Acute Urinary Retention in Pregnancy

8 Mar
RAGING HYPOTHETICAL:
31 year old G2P1 presents with inability to void the bladder. She is 14th weeks pregnant. Her first pregnancy was uneventful. I&O catheterization drains 900ml of clear yellow urine.  What now?
 
Background
Acute urinary retention in pregnancy is rare. It has been described in all trimesters but most commonly occurs between weeks 10-16.
It is initially treated with catheterization, however definitive cause must be determined for treatment.

Pathphysiology
Interestingly, direct urethral obstruction is most commonly not the cause. Cystoscopy and ultrasonography have shown an alternative mechanism based on anatomy.
The gravid uterus is confined by the sacrum below and promontory above which cause anterior and superior displacement of the cervix. The cervix then compresses the lower bladder obstructing the urethral orifice but not the urethra itself.
Disposition
Patients should be referred to urogynecology for further evaluation.
Prophylactic recommendations (thought to help although no good studies have been conducted):
  • limiting fluids before sleep,
  • changing from supine to prone position for a few minutes before attempting to void,
  • leaning forward when initiating voiding, avoiding any Valsalva maneuver,
  • using a Cred’e maneuver (manual pressure just over the anterior bladder) to initiate voiding

Patients should be educated on signs and symptoms of acute urinary retention and instructed to return if those should develop.

It is not recommended to discharge with a Foley in place due to the risk of urinary tract infections complicating pregnancy.
Submitted by K. Dabrowski
References: Yang, JM. Acute Urinary Retention in Early 2nd Trimester. Incont Pelvic Floor Dysfunct; 2007; 2:65-66.; picture
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