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Arabin Cerclage Pessary as a Treatment of an Acute Urinary Retention in a Pregnant Woman with Uterine Prolapse

DOI: 10.1155/2013/161376

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A 35-year-old gravida 7, para 1, and abortus 5?female with hypogastric pain and inability to void urine after 14?+?3 weeks of amenorrhea was examined in the emergency department. One year before, a uterine prolapse had been diagnosed in another hospital. Examination showed a uterine prolapse grade 2 with palpable bladder. The patient was unable to void urine. After a manual reduction of the uterine prolapse, the patient underwent an emergency catheterization for bladder drainage. A Hodge pessary (size 70) was placed, which led to spontaneous micturitions. Due to the persistence of the symptoms the following day, Hodge pessary was replaced by an Arabin cerclage pessary. Although the pessary could be removed from the beginning of the second trimester, due to the uterine prolapse as a predisposing factor in the patient and the uncomplicated progression of pregnancy, it was decided to maintain it in our patient. Therefore, Arabin cerclage pessary allowed a successful pregnancy outcome and was not associated with threatened preterm delivery or vaginal infection. 1. Introduction Acute urinary retention (AUR) is defined as the inability to void urine, with a retained volume of urine of 200?mL or greater [1]. AUR in early pregnancy is a very rare complication which leads to a real emergency [2]. 2. Case Presentation A 35-year-old gravida 7, para 1, and abortus 5 female with hypogastric pain and inability to void urine after weeks of amenorrhea was examined in the emergency department. One year before, a uterine prolapse had been diagnosed in another hospital. Examination showed an anteverted uterus and uterine prolapse grade 2 with palpable bladder. The patient was unable to void urine. Ultrasound revealed a cervical length of 30?mm and a singleton, cephalic fetus. A manual reduction of the uterine prolapse was made, and the patient underwent an emergency catheterization for bladder drainage (500?mL urine). No urinary tract infection was found. Then, it a Hodge pessary (size 70), and was placed after a spontaneous micturition, the woman was discharged for further ambulatory followup. The following day, the patient was admitted in to the emergency department because of a new AUR. Hodge pessary was replaced by another one of size 75, and due to the persistence of the symptoms, finally an Arabin cerclage pessary was placed (Figure 1). The patient was discharged after a rapid resolution of symptoms. Figure 1: Arabin cerclage pessary as a treatment for uterine prolapse in a pregnant woman. Obstetric controls, which included vaginal cultures, were made every two

References

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