ABSTRACT
BACKGROUND: Postpartum urinary retention is a common complication in the immediate postpartum period. However, there is no consensus regarding optimal management. OBJECTIVE: This study aimed to compare 2 catheterization strategies for the treatment of postpartum urinary retention. STUDY DESIGN: A multicenter prospective randomized controlled trial was conducted at 4 university-affiliated medical centers between January 2020 and June 2022. Individuals with postpartum urinary retention (bladder volume of >150 mL) up to 6 hours after vaginal or cesarean delivery were randomly allocated to 1 of 2 protocols: intermittent catheterization every 6 hours, up to 4 times, or continuous catheterization with an indwelling urinary catheter for 24 hours. If postpartum urinary retention was not resolved after 24 hours, an indwelling catheter was inserted for an additional 24 hours in both groups. The primary endpoint was the mean time to postpartum urinary retention resolution. The secondary endpoints included postcatheter urinary tract infection rate and length of hospital stay. The satisfaction rate was estimated using the 30-Item Birth Satisfaction Scale questionnaire. RESULTS: After randomization, 73 individuals were allocated to the intermittent catheterization group, and 74 individuals were allocated to the continuous catheterization group. The mean time to postpartum urinary retention resolution was significantly shorter in the intermittent catheterization group than in the continuous catheterization group (10.2±11.8 vs 26.5±9.0 hours; P<.001), with 75% and 93% resolution rates after 1 and 2 catheterizations, respectively. The number of individuals who achieved resolution at 24 hours was 72 (99%) in the intermittent catheterization group and 67 (91%) in the continuous catheterization group (P=.043). The satisfaction rate was higher in all categories in the intermittent catheterization group than in the continuous catheterization group (P<.001). No intercohort difference was found in the urinary tract infection rates (P=.89) or hospital stay length (P=.58). CONCLUSION: Compared with indwelling catheterization, intermittent catheterization for urinary retention after delivery was associated with quicker postpartum urinary retention resolution and a higher satisfaction rate without increasing the complication rates.
ABSTRACT
Repeated blood pressure (BP) measurements allow better control of hypertension. Current measurements rely on cuff-based devices. The aim of the present study was to compare BP measurements using a novel cuff-less photoplethysmography-based device to a standard sphygmomanometer device. Males and females were recruited from within the general population who arrived at a public BP screening station. One to two measurements were taken from each using a sphygmomanometer-based and the photoplethysmography-based devices. Devices were considered equal if the mean difference between paired measurements was below 5 mmHg and the Standard Deviation (SD) was no greater than 8 mmHg. Agreement and reliability analyses were also performed. 1057 subjects were included in the study analysis. There were no adverse events during the study. The mean (± SD) difference between paired measurements for all subjects was -0.1 ± 3.6 mmHg for the systolic and 0.0 ± 3.5 mmHg for the diastolic readings. We found 96.31% agreement in identifying hypertension and an Interclass Correlation Coefficient of 0.99 and 0.97 for systolic and diastolic measurements, respectively. The photoplethysmography-based device was found similar to the gold-standard sphygmomanometer-based device with high agreement and reliability levels. The device might enable a reliable, more convenient method for repeated BP monitoring.
Subject(s)
Blood Pressure Determination/methods , Blood Pressure/physiology , Photoplethysmography/methods , Adolescent , Adult , Aged , Aged, 80 and over , Blood Pressure Monitors , Child , Female , Humans , Hypertension/physiopathology , Male , Manometry/methods , Middle Aged , Oscillometry/methods , Prospective Studies , Reference Standards , Reproducibility of Results , Sphygmomanometers , Young AdultABSTRACT
Accurate and continuous monitoring of critically ill patients is frequently achieved using invasive catheters, which is technically complex. Our purpose was to evaluate the validity and accuracy of a photoplethysmography (PPG)-based remote monitoring device compared to invasive methods of arterial line (AL) and Swan-Ganz (SG) catheters in a swine model of controlled hemorrhagic shock. Following a baseline phase, hemorrhagic shock was induced in 11 pigs by bleeding 35% of their blood volume, followed by a post-bleeding follow-up phase. Animals were monitored concomitantly by the PPG device, an AL and a SG catheter, for a median period of 447 min. Heart rate (HR), systolic and diastolic blood pressure (SBP and DBP, respectively), and cardiac output (CO) were recorded continuously. The complete data set consisted of 1312 paired observations. Correlations between the PPG-based technique and the invasive methods were significant (p < 0.001) during baseline, bleeding and follow-up phases for HR (r = 0.90-0.98), SBP (r = 0.90-0.94), DBP (r = 0.89-0.93), and CO (r = 0.76-0.90). Intraclass correlations for all phases combined were 0.96, 0.92, 0.93 and 0.87 for HR, SBP, DBP and CO, respectively. Correlations for changes in CO, SBP and DBP were significant (p < 0.001) and strong (r > 0.88), with concordance rates (determined by quadrant plots) of 86%, 66% and 68%, respectively. The novel PPG-based device was accurate and valid compared to existing invasive techniques and might be used for continuous monitoring in several clinical settings following further studies.
Subject(s)
Hemodynamics , Monitoring, Physiologic/instrumentation , Shock, Hemorrhagic/physiopathology , Wearable Electronic Devices , Animals , Blood Pressure Determination , Cardiac Output , Disease Models, Animal , Heart Rate , SwineABSTRACT
PURPOSE: To identify trends in preterm delivery (PTD) as well as seasonality, temporal variation and the effect of heat stress on its incidence. MATERIALS AND METHODS: In this retrospective population-based study, we included all deliveries taking place at the Soroka University Medical Center between the years 1988-2012. A time series database was built including meteorological factors and the number of spontaneous versus induced PTDs for each day. Data were analyzed using time-series analyses. RESULTS: During the study period, 263 709 deliveries occurred, 7.9% of which were preterm. Spontaneous PTD rate steadily decreased, while induced PTD rate increased. A significant annual and seasonal variation was noted in PTD incidence. A significant higher incidence of spontaneous PTD was demonstrated during the summer period with an incidence rate ratio (IRR) of 4.1 (95%CI: 3.1-5.5; p < 0.001). This trend was not significant for induced PTD. A significant linear association was noted between the heat-stress index and the rates of spontaneous (IRR = 1.07, 95%CI: 1.05-1.10; p < 0.001) but not induced PTDs. CONCLUSIONS: Spontaneous PTD is more common during the summer and its rate is declining steadily over the past decades. Increased outdoor temperature has a significant effect on the incidence of spontaneous, but not induced, PTD.
