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

Abstract

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.