catheterization (CC) with that of intermittent bladder catheterization (IC) on the duration of the second stage of labor.

METHODS

In a randomized trial, term nulliparous women with singleton gestation who requested epidural analgesia and were unable to void spontaneously were eligible and randomized to either CC or IC. Epidural analgesia was maintained with patient control until delivery. The primary outcome was duration of the second stage of labor. Secondary outcomes were mode of delivery, and incidences of postpartum hemorrhage, bladder retention, and infection. It was assumed that, compared with IC, CC might better prevent bladder distention, which is thought to delay fetal descent. A sample size of 90 women in each group was calculated to be adequate to detect a reduction of 30 min in the duration of the second stage of labor among the CC group.

RESULTS

Between July 2014 and May 2015, a total of 184 women were randomized and included in the analysis; 90 and 94 women in the CC and IC groups respectively. Demographic and obstetric characteristics were similar. Duration of the second stage was 121.0 ± 89.4 and 131.9 ± 87.5 min in the CC and IC groups respectively (p = 0.29). The two groups did not differ significantly with regard to delivery mode, third-stage duration, and incidences of postpartum hemorrhage, bladder retention, and urinary tract infection.

CONCLUSION

Duration of the second stage of labor is not influenced by bladder catheterization type in nulliparous women receiving an epidural.

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