Irani M, Fisher N, Mor A, Bensinger G
Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, USA.
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York, USA.
J Obstet Gynaecol Res. 2016 Jun;42(6):734-737. doi: 10.1111/jog.12963. Epub 2016 Feb 24.
Urinary retention is an emergency that rarely occurs during pregnancy. Previous case reports have suggested multiple risk factors that can cause the gravid uterus to become impacted in the pelvis leading to lower bladder or urethral compression with subsequent urinary retention. However, no cases of urinary obstruction in a pregnancy that was complicated with severe electrolyte imbalance have been reported. To our knowledge, we report the first case of a 31-year-old woman presenting at 8 weeks' gestation with acute urinary retention caused by a retroflexed, retroverted uterus with a 6-cm posterior uterine fibroid leading to syndrome of inappropriate antidiuretic hormone secretion and severe hyponatremia requiring intensive care unit admission. The cornerstones of effective management of urinary retention should include: (i) urgent bladder catheterization; (ii) assessment of sodium levels to rule out syndrome of inappropriate antidiuretic hormone secretion, and prompt treatment before neurological damage occurs; (iii) reduction of the impacted uterus; and (iv) monitoring for post-obstructive diuresis.
尿潴留是一种在孕期很少发生的急症。既往病例报告提示了多种危险因素，这些因素可导致妊娠子宫嵌顿于盆腔，致使膀胱下部或尿道受压，继而引发尿潴留。然而，尚无妊娠合并严重电解质失衡导致尿路梗阻的病例报道。据我们所知，我们报告了首例31岁女性，孕8周时因子宫后屈、后倾伴6cm子宫后壁肌瘤导致急性尿潴留，进而引发抗利尿激素分泌不当综合征及严重低钠血症，需入住重症监护病房。有效处理尿潴留的关键措施应包括：（i）紧急膀胱插管；（ii）评估钠水平以排除抗利尿激素分泌不当综合征，并在神经损伤发生前迅速进行治疗；（iii）解除嵌顿的子宫；（iv）监测梗阻后利尿情况。
