Obstetrics Consultation
Given the rare presentation, the authors submit that acute urinary retention in a pregnant patient without clear identifiable cause (history of neurogenic bladder, recent medications with anticholinergic side effects, cauda equina signs or symptoms, etc.) should lead to obstetrics consultation. In addition, while abdominal MRI and/or ultrasound may aid in the diagnosis of IGU, this should not delay care. Bladder decompression and obstetrics consultation should be prioritized.
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The decision to reduce the uterus should be made by the obstetrics specialist. Maintaining a high level of suspicion for this rare diagnosis will help establish early identification and treatment, therefore reducing risk of maternal and fetal complications.2
Dr. McKinley completed Emergency Medicine ultrasound fellowship at Maine Medical Center and is currently the Assistant Director of Point of Care Emergency Ultrasound with the Miami Valley Emergency Specialists in Dayton, Ohio. She is a clinical faculty associated with the Wright State University Emergency Medicine Residency.
Dr. Bauman completed an Emergency Medicine ultrasound fellow at Maine Medical Center and is currently the Co-Director of Ultrasound at Southern Maine Health Care Medical Center where he practices as an attending physician.
Dr. Christensen completed an emergency medicine Ultrasound fellowship at Maine Medical Center and is currently the director of Point of Care Ultrasound with Blue Water Health in Brunswick, Maine.
Dr. Gaudet completed emergency medicine residency at Maine Medical Center and is currently a fellow in Emergency Department Quality & Management at Beth Israel Deaconess Medical Center. She is a Clinical Instructor associated with Harvard Medical School.
Dr. Wood is an associate professor of Emergency Medicine at Tufts University School of Medicine and an emergency medicine attending physician at Maine Medical Center
Dr. Linnell is an Obstetrics and Gynecology attending physician at Maine Medical Center. She is a clinical instructor for Tufts University School of Medicine and is the co-site director of the Tufts University School of Medicine third year OB-GYN clerkship.
Dr. Wilson is an emergency medicine attending physician and director of Emergency Medicine Ultrasound Fellowship at Maine Medical Center.
References
- Vidaeff A, Schneider K. Incarcerated gravid uterus. UpToDate website. Last updated November 23, 2022. Accessed December 8, 2023.
- Gardner C, Jaffe T, Hertzberg B, et al. The incarcerated uterus: A review of MRI and ultrasound imaging appearances. AJR Am J Roentgenol. 2013;201(1):223-9.
- Carney A, Tobler K, James K. First trimester uterine incarceration resolved with conservative management in a multifetal gestation. Obstetrics & Gynecology. 2019;133:122S-123S.
- Newell S, Crofts J, Grant S. The incarcerated gravid uterus: complications and lessons learned. Obstet Gynecol. 2014;123(2 Pt 2 Suppl 2):423-42.
- Ntafam C, Beutler B, Harris R. Incarcerated gravid uterus: A rare but potentially devastating obstetric complication. Radiol Case Rep. 2022;17(5):1583-1586.
- Tougas K, Hicks B, Mayersak R. Acute urinary retention: A rare case of incarcerated uterus in the gravid ED patient. EMResident website. Published June 10, 2022. Accessed December 8, 2023.
- Dai C, Peng J, Chen R. Acute urinary retention in the first-trimester of pregnancy: A case report. Cureus. 2022;14(3):e23057.
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