A 28-year-old woman experienced urinary retention occurring at midnight at 12 weeks of her first pregnancy (). She was presented to the Emergency Department for urethral catheterization, which drained 900 ml of clear urine. On vaginal examination, the cervix was drawn up into the anterior fornix behind the symphysis pubis. Transabdominal and vaginal sonography revealed a retroverted uterus with a gestational sac and fetus located in the pelvic cavity (Figs. and ). There were no clinical findings indicating having urinary tract infection or bladder stone, and she had no history of excessive fluid intake (alcohol), constipation or medication.\nThe following prophylactic measures were suggested to the patient: limiting fluid intake before sleep and changing from supine to the prone position for a while before getting up to go to the toilet. Until 14 weeks’ gestation, however, urinary retention requiring urethral catheterization recurred three times. Each catheterization yielded around 600-1000 ml urine. At 15 weeks’ gestation, the gravid uterus was examined and no retroversion was found anymore (). She had no more recurrence of urinary retention during the rest of this pregnancy.\nThree years later, the patient consulted our hospital again due to urinary retention at 11 weeks of her second pregnancy. Urethral catheterization, which drained 600 ml of clear urine, was performed with prompt effect. At this time, transvaginal sonography revealed a retroverted uterus again. She had no recurrence of urinary retention during the rest of the pregnancy.
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.\nExamination 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 (). The patient was discharged after a rapid resolution of symptoms.\nObstetric controls, which included vaginal cultures, were made every two weeks during the whole pregnancy. With negative vaginal cultures, the pregnancy progressed without incidences. The woman was admitted into the hospital at 36 + 5 weeks of gestation, due to a premature rupture of membranes. No evidence of vaginal infection was found. Then, Arabin cerclage pessary was removed, and the patient underwent a vaginal delivery, giving birth to a boy weighing 2,650 g.