title: Urinary retention and syndrome of inappropriate antidiuretic hormone secretion (SIADH) secondary to impacted gravid uterus.
abstract: 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.
authors.affiliation: Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, USA.
authors.forename: M
authors.initials: M
authors.lastname: Irani
authors.affiliation: Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York, USA.
authors.forename: N
authors.initials: N
authors.lastname: Fisher
authors.affiliation: Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York, USA.
authors.forename: A
authors.initials: A
authors.lastname: Mor
authors.affiliation: Division of Urogynecology, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York, USA.
authors.forename: G
authors.initials: G
authors.lastname: Bensinger
keywords: fibroid; impacted uterus; retroverted uterus; syndrome of inappropriate antidiuretic hormone secretion; urinary retention