Recurrent incarceration of the retroverted gravid uterus at term - two times transvaginal caesarean section: a case report

Tuuk, Karin van der; Krenning, R. A.; Krenning, Guido; Monincx, Wilma M.

doi:10.1186/1752-1947-3-103

Cited by 32 publications

(21 citation statements)

References 11 publications

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“…Common misdiagnosis on ultrasound scan is placenta praevia. The symptoms are non-specific -obstetric and gynaecological (bleeding, miscarriages, contractions), pressure symptoms (lower abdominal pain), gastroenterologic (rectal pressure, tenesmus, constipation) and urologic (hydronephrosis, dysuria, urinary retention) [9]. Some cases were without symptoms, as in our case.…”

Section: Introductionmentioning

confidence: 49%

Spontaneous reposition of a posterior incarceration (“sacculation”) of the gravid uterus in the 3^rd trimester

Tauscher

Schrey

Stepan

2015

Case Reports in Perinatal Medicine

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We present a case of a spontaneous reposition of an incarcerated uterus in the third trimester. The uterus is retroverted in approximately 15% of pregnancies during the first trimester. The uterus raises and the fundus usually enters the abdominal cavity by the 14th week. Diagnosis and treatment of posterior incarceration with sacculation of the anterior uterine wall remain a challenge for the obstetrician. If the diagnosis is missed, there is a high risk of damaging the bladder and the cervix during a caesarean section, as the surgeon might not be aware of the disturbed anatomical situation. Treatment of a persistent retroverted uterus and outcome of intervention depend mainly on time of diagnosis as well as the presence of symptoms and other associated risk factors. A 36-year-old primigravida with known uterine posterior incarceration since 22 weeks and 5 days, confirmed by ultrasound scan and magnetic resonance imaging (MRI), presented at the 31st week with correct uterine polarity. To our knowledge, there is only one well-documented case in the literature with spontaneous reposition of an incarcerated uterus after the 28th week of pregnancy.

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Section: Introductionmentioning

confidence: 49%

Spontaneous reposition of a posterior incarceration (“sacculation”) of the gravid uterus in the 3^rd trimester

Tauscher

Schrey

Stepan

2015

Case Reports in Perinatal Medicine

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show abstract

“…Several complications such as complete cutting of the cervix or the vagina, extended uterine incision, incision on the posterior wall of the uterus through the vagina, or laceration due to massive hemorrhage may occur, because the lower uterine segment is dislocated extremely to the upper site compared with that in an ordinary cesarean section. 3,4,6 Therefore, a strategy for a safe cesarean section to avoid special complications of incarceration should be developed.…”

Section: Cesarean Section In Case Of Incarcerated Uterus or The Cervimentioning

confidence: 99%

“…There is a report of the fetus being delivered twice via the vagina. 6 There are also cases in which the cervical canal was cut cross-sectionally without realizing that this had taken place or in which the fetus was delivered from the posterior wall of the uterus after partial incision.…”

Section: Tips and Warningsmentioning

confidence: 99%

Clinical Tips of Cesarean Section in Case of Breech, Transverse Presentation, and Incarcerated Uterus

2020

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The presentation, position, and attitude of the fetus should be confirmed by transabdominal ultrasonography on admission and at departure from the ward for cesarean section. It is important to have images of the course of the surgery and delivery of the fetus by confirming the fetal position, location of the placenta and umbilical cord, and volume of amniotic fluid. The operation should be performed by imaging the descent, presentation, position, and attitude of the fetus through external examination according to Leopold's maneuver before laparotomy. Such imaging facilitates learning of the cesarean section techniques and obstetric management in the long run. AbstractCesarean section in breech or transverse presentation involves more complicated procedures than cesarean section in cephalic presentation because the former requires additional manipulations for guiding the presenting part of the fetus, liberation of the arms, and the after-coming head delivery; therefore, those cesarean sections are likely to be more invasive. Making a rather wide uterine incision to prevent uterine injury during delivery of the fetus facilitates smooth delivery of the fetus. Furthermore, in cases of breech or transverse presentation, it is important to initially identify the presenting part of the fetus and guide it to the incision opening in the lower uterine segment, because delivering the presenting part of the fetus first is a basic rule of delivery of the fetus. Smooth delivery of the fetus by means of breech extraction can prevent excessive stress or injury to the fetus. Therefore, it is important to acquire the knowledge and skills necessary to perform these techniques, including the internal version. Smooth delivery of the fetus is also less invasive for the mother because an extension of the uterine excision or injury to arteries and veins in the uterus and parametrium can be avoided. Incarcerated uterus occurring in cases of pregnancy with intrapelvic adhesion, endometriosis, cervical myoma, or extended cervix may result in excessive uterine and cervical injury when a transverse incision of the lower uterine segment is performed without caution. These conditions may result in difficulty in fetal delivery. Therefore, it is important to identify risks in advance and to choose the incision line with great care. Countermeasures for difficult delivery of the fetus need to be mastered by all practitioners of obstetrics. If the transverse incision fails to reach the uterine cavity, an inverted T-shaped or J-shaped incision should be made. Risks of complications such as injury to the cervical canal, the vagina, the bladder or ureter, and massive hemorrhage must be kept in mind.

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“…Gibbons and Paley 1 in 1969 stated that attempts to correct uterus position later than the 15 weeks are more likely to fail and are associated with poor foetal outlook, quoting foetal loss rate of 33%. Van de Tuuk et al 3 dealt with a recurrent case in the 2 nd pregnancy at 18 weeks, however repositioning was not attempted due to this fear. The patient had to undergo technically challenging 2 nd .…”

Section: Managementmentioning

confidence: 99%

“…1,2 Technically challenging trans-vaginal caesarean deliveries have been described late gestations in uncorrected cases. [3][4][5] We report an interesting case of an incarcerated gravid uterus who had a spontaneous uterine repositioning following general anaesthesia without any further need for manual manipulation. Based on this report, we believe that the management of incarcerated uterus at late gestation is feasible with the aid of general anaesthesia.…”

Section: Introductionmentioning

confidence: 99%

Spontaneous repositioning of incarcerated gravid uterus following general anaesthesia: a case report and review of literature

Ramli

Abdullah

Yusoff

et al. 2015

Int J Reprod Contracept Obstet Gynecol

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Recurrent incarceration of the retroverted gravid uterus at term - two times transvaginal caesarean section: a case report

Cited by 32 publications

References 11 publications

Spontaneous reposition of a posterior incarceration (“sacculation”) of the gravid uterus in the 3^rd trimester

Spontaneous reposition of a posterior incarceration (“sacculation”) of the gravid uterus in the 3^rd trimester

Clinical Tips of Cesarean Section in Case of Breech, Transverse Presentation, and Incarcerated Uterus

Spontaneous repositioning of incarcerated gravid uterus following general anaesthesia: a case report and review of literature

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Recurrent incarceration of the retroverted gravid uterus at term - two times transvaginal caesarean section: a case report

Cited by 32 publications

References 11 publications

Spontaneous reposition of a posterior incarceration (“sacculation”) of the gravid uterus in the 3rd trimester

Spontaneous reposition of a posterior incarceration (“sacculation”) of the gravid uterus in the 3rd trimester

Clinical Tips of Cesarean Section in Case of Breech, Transverse Presentation, and Incarcerated Uterus

Spontaneous repositioning of incarcerated gravid uterus following general anaesthesia: a case report and review of literature

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Spontaneous reposition of a posterior incarceration (“sacculation”) of the gravid uterus in the 3^rd trimester

Spontaneous reposition of a posterior incarceration (“sacculation”) of the gravid uterus in the 3^rd trimester