Incarcerated gravid uterus: early manual reduction vs. late spontaneous resolution

Spontaneous reduction of an incarcerated gravid uterus in the third trimester

“…A change in fetal position was identified in an ultrasound performed immediately before the elective cesarean section at 36 weeks of gestation; the uterus was confirmed to be in a normal position during surgery, and a baby was delivered in breech presentation. In case 3, although the patient experienced abdominal pain, constipation, and dysuria from 21 weeks of gestation, the symptoms resolved at around 30 weeks; as the examination findings changed at 30 weeks of gestation, the patient's condition resolved spontaneously and a healthy infant was born vaginally at term .…”

“…only contraindicated but also impossible, and cesarean delivery is recommended [2,7,16,19]. Considering that the anterior wall of the uterus is abnormally stretched (i.e., the bladder and cervix are displaced anterosuperiorly), the uterine incision needs to be made as superiorly as possible to prevent bladder injury, as well as cervical and vaginal transection [13,15,21].…”

“…Therefore, if an incarcerated uterus is diagnosed before around 20 weeks of gestation, passive reduction in which the patient assumes the knee‐chest position after urination is considered first, followed by manual reduction, and then endoscopic or laparoscopic reduction . However, some reports do not recommend reduction after 20 weeks of gestation because of a low success rate and the possibility of serious complications associated with reduction, such as miscarriage, preterm delivery, and uterine rupture . On the other hand, there have been some reports of a successful reduction after 20 weeks of gestation; therefore, reduction may be worth considering when patients are presumed to have no adhesion.…”

Incarceration of the gravid uterus: a case report and literature review

“…It has been reported that the epidural anesthesia is an effective way to manage reduction of an incarcerated uterus [54]. In our literature review, six cases ended in a normal pregnancy after reposition under anesthesia [1, 27, 43, 83, 91, 92]. Anesthesia may increase the chance of a successful reduction because the uterus was easily released under anesthesia.…”

“…Treatment of reposition was successfully attempted in 83 cases. After reposition, 68 patients successfully delivered infants [2, 15, 16, 19, 21, 23, 25, 27, 28, 36, 37, 41, 43, 44, 48, 50, 55, 62, 63, 66, 76, 77, 82, 83, 85, 88–92, 95, 98–101], including 36 term deliveries [16, 19, 21, 27, 28, 35, 37, 41, 43, 44, 48, 50, 62, 66, 76, 77, 87, 91, 98, 100, 101], and information for other cases was not available. Treatment methods vary in invasiveness, and because incarceration was quite rare, no study has yet been performed to determine the supremacy of any single treatment modality.…”