Ozel Begüm
Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles 90033, USA.
J Reprod Med. 2005 Aug;50(8):624-6.
Acute urinary retention as a result of incarceration of a retroflexed, gravid uterus is a known phenomenon. However, prolapse as a risk factor has not been previously described.
A 40-year-old woman, gravida 4, para 2, with an intrauterine gestation of 19 weeks presented to the emergency room complaining of inability to void for the previous 12 hours and difficulty voiding and constipation for the previous 6 weeks. She had a history significant for stage III uterine prolapse in early pregnancy. Foley catheterization yielded 800 mL of urine, and an examination revealed a retroflexed uterus. The cervix was displaced anteriorly behind the pubic symphysis. Ultrasound confirmed these findings and the presence of a viable gestation. The uterus was successfully manually displaced under epidural anesthesia. The patient was able to void without difficulty after uterine displacement.
Incarceration of a retroflexed uterus should be considered in the differential diagnosis in any woman who presents with voiding difficulty in the late first or second trimester. Uterine prolapse is a risk factor for incarceration of a retroflexed uterus. Epidural anesthesia should be considered for a patient if manual uterine displacement cannot be performed successfully without anesthesia.
后屈妊娠子宫嵌顿导致急性尿潴留是一种已知现象。然而，子宫脱垂作为一个危险因素此前尚未见报道。
一名40岁女性，孕4产2，宫内妊娠19周，因前12小时无法排尿及前6周排尿困难和便秘就诊于急诊室。她在孕早期有Ⅲ度子宫脱垂病史。导尿引出800毫升尿液，检查发现子宫后屈。宫颈向前移位至耻骨联合后方。超声证实了这些发现及存活妊娠的存在。在硬膜外麻醉下成功手动复位子宫。子宫复位后患者能够顺利排尿。
对于孕早期末或孕中期出现排尿困难的任何女性，鉴别诊断时应考虑后屈子宫嵌顿。子宫脱垂是后屈子宫嵌顿的一个危险因素。如果不使用麻醉无法成功进行手动子宫复位，则应考虑为患者实施硬膜外麻醉。
