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Incarcerated uterusFrom: Jane Helwig, MD (jane@seasonedsystems.com)Fri Jun 30 18:08:04 2000
G3P2 at 11 weeks presents with urinary retention. She says this happened in each of her previous pregnancies and both times her OB pushed on her uterus from below to resolve the problem. On exam, the uterus is so retroflexed as to be almost horizontal, with the cervix under the symphysis. Foley was inserted for 24 hours and urinary retention has resolved. I tried to push the uterus up vaginally while the patient was in lithotomy position and again while she was in knee-chest position, but didn't feel any change in its position. Questions for those who have successfully pushed the uterus up, with or without anesthesia: could you tell from movement of the uterus that you had succeeded? Did you monitor with ultrasound? How did you know it worked? Since she's now asymptomatic, do I need to do anything more? If urinary retention or pain returns, I have Plans B, C, D: pushing from below rectally, pushing from below under spinal anesthesia, colonoscopy a la recent article. Don't have any elemental mercury on hand for Plan E. Any comments?
-- Jane Helwig, MD, FACOG Private practice Nassawadox, VA
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