Abdullah, Suhaiza
(2006)
A comparative study between routine catheterization and non-catheterization in elective caesarean delivery.
Masters thesis, Universiti Sains Malaysia.
Abstract
In the patients who were undergoing elective caesarean section, several
preoperative preparation were made such as insertion of Foley's catheter for
urinary drainage intra operative and postoperatively. The indication for the regular
practice however was of doubtful benefit even though some may think that the
procedure facilitates surgery on the lower segment during caesarean section. This
routine practice however entails the cost of Foley's catheter and urine bags,
urinary symptoms in patients and antibiotic therapy if urine microscopy suggests
infection.
Objectives: To evaluate role of routine Foley's catheter during and after
caesarean section and compare the outcome of routine use of urinary
catheterisation and non catheterisation in patient undergoing elective caesarean
section.
Methods: This study was a case control study conducted from 1st January 2005
until September 2005. All patients who underwent elective caesarean section were
included in this study.
The patients were divided into 2 groups i.e. control group containing 70 patients
who had Foley's catheter inserted preoperatively and were kept during and until
day 1 postoperatively and another 70 patients Foley's catheter were not inserted
prior to caesarean section but instead the patients were asked to pass urine one
hour before start of caesarean section to empty the bladder. The two groups of
patients were compared in terms of duration of caesarean section, intra-operative
difficulty and also post operative outcome namely time of first void, discomfort at
first void, duration of ambulation time postoperatively and incidence of urinary tract
infection after caesarean section.
Results: In this study, the main ethnic group involved was Malay 93.6o/o followed
by Chinese {3.6%), Indian (0. 7%) and Siamese 2.1 %. The commonest indication
for elective caesarean section was repeat caesarean section ( 40o/o) followed by
breech {19o/o) and placenta praevia (12.4o/o). Regional anaesthesia was given in
82.9°/o of patients while 17.1 o/o were given general anaesthesia.
There was no significant difference in terms of duration of caesarean section
{46.67 minutes in control versus 44.49 in patients without Foley's catheter in situ),
difficulty encountered during performance of caesarean section and mean length
of hospital stay after operation (3.1 0 day in control as compared to 3.17 day incase group) .There was however significant difference in discomfort at first void,
mean ambulating time and incidence of urinary tract infection in both groups.
Conclusion: Continuous urinary catheter by using Foley's catheter is not
necessary in patients undergoing elective caesarean section as it does not show
any significant difference in terms of mean operating time, difficulty in performing
caesarean section but it creates discomfort at first void, delay mean ambulating
time and higher risk to urinary tract infection related to CBD.
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