From the Guidelines
Urethral injury from vaginal birth with a Foley catheter in place during the pushing stage is a rare but potential complication that can be mitigated by removing the catheter before active pushing begins or ensuring it is properly secured and positioned to minimize urethral pressure. The literature on this topic is limited, but guidelines such as the urotrauma guideline 2020 from the American Urological Association 1 provide insight into the management of urethral injuries. Key points to consider include:
- The mechanism of injury involves compression of the urethra between the descending fetal head and the pubic symphysis, potentially exacerbated by the presence of a rigid catheter.
- Prevention strategies are crucial and include removing the Foley catheter before the pushing stage or carefully positioning it to avoid urethral pressure.
- Should an injury occur, management may involve urologic consultation, possible catheter replacement under guidance, and monitoring for complications.
- Injuries can present with symptoms such as hematuria, difficulty with catheter replacement, or postpartum voiding dysfunction.
- Most minor injuries may heal with temporary catheter drainage, but severe cases may require surgical intervention.
Given the potential for urethral injury, it is essential to weigh the benefits of having a Foley catheter in place during the pushing stage against the risks. If the catheter is not necessary for epidural management or urinary retention, removing it before active pushing begins is the most straightforward way to reduce the risk of urethral trauma. This approach aligns with the principle of minimizing interventions that could potentially cause harm, especially when evidence on the specific topic of urethral injury from vaginal birth with a Foley catheter in place is limited but suggests that prevention is key 1.
From the Research
Urethral Injury from Vaginal Birth with a Foley Catheter
There is limited literature on urethral injury from vaginal birth with a Foley catheter in place during the pushing stage.
- The available studies do not directly address the issue of urethral injury from vaginal birth with a Foley catheter in place during the pushing stage 2, 3, 4, 5, 6.
- These studies focus on the use of Foley catheters for labor induction, postpartum hemorrhage treatment, and urinary prophylaxis after hypospadias repair, but do not provide information on urethral injury during vaginal birth.
- One study compares the use of a Foley catheter and prostaglandins for cervical ripening during labor induction, but does not mention urethral injury 4.
- Another study evaluates the effect of tugging the Foley balloon on the induction to birth interval and patient satisfaction, but does not report on urethral injury 6.
- Overall, there is a lack of research on the specific topic of urethral injury from vaginal birth with a Foley catheter in place during the pushing stage.