postpartum diuresis

Patient care

The nurse should be particularly alert to the potential for rapid bladder distention during the final stage of labor and immediately postpartum. A distended bladder is the most common cause of fundal displacement, loss of uterine tone, a boggy uterus, and excessive bleeding. Despite the marked increase in urine formation related to the rapid postbirth fluid shift, the woman may be unaware of a need to void because of urethral edema, trauma, or the continuing effects of regional anesthesia or analgesia. Ultrasound scanning can be used to create an image of the patient’s bladder, calculate and display the urine volume if bladder distention is suspected, and determine the extent of emptying after voiding. Spontaneous bladder emptying is encouraged by early ambulation, running water, and warm perineal cascades; catheterization may be necessary if nursing measures are unsuccessful and distention increases.