Postpartum Catheterization for Severe Tears Linked to Higher Complication Risks

Routine postpartum urinary catheterization does not lower the risk of urinary retention among women who sustain obstetric anal sphincter injuries during childbirth and is instead associated with a significantly elevated risk of adverse outcomes, according to a retrospective cohort study published in BMC Pregnancy and Childbirth.

The retrospective investigation was conducted by a research team including Aharon Dick, Henry H. Chill, Or Ribak, Nir Cohen, Ron Schonman, Maya Youran Kimhi, Nissim Arbib, and Yair Daykan. Their primary research objective was to evaluate whether the implementation of postpartum urinary catheterization actively reduces urinary retention in women diagnosed with obstetric anal sphincter injury, as well as to determine its statistical association with subsequent adverse clinical outcomes.

To investigate these outcomes, the researchers established a retrospective cohort comprising adult women aged 18 to 50 years who sustained an obstetric anal sphincter injury following vaginal delivery across two tertiary medical centers between 2015 and 2024. Across the study period, the two medical centers recorded a total of 167,821 deliveries. Among this broad obstetric population, 804 women were confirmed to have sustained an obstetric anal sphincter injury, reflecting an overall injury rate of 0.47 percent. The study population was subsequently stratified into two comparative clinical cohorts based on whether the patients received postpartum urinary catheterization during their inpatient care.

Within the evaluated cohort of 804 patients, 383 women, representing 47.6 percent of the cohort, underwent postpartum urinary catheterization, whereas 421 women, or 52.4 percent, were managed without catheter placement. The primary clinical outcome established for the investigation was the occurrence of persistent urinary retention. The secondary clinical outcomes tracked by the researchers encompassed overt urinary retention, the development of documented urinary tract infections, readmission to the hospital, and a composite adverse outcome. Bladder retention events proved to be exceedingly uncommon across the entire study group, with only four cases of overt urinary retention and a single documented case of persistent retention recorded, totaling an overall retention incidence of 0.5 percent.

Because urinary retention was so infrequent across both management groups, the researchers noted that the sparse event count precluded meaningful comparative statistical analysis for retention endpoints alone. Nonetheless, substantial divergences appeared when assessing broader patient morbidity. The composite adverse outcome—specifically defined by the investigators as the presence of persistent urinary retention, urinary tract infection, or hospital readmission—occurred in 43 patients, accounting for 5.3 percent of the entire obstetric anal sphincter injury cohort. When multivariable logistic regression was conducted to identify independent risk factors, postpartum catheterization emerged as an independent predictor of these complications, yielding an odds ratio of 3.67 with a 95 percent confidence interval between 1.81 and 7.43 and a p-value below 0.01.

Beyond catheter placement, the multivariable regression analysis identified two additional independent clinical risk factors associated with the development of the composite adverse outcome. Nulliparity demonstrated an independent association with composite complications, carrying an odds ratio of 3.50, a 95 percent confidence interval ranging from 1.22 to 10.05, and a p-value of 0.02. Concurrently, the administration of epidural analgesia during labor was independently linked to increased complication odds, exhibiting an odds ratio of 2.77, a 95 percent confidence interval from 1.06 to 7.24, and a p-value of 0.03.

Urinary tract infection represented a major component of maternal morbidity, occurring in 1.6 percent of the overall study cohort and demonstrating a statistically significant association with catheter use at a p-value under 0.01. Given that urinary retention was rare and unmitigated by catheter placement, the authors concluded that routine postpartum catheterization does not provide prophylactic benefit against bladder retention in women sustaining obstetric anal sphincter injuries. Instead, catheterization was linked to heightened postpartum morbidity driven primarily by urinary tract infections, prompting the study authors to directly question the utility of routine catheterization protocols in this obstetric patient group.

Subject of Research: Postpartum urinary catheterization and adverse outcomes in obstetric anal sphincter injury

Article Title: Association between postpartum urinary catheterization and adverse outcomes in women with obstetric anal sphincter injury: a retrospective cohort study

Article References: Dick, A., Chill, H. H., Ribak, O., Cohen, N., Schonman, R., Kimhi, M. Y., Arbib, N., & Daykan, Y. (2026). Association between postpartum urinary catheterization and adverse outcomes in women with obstetric anal sphincter injury: a retrospective cohort study. BMC Pregnancy and Childbirth. https://doi.org/10.1186/s12884-026-10147-8

Image Credits: AI Generated

DOI: 10.1186/s12884-026-10147-8

Keywords: obstetric anal sphincter injury, postpartum urinary catheterization, urinary retention, urinary tract infection, retrospective cohort study, tertiary medical centers, vaginal delivery, nulliparity, epidural analgesia, hospital readmission, composite adverse outcomes, maternal morbidity, perineal tear, multivariable logistic regression, bladder catheterization, postpartum care, overt urinary retention