Journal of Clinical and Diagnostic Research (May 2023)
Diagnostic Accuracy of Urine Volume Estimation by Ultrasound to Prevent Unnecessary Catheterisation in the Intrapartum Period: A Cross-sectional Study
Abstract
Introduction: Catheterisation for urinary retention could cause bacteriuria and even frequent Urinary Tract Infection (UTI), especially in a traumatised urethra and bladder wall. Currently, there are no recommended non invasive ways to assess urinary retention in laboring women other than clinical estimation by palpation. Ultrasonography (USG) is a good non invasive diagnostic aid for measuring bladder volume in the intrapartum period, thereby avoiding unnecessary urinary catheterisation. Aim: To assess the diagnostic accuracy of USG, estimation of urine in comparison to actual catheterised volume in antenatal women in labour and not in labour. Materials and Methods: This was a cross-sectional study done in the Department of Obstetrics and Gynaecology at Christian Medical College, Vellore, Tamil Nadu, India, from February 2018 to August 2021. The present study was done on 405 females out of which 211 women, who were not in labour and 194 women who were in labour. Bladder volume was measured by using an abdominal portable basic ultrasound machine. A palpable bladder was also assessed clinically, by palpation and percussion and both these measurements were compared to the actual volume of urine at catheterisation. The Intraclass Correlation Coefficient (ICC) for methods of estimation of urine volume was done. To find the association between groups and study variables. Chi-square test and Fisher’s-exact test were used. Results: The mean age of the study participants were 28.29±4.6 (group 1) and 25.95±4.2 (group 2). A total of 405 women were recruited with 211 women in group 1 (not in labour) and 194 women in group 2 (in labour). Clinical examination for predicting palpable bladder with urine volume of more than 150 mL showed a sensitivity of 80-90% and a specificity of 3-5%. Comparison of ultrasound estimation of bladder volume and actual urine volume showed an intraclass correlation of 0.88 (95%CI:0.86-0.90, p<0.001) in both not in labour and in labour group. Conclusion: Estimation of urine volume by USG revealed an excellent association with catheter measurement for the prediction of a significant bladder volume, requiring catheterisation.
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