From the Guidelines
The use of a Foley catheter during cesarean delivery is not recommended unless necessary for strict assessment of urine output, as it increases the risk of urinary tract infections and does not improve surgical outcomes. The placement of a urinary catheter during cesarean delivery has been a widely accepted practice, but recent studies have shown that it may not be necessary for all patients 1. A prospective study with 420 patients who underwent elective cesarean delivery found that the mean time to patient ambulation, first postoperative voiding, oral rehydration, bowel movement, and length of hospital stay were significantly less in the noncatheterized group 1.
The ERAS Society recommendations suggest that in women who do not need ongoing strict assessment of urine output, the urinary catheter should be removed immediately after cesarean delivery, if placed during surgery 1. This recommendation is based on the evidence that urinary catheter usage is associated with higher rates of urinary tract infections and does not improve outcomes after cesarean delivery 1.
Some key points to consider when deciding whether to use a Foley catheter during cesarean delivery include:
- The risk of urinary tract infections associated with indwelling urinary catheters 1
- The potential benefits of earlier removal of the catheter, such as reduced risk of urinary tract infections and promotion of earlier mobilization 1
- The need for strict assessment of urine output in certain patients, such as those who have received magnesium sulfate for preeclampsia management 1
- The importance of proper aseptic technique during insertion and securing the catheter to prevent traction injury to the urethra 1.
Overall, the decision to use a Foley catheter during cesarean delivery should be made on a case-by-case basis, taking into account the individual patient's needs and risks 1.
From the Research
Foley Catheter Use During Cesarean Section
- The use of a Foley catheter during cesarean section is a common practice to prevent urinary tract infections and ensure a clear surgical field 2.
- A study comparing intermittent and indwelling catheterization found that indwelling catheterization was the favorable method, with a lower incidence of urinary tract infection (19.1% vs 31.4%) 2.
- However, a more recent study found that self-bladder emptying (without a Foley catheter) may be a safe and effective alternative, with lower rates of postpartum urinary retention and improved maternal satisfaction 3.
Risks and Complications
- Urinary bladder injury during cesarean delivery is a rare but severe complication, with an incidence of 0.3% 4.
- Risk factors for bladder injury include urinary bladder adhesions, failed vacuum attempt prior to cesarean delivery, and size of uterine incision extension 4.
- Prior cesarean delivery is also a significant risk factor for bladder injury, with an adjusted risk of 3.82 (95% confidence interval 1.62-8.97) 5.
- Ureteral injury is another potential complication, with an incidence of 0.06% 6.
Management and Outcomes
- Most bladder injuries can be diagnosed and repaired intra-operatively, with good long-term outcomes 6.
- Ureteral injuries may require further surgery for definitive treatment, but most women do not suffer from long-term adverse effects 6.
- A high index of suspicion is recommended to avoid late diagnosis and complications, and a comprehensive protocol for the management of urinary tract injuries should be established 6.