A woman treated for infeility, presents with 6 week amenorrhea with urinary retention. The most likely etiology is :
Ans. is c i.e. impacted cervical fibroid The patient in the question : Was being treated for infeility. Now H/0 a 6 weeks of amenorrhea. Presents with urinary retention. The first diagnosis which comes in our mind is Retroveed gravio uterus. Points which our the diagnosis are : The woman is pregnant and has complain of urinary retention. But friends, here it is impoant to understand that retroveed gravid uterus causes urinary retention at 14 - 15 weeks of gestation (not 6 weeks). Jeffcoate 7/e. p 299 So Option -a-. is ruled out Option "b" Pelvic hematocele "Pelvic hematocele is formed in a patient complaining of 6 weeks amenorrhea in case of ectopic pregnancy." Though 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 fuher enlarged by congestion or during early pregnancy." Fibroid is associated with infeility. Thus an impacted cervical fibroid can explain all features seen this woman and is our option of choice.
Retroveed uterus
Pelvic hematocoele
Impacted Cervical Fibroid
Carcinoma Cervix