Importance of the early diagnosis of incarcerated gravid uterus: Case report and systematic review

Moreno, Juan Manuel Pina; Minaya, María Ruiz; López, Andrea Fraile; Hidalgo, Marta Feltrer; Abad, Virginia Ortega; Larroca, Santiago García‐Tizón

doi:10.1002/ijgo.14615

Intl J Gynecology & Obste

2022

DOI: 10.1002/ijgo.14615

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Importance of the early diagnosis of incarcerated gravid uterus: Case report and systematic review

Juan Manuel Pina Moreno

María Ruiz Minaya

Andrea Fraile López

et al.

Abstract: Incarcerated gravid uterus is a very rare gestational complication.Older studies report an approximate incidence of one of 3000 pregnancies or even lower, 1 but in a recent study, which took into account asymptomatic cases, an incidence of up to one of 500 pregnancies was reported. 2 Uterine incarceration is defined as the entrapment of the pregnant uterus between the pubic symphysis and the sacral promontory. This uterine malposition causes the occupation of the pouch of Douglas by the uterine fundus and the … Show more

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2024

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Cited by 5 publications

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Imaging and video of late preterm delivery by midline laparotomy due to incarcerated uterus: A case report and literature review of a rare but morbid condition

Taylor,

Bartels,

Brophy

et al. 2024

Intl J Gynecology & Obste

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Incarcerated gravid uterus (IGU) is a rare and serious obstetric complication. IGU is defined as the entrapment of the gravid uterus between the pubic symphysis and the sacral promontory. The incidence of IGU is 1 in 3000–10 000 cases. IGU is associated with significant obstetric complications, including preterm labor, intrauterine fetal death, growth restriction, renal failure, uterine ischemia/rupture and thrombosis. Here, we present the case of a primigravida with urinary retention at 14 weeks. On transabdominal ultrasound at 19+5/7 weeks the cervix was difficult to visualize, and the anterior uterine wall appeared thickened. The bladder was elongated superior to the uterus and the placenta was low‐lying. Initially the patient was managed with intermittent self‐catheterization, and subsequently indwelling catheterization was required from 22 weeks. At 30 weeks, the patient was transferred to a tertiary center and magnetic resonance imaging (MRI) was preformed due to challenging visualization of the cervix on ultrasound and the patient's continued symptoms of constipation and recurrent urinary infections. The MRI found a retroflexed gravid uterus, with vagina and endocervix displaced anteriorly and compressed by the gravid uterus. The findings were consistent with an incarcerated uterus. The patient subsequently had positive urinary cultures for Pseudomonas and rising creatinine. Given the obstructive uropathy and associated morbidity and mortality, a plan for elective pre‐term delivery at 33+6/7 weeks was made. Delivery was by midline laparotomy, normal anatomy was restored after manual evacuation of the fundus from below the sacral promontory, and an uncomplicated lower segment transverse uterine cesarean section was performed.

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Imaging and video of late preterm delivery by midline laparotomy due to incarcerated uterus: A case report and literature review of a rare but morbid condition

Taylor,

Bartels,

Brophy

et al. 2024

Intl J Gynecology & Obste

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Incarceration of the gravid uterus: Ultrasound diagnosis and pregnancy outcomes

Zhang,

Luo,

Liu

et al. 2024

J of Clinical Ultrasound

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BackgroundThis research aims to summarize the ultrasound features and pregnancy outcomes of incarceration of the gravid uterus (IGU), providing a basis for clinical management.MethodsA retrospective cohort study was conducted on pregnant patients with IGU at Hunan Provincial Maternal and Child Health Care Hospital in China, spanning from September 30, 2016, to May 31, 2024. Data on maternal age, parity, medical history, risk factors, gestational age, clinical manifestations, ultrasound examination, treatment methods, time, and method for terminating pregnancy, and pregnancy outcomes were collected. We compared cases diagnosed before and after 20 gestational weeks.ResultsDuring the study period, 13 pregnant women were diagnosed with IGU, and 140 162 deliveries were recorded at our hospital. Two cases were referred from other hospitals and did not deliver in our hospital. Accordingly, the incidence of IGU was 0.08‰ (11/140, 162). The most prevalent risk factor for IGU was previous abdominal or pelvic surgery (61.54%, 8/13). Dysuria or even urinary retention was the primary symptom (38.46%, 5/13). Spontaneous resolution occurred in only one case (7.69%). All cases were detected using prenatal ultrasound examination with typical characteristics, including a retroverted uterus and the fundus located behind the cervix. No statistically significant differences between the two comparison groups were found in successful uterine reduction (p > 0.05).ConclusionThe definition of IGU should include symptomatic cases of any gestational age. Despite a low prevalence of this pregnancy complication, the overall prognosis of IGU is good. In the absence of severe symptoms, regular monitoring may be an option. Typical ultrasound imaging features enable a definitive diagnosis of IGU.

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Incarcerated gravid uterus: a new treatment using the transvaginal ultrasound probe and narrative literature review

Kantorowska,

Patberg,

Ali

et al. 2024

American Journal of Obstetrics and Gynecology

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Importance of the early diagnosis of incarcerated gravid uterus: Case report and systematic review

Cited by 5 publications

References 16 publications

Imaging and video of late preterm delivery by midline laparotomy due to incarcerated uterus: A case report and literature review of a rare but morbid condition

Imaging and video of late preterm delivery by midline laparotomy due to incarcerated uterus: A case report and literature review of a rare but morbid condition

Incarceration of the gravid uterus: Ultrasound diagnosis and pregnancy outcomes

Incarcerated gravid uterus: a new treatment using the transvaginal ultrasound probe and narrative literature review

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