alexa Acute Urinary Retention Due to an Incarcerated Retroverted Gravid Uterus | OMICS International
ISSN: 2157-7420
Journal of Health & Medical Informatics
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Acute Urinary Retention Due to an Incarcerated Retroverted Gravid Uterus

Enrique González Díaz*, Paloma Ortega Olivas, Camino Fernández Fernández, Noelia Gómez González and Alfonso Fernández Corona

Pelvic Floor Unit, Servicio de Obstetricia y Ginecología. Complejo Asistencial Universitario de Leon, Spain

*Corresponding Author:
Enrique González Díaz
Pelvic Floor Unit
Servicio de Obstetricia y Ginecología
Complejo Asistencial Universitario de Leon, Spain
Tel: 34649455743
E-mail: [email protected]

Received date: May 24, 2015 Accepted date: July 15, 2015 Published date: July 22, 2015

Citation: Díaz EG, Olivas PO, Fernández CF, González NG, Corona AF (2015) Acute Urinary Retention Due to an Incarcerated Retroverted Gravid Uterus. J Health Med Informat 6:193. doi: 10.4172/2157-7420.1000193

Copyright: © 2015 Díaz EG, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

We report a case of a woman in the second trimester of pregnancy who attended our center with difficulty voiding. Based on physical and ultrasound examination, she was diagnosed with uterine incarceration. Management was conservative, through manual reduction and by bladder catheterization, facilitating spontaneous resolution of the uterine incarceration.

Keywords

Urinary retention; Pregnancy; Retroversion; Incarceration

Introduction

Acute urinary retention is a rare occurence during pregnancy [1]. Incarcerated retroverted uterus has been implicated in the pathogenesis of acute urinary retention in approximately one in 3,000 pregnancies [1-3]. The enlarged uterus due to pregnancy induces uterine entrapment in the pelvis between the sacral promontory and pubic symphysis. The most common symptoms are pain and progressive difficulty in voiding [4,5].

Case

A 33 years-old second gravid woman at 17 weeks gestation presented with an acute urinary retention. Pelvic and rectovaginal examination revealed fullness in the posterior cul-de-sac. Bladder catheterization revealed a residual volume 1200 ml clear urine. After discarded the possibility of urinary infection, she was discharged. After six hours, she returned with the same symptoms, and a new bladder catheterization showed a residual volume of 800 ml.

Transvaginal ultrasonographic imaging is shown in Figures 1 and 2. Uterine incarceration was suspected. The change in uterine polarity was noted after manual reduction in the emergency room. The patient was moved to an area under observation until spontaneous urination without difficulty. She was discharged with several suggestions, including use muslim prayer position for 2-3 weeks.

health-Medical-Informatics-uterus-extends-backwards

Figure 1: Transvaginal ultrasonography showing a retroverted uterus during pregnancy. The cervix lies posteriorly to the urinary bladder, and the uterus normally extends superiorly from it, but the direction of the body of the fetus reveals that the uterus extends backwards.

health-Medical-Informatics-Transvaginal-ultrasonography

Figure 2: Transvaginal ultrasonography showing a retroverted uterus during pregnancy. The cervix lies posteriorly to the urinary bladder, and the uterus normally extends superiorly from it, but the direction of the body of the fetus reveals that the uterus extends backwards.

Thereafter, her pregnancy remained uneventful, and she vaginally delivered a healthy girl at 39 weeks. She had no urinary complaint at her postpartum visit 5 weeks later.

Discussion

Uterine incarceration is a rare entity that occurs most frequently in the second trimester [4]. It affects pregnant women, usually with retroverted uterus. The incidence of uterine retroversion during pregnancy is 15% [1-3], and is described as a rotation of more than 45 degrees respect to the uterine longitudinal axis. In most of the cases, this retroversion is resolved spontaneously in the 14th weeks of gestation [2,3]. Rarely the retroverted uterus may become trapped [1,2]. There are several risk factors, as a very deep sacrum concavity, which favors the status of the uterus embedded. Clinical manifestations may be acute or chronic, or even entirely absent, in which case the torsion is identified as an intraoperative finding. Urinary retention may occur quickly urethral obstruction by an extrinsic compression of the expansion and imprisoned uterus [1-3]. The putative mechanism involved is believed that one displaced cervix lower compressing the bladder, interfering with drainage to the urethra or urethral compression distortion [1].

The diagnosis of incarcerated uterus is based on physical and ultrasound examination [2,4]. The clinical criteria for diagnosing a incarceration of a gravid uterus are: pregnancy over 12 weeks, the location of the cervix to the pubic symphysis, uterus retroverted placed in the sacral cavity and symptoms solved by reducing the uterus.

Various treatments have been described to solve the uterine incarceration, including conservative maneuvers that are based on manual reduction; which are not recommended after week 20. In our case, the incarceration was resolved with bladder catheterization and manual operation. However complicated cases need IUC and other aggressive techniques, including surgery.

Conflict of Interest

None

References

  1. Yang JM, Huang WC (2004) Sonographic findings in acute urinary retention secondary to retroverted gravid uterus: pathophysiology and preventive measures. Ultrasound ObstetGynecol 23: 490-495.
  2. Fernandes DD, Sadow CA, Economy KE, Benson CB (2012) Sonographic and magnetic resonance imaging findings in uterine incarceration. J Ultrasound Med 31: 645-650.
  3. Newell SD, Crofts JF, Grant SR (2014) The incarcerated gravid uterus: complications and lessons learned. ObstetGynecol 123: 423-427.
  4. Benítez GA, Collantes MA, Selva RM, García JN, de Merlo GG (2013) Incarceración y torsiónuterina en gestante. Progresos de Obstetricia y Ginecología 56: 210-212.
  5. Ruiz FM,Viñas AF, Mayor MS, Sierra VA, López PH, et al.(2012) Úteroincarceradorecidivante. Progresos de Obstetricia y Ginecología55: 334-336.
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