A woman treated for infertility, presents with 6 week amenorrhea with urinary retention. The most likely etiology is:
Ans. is c, i.e. Impacted cervical fibroidRef: Read belowThe patient in the question:* Was being treated for infertility.* Now has H/O 6 weeks of amenorrhea.* Presents with urinary retention.The first diagnosis which comes in our mind is retroverted gravid uterus.Points which favour the diagnosis are: The woman is pregnant and has complain of urinary retention.But here it is important to understand that retroverted gravid uterus causes urinary retention at 14-15 weeks of gestation (not 6 weeks). - Ref: Jeffcoate 7th/ed, p299So Option "a" is ruled outOption "b" Pelvic hematocele"Pelvic hematocele is formed in a patient complaining of 6 weeks amenorrhea in case of ectopic pregnancy." - Ref: Jeffcoate 6th/ed, p212Though pelvic hematocele causes urine retention but then other symptoms (pain) and signs of ectopic pregnancy should be present.Option "c" Impacted cervical fibroid"A cervical fibroid impacted in pouch of Douglas can cause retention of urine. The onset of retention is acute and usually occurs immediately before menstruation, when the uterus is further enlarged by congestion or during early pregnancy." - Ref: Jeffcoate 7th/ed, p493Fibroid is associated with infertility.Thus, an impacted cervical fibroid can explain all features seen this woman and is our option of choice.
Retroverted uterus
Pelvic hematocele
Impacted cervical fibroid
Carcinoma cervix
Urinary Fistulas