Postpartum Urinary Retention in Vaginal Delivery Women Under Epidural Analgesia: Risk Factors and Nursing Strategies

Abstract

The widespread use of epidural labor analgesia has introduced new challenges in postpartum bladder function management. Postpartum urinary retention (PUR) not only causes maternal discomfort but may also lead to bladder overdistension and long-term voiding dysfunction. This study aimed to investigate the incidence and risk factors for PUR in women undergoing vaginal delivery under epidural analgesia and to develop a predictive model for early identification of high-risk individuals. A retrospective case-control study was conducted on 1002 parturients who underwent vaginal delivery under epidural analgesia at our hospital from January 2024 to January 2026. Clinical data including demographic characteristics, labor parameters, obstetric interventions, analgesia-related factors, and neonatal outcomes were collected. The incidence of PUR was 6.4% (64/1002). Multivariate logistic regression identified five independent risk factors: prolonged second stage of labor (≥ 60 min, OR = 2.000, 95% CI: 1.182-3.384), episiotomy (OR = 2.801, 95% CI: 1.450-5.412), second-degree or higher perineal laceration (OR = 3.099, 95% CI: 1.542-6.229), prolonged epidural analgesia (≥ 300 min, OR = 1.600, 95% CI: 1.019-2.513), and macrosomia (≥ 4.0 kg, OR = 2.199, 95% CI: 1.186-4.077). The simplified scoring model (range 0–5) demonstrated good predictive performance with an area under the ROC curve of 0.789. Prolonged second stage of labor, episiotomy, severe perineal laceration, prolonged epidural analgesia, and macrosomia are independent risk factors for PUR in women undergoing vaginal delivery under epidural analgesia. The simplified scoring model based on these factors exhibits satisfactory predictive accuracy and may serve as a practical clinical tool for early identification of high-risk parturients.