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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2019

Open Access 01-12-2019 | Ultrasound | Case report

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

Authors: Cha Han, Chen Wang, Lulu Han, Guoyan Liu, Huiyang Li, Fuman She, Fengxia Xue, Yingmei Wang

Published in: BMC Pregnancy and Childbirth | Issue 1/2019

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Abstract

Background

Incarceration of the gravid uterus is a rare obstetric disorder that contributes to pregnancy-related complications. To understand its clinical characteristics and managements, we have reviewed the etiology, risk factors, clinical characteristics and current treatments of an incarcerated gravid uterus based on 162 cases reported in the English language literature, including our patient.

Case presentation

A 25-year-old primigravida, with a history of lymphatic tuberculosis, infertility due to blocked fallopian tubes and received in vitro fertilization. The patient presented with urine retention and lower abdominal pain in the early second trimester. Uterine incarceration was diagnosed based on pelvic examination and abdominal ultrasound. A Foley catheter was placed and manual reposition was successful. No episode of retention was experienced after the further enlargement of the uterus and its ascent. A healthy infant was delivered vaginally on 38th week of pregnancy.

Conclusions

Uterine incarceration due to pelvic adhesions is rare and, because of it non-specific clinical presentations, is often misdiagnosed. Abdominal ultrasound is instrumental for the diagnosis because it can directly image the disturbed uterine and pelvic anatomy. There are limited treatment options for uterine incarceration, but definitive diagnosis allows procedures to treat and to reduce severe complications of uterine incarceration.
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Literature
1.
Sweigart AN, Matteucci MJ. Fever, sacral pain, and pregnancy: an incarcerated uterus. West J Emerg Med. 2008;9:232–4.PubMedPubMedCentral
2.
Hamod H, Chamberlain PF, Moore NR, Mackenzie IZ. Conservative treatment of an incarcerated gravid uterus. BJOG. 2002;109:1074–5.CrossRefPubMed
3.
Oldham H. Case of retroflexion of the gravid uterus during labour at term. Trans Obstet Soc Lond. 1895;1:317–22.
4.
Maiss. Retroflexio uteri gravidi partialis: spontanruptur bei der Geburt. Arch Gynaekol 1899; 58:125–133.CrossRef
5.
6.
Dorman FA. Posterior sacculation of bicornate uterus-cesarian section. Am J Obstet Gynecol. 1923;6:218–9.CrossRef
7.
Oldfield C. Unusual case of obstructed labour, due to retroflexion of the full-time gravid uterus. Trans North Engl Obstet Gynaecol Soc. 1931-1932:29.
8.
Murray F. Caesarean section on an incarcerated retroverted gravid uterus at term. J Obstet Gynaecol Br Emp. 1934;41:840.
9.
Mendoza JT. Incarceration of 6 month gravid uterus; report of a case. Philipp J Surg. 1948;3:60–3.PubMed
10.
11.
12.
Spring M, Hymes JJ. Acute urinary retention as a complication of pregnancy; report of a case. J Am Med Assoc. 1952;149:1011–2.CrossRefPubMed
13.
14.
15.
16.
Terry RB. Incarcerated retroflexed gravid uterus; simple maneuver for its correction. Obstet Gynecol. 1959;13:630–1.PubMed
17.
Smith JJ, Schwartz ED, Romney SL. Anterior sacculation of the pregnant uterus. Obstet Gynecol. 1962;20:536–8.PubMed
18.
Wood PA. Posterior sacculation of the uterus in a patient with a double uterus. Am J Obstet Gynecol. 1967;99:907–8.CrossRefPubMed
19.
Gibbons JM Jr, Paley WB. The incarcerated gravid uterus. Obstet Gynecol. 1969;33:842–5.PubMed
20.
Fadel HE, Misenhimer HR. Incarceration of the retroverted gravid uterus with sacculation. Obstet Gynecol. 1974;43:46–9.PubMed
21.
Swartz EM, Komins JI. Postobstructive diuresis after reduction of an incarcerated gravid uterus. J Reprod Med. 1977;19:262–4.PubMed
22.
Spearing GJ. Uterine sacculation. Obstet Gynecol (Suppll) 1978;51:11s–13s.
23.
Laing FC. Sonography of a persistently retroverted gravid uterus. AJR Am J Roentgenol. 1981;136:413–4.CrossRefPubMed
24.
Kondo A, Otani T, Takita T, Hayashi H, Kihira M, Itoh F. Urinary retention caused by impaction of enlarged uterus. Urol Int. 1982;37:87–90.CrossRefPubMed
25.
Chatterjee G, Biswas BP, Biswas S. Sacculation of pregnant uterus. J Indian Med Assoc. 1984;82:365–8.PubMed
26.
Nelson MS. Acute urinary retention secondary to an incarcerated gravid uterus. Am J Emerg Med. 1986;4:231–2.CrossRefPubMed
27.
Silva PD, Berberich W. Retroverted impacted gravid uterus with acute urinary retention: report of two cases and a review of the literature. Obstet Gynecol. 1986;68:121–3.PubMed
28.
Evans AJ, Anthony J, Masson GM. Incarceration of the retroverted gravid uterus at term. Case report Br J Obstet Gynaecol. 1986;93:883–5.CrossRefPubMed
29.
Schwartz Z, Dgani R, Katz Z, Lancet M. Urinary retention caused by impaction of leiomyoma in pregnancy. Acta Obstet Gynecol Scand. 1986;65:525–6.CrossRefPubMed
30.
31.
32.
Vleugels MP, Meuwissen JH. Confusing presentation in a retroflexed septate uterus at term. Eur J Obstet Gynecol Reprod Biol. 1987;24:237–41.CrossRefPubMed
33.
McGann KP, Griffin WT. Recurrent classical sacculation of the pregnant uterus. J Fam Pract. 1988;26:339–41.PubMed
34.
Jackson D, Elliott JP, Pearson M. Asymptomatic uterine retroversion at 36 weeks' gestation. Obstet Gynecol. 1988;71:466–8.PubMed
35.
Hess LW, Nolan TE, Martin RW, Martin JN Jr, Wiser WL, Morrison JC. Incarceration of the retroverted gravid uterus: report of four patients managed with uterine reduction. South Med J. 1989;82:310–2.CrossRefPubMed
36.
Hankins GD, Cedars MI. Uterine incarceration associated with uterine leiomyomata: clinical and sonographic presentation. J Clin Ultrasound. 1989;17:385–8.CrossRefPubMed
37.
Smalbraak I, Bleker OP, Schutte MF, Treffers PE. Incarceration of the retroverted gravid uterus: a report of four cases. Eur J Obstet Gynecol Reprod Biol. 1991;39:151–5.CrossRefPubMed
38.
Van Winter JT, Ogburn PL Jr, Ney JA, Hetzel DJ. Uterine incarceration during the third trimester: a rare complication of pregnancy. Mayo Clin Proc. 1991;66:608–13.CrossRefPubMed
39.
Keating PJ, Walton SM, Maouris P. Incarceration of a bicornuate retroverted gravid uterus presenting with bilateral ureteric obstruction. Br J Obstet Gynaecol. 1992;99:345–7.CrossRefPubMed
40.
41.
Hill LM, Chenevey P, DiNofrio D. Sonographic documentation of uterine retroversion mimicking uterine sacculation. Am J Perinatol. 1993;10:398–400.CrossRefPubMed
42.
Nwosu UC, Thatcher S. Pregnancy in a non-communicating uterine horn mimicking incarceration with sacculation of a retroflexed uterus. Acta Obstet Gynecol Scand. 1993;72:580–2.CrossRefPubMed
43.
Lettieri L, Rodis JF, McLean DA, Campbell WA, Vintzileos AM. Incarceration of the gravid uterus. Obstet Gynecol Surv. 1994;49:642–6.CrossRefPubMed
44.
Wittich AC, Polzin WJ, Thomas CS. Incarceration of the gravid uterus due to an impacted leiomyoma: a case report. Mil Med. 1994;159:583–4.CrossRefPubMed
45.
Emery D, Nolan R. Ultrasonography of an incarcerated uterus during pregnancy. Can Assoc Radiol J. 1994;45:397–8.PubMed
46.
Myers DL, Scotti RJ. Acute urinary retention and the incarcerated, retroverted, gravid uterus. A case report. J Reprod Med. 1995;40(6):487–90.PubMed
47.
Renaud MC, Bazin S, Blanchet P. Asymptomatic uterine incarceration at term. Obstet Gynecol. 1996;88:721.CrossRefPubMed
48.
49.
50.
51.
Dietz HP, Teare AJ, Wilson PD. Sacculation and retroversion of the gravid uterus in the third trimester. Aust N Z J Obstet Gynaecol. 1998;38:343–5.CrossRefPubMed
52.
Jacobsson B, Wide-Swensson D. Recurrent incarceration of the retroverted gravid uterus-a case report. Acta Obstet Gynecol Scand. 1999;78:737.PubMed
53.
O'Connell MP, Ivory CM, Hunter RW. Incarcerated retroverted uterus--a non recurring complication of pregnancy. J Obstet Gynaecol. 1999;19:84–5.CrossRefPubMed
54.
Algra LJ, Fogel ST, Norris MC. Anesthesia for reduction of uterine incarceration: report of two cases. Int J Obstet Anesth. 1999;8:142–3.CrossRefPubMed
55.
Seubert DE, Puder KS, Goldmeier P, Gonik B. Colonoscopic release of the incarcerated gravid uterus. Obstet Gynecol. 1999;94:792–4.CrossRefPubMed
56.
Love JN, Howell JM. Urinary retention resulting from incarceration of a retroverted, gravid uterus. J Emerg Med. 2000;19:351–4.CrossRefPubMed
57.
DeFriend DE, Dubbins PA, Hughes PM. Sacculation of the uterus and placenta accreta: MRI appearances. Br J Radiol. 2000;73:1323–5.CrossRefPubMed
58.
Li YT, Tsui MS, Yin CS, Lin HM, Chan CC. Asymptomatic uterine incarceration at term gestation: a case report. J Obstet Gynaecol Res. 2000;26:31–3.CrossRefPubMed
59.
Minassian VA, Dunn M. Recurrent sacculation of the pregnant uterus. A case report. J Reprod Med. 2000;45:1003–6.PubMed
60.
Yohannes P, Schaefer J. Urinary retention during the second trimester of pregnancy: a rare cause. Urology. 2002;59:946.CrossRefPubMed
61.
Uma R, Oláh KS. Transvaginal caesarean hysterectomy: an unusual complication of a fibroid gravid uterus. BJOG. 2002;109:1192–4.CrossRefPubMed
62.
van Beekhuizen HJ, Bodewes HW, Tepe EM, Oosterbaan HP, Kruitwagen R, Nijland R. Role of magnetic resonance imaging in the diagnosis of incarceration of the gravid uterus. Obstet Gynecol. 2003;102:1134–7.PubMed
63.
Childs AJ, Goldkrand JW. Uterine incarceration in a 9-week multifetal pregnancy resulting from in vitro fertilization. A case report. J Reprod Med. 2003;48:992–4.PubMed
64.
Matsushita H, Kurabayashi T, Higashino M, Kojima Y, Takakuwa K, Tanaka K. Incarceration of the retroverted uterus at term gestation. Am J Perinatol. 2004;21:387–9.CrossRefPubMed
65.
Yang JM, Huang WC. Sonographic findings in acute urinary retention secondary to retroverted gravid uterus: pathophysiology and preventive measures. Ultrasound Obstet Gynecol. 2004;23:490–5.CrossRefPubMed
66.
Inaba F, Kawatu T, Masaoka K, Fukasawa I, Watanabe H, Inaba N. Incarceration of the retroverted gravid uterus: the key to successful treatment. Arch Gynecol Obstet. 2005;273:55–7.CrossRefPubMed
67.
Frei KA, Duwe DG, Bonel HM, Dürig P, Schneider H. Posterior sacculation of the uterus in a patient presenting with flank pain at 29 weeks of gestation. Obstet Gynecol. 2005;105:639–41.CrossRefPubMed
68.
Ozel B. Incarceration of a retroflexed, gravid uterus from severe uterine prolapse: a case report. J Reprod Med. 2005;50:624–6.PubMed
69.
Sutter R, Frauenfelder T, Marincek B, Zimmermann R. Recurrent posterior sacculation of the pregnant uterus and placenta increta. Clin Radiol. 2006;61:527–30.CrossRefPubMed
70.
Singh MN, Payappagoudar J, Lo J, Prashar S. Incarcerated retroverted uterus in the third trimester complicated by postpartum pulmonary embolism. Obstet Gynecol. 2007;109:498–501.CrossRefPubMed
71.
Barton-Smith P, Kent A. Asymptomatic incarcerated retroverted uterus with anterior sacculation at term. Int J Gynaecol Obstet. 2007;96:128.CrossRefPubMed
72.
Chauleur C, Vulliez L, Seffert P. Acute urine retention in early pregnancy resulting from fibroid incarceration: proposition for management. Fertil Steril. 2008;90:1198.e7–10.CrossRef
73.
Charova J, Yunus D, Sarkar PK. Incarcerated retroverted gravid uterus presenting as placenta praevia. J Obstet Gynaecol. 2008;28:537–9.CrossRefPubMed
74.
Gottschalk EM, Siedentopf JP, Schoenborn I, Gartenschlaeger S, Dudenhausen JW, Henrich W. Prenatal sonographic and MRI findings in a pregnancy complicated by uterine sacculation: case report and review of the literature. Ultrasound Obstet Gynecol. 2008;32:582–6.CrossRefPubMed
75.
Lee SW, Kim MY, Yang JH, Moon MH, Cho JY. Sonographic findings of uterine sacculation during pregnancy. Ultrasound Obstet Gynecol. 2008;32:595–7.CrossRefPubMed
76.
Rose CH, Brost BC, Watson WJ, Davies NP, Knudsen JM. Expectant management of uterine incarceration from an anterior uterine myoma: a case report. J Reprod Med. 2008;53:65–6.PubMed
77.
Hooker AB, Bolte AC, Exalto N, Van Geijn HP. Recurrent incarceration of the gravid uterus. J Matern Fetal Neonatal Med. 2009;22:462–4.CrossRefPubMed
78.
van der Tuuk K, Krenning RA, Krenning G, Monincx WM. Recurrent incarceration of the retroverted gravid uterus at term-two times transvaginal caesarean section: a case report. J Med Case Rep. 2009;3:103.CrossRefPubMedPubMedCentral
79.
Gerscovich EO, Maslen L. The retroverted incarcerated uterus in pregnancy: imagers beware. J Ultrasound Med. 2009;28:1425–7.CrossRefPubMed
80.
Dierickx I, Mesens T, Van Holsbeke C, Meylaerts L, Voets W, Gyselaers W. Recurrent incarceration and/or sacculation of the gravid uterus: a review. J Matern Fetal Neonatal Med. 2010;23:776–80.CrossRefPubMed
81.
Al Wadi K, Helewa M, Sabeski L. Asymptomatic uterine incarceration at term: a rare complication of pregnancy. J Obstet Gynaecol Can. 2011;33:729–32.CrossRefPubMed
82.
Dierickx I, Van Holsbeke C, Mesens T, Gevers A, Meylaerts L, Voets W, et al. Colonoscopy-assisted reposition of the incarcerated uterus in mid-pregnancy: a report of four cases and a literature review. Eur J Obstet Gynecol Reprod Biol. 2011;158:153–8.CrossRefPubMed
83.
Grossenburg NJ, Delaney AA, Berg TG. Treatment of a late second-trimester incarcerated uterus using ultrasound-guided manual reduction. Obstet Gynecol. 2011;118:436–9.CrossRefPubMed
84.
Al Wadi K, Helewa M, Sabeski L. Asymptomatic uterine incarceration at term: a rare complication of pregnancy. J Obstet Gynaecol Can. 2011;33:729–32.CrossRefPubMed
85.
Wang L, Wang J, Huang L. Incarceration of the retroverted uterus in the early second trimester performed by hysterotomy delivery. Arch Gynecol Obstet. 2012;286:267–9.CrossRefPubMed
86.
Hachisuga N, Hidaka N, Fujita Y, Fukushima K, Wake N. Significance of pelvic magnetic resonance imaging in preoperative diagnosis of incarcerated retroverted gravid uterus with a large anterior leiomyoma: a case report. J Reprod Med. 2012;57:77–80.PubMed
87.
Shima E, Serikawa T, Itsukaichi M, Haino K, Ooki I, Takakuwa K, et al. Pregnancy complicated by uterine sacculation due to a huge myoma. J Obstet Gynaecol Res. 2012;38:1111–4.CrossRefPubMed
88.
Fernandes DD, Sadow CA, Economy KE, Benson CB. Sonographic and magnetic resonance imaging findings in uterine incarceration. J Ultrasound Med. 2012;31:645–50.CrossRefPubMed
89.
Katopodis C, Menticoglou S, Logan A. Incarcerated fibroid uterus: the role of conservative management. J Obstet Gynaecol Can. 2013;35:536–8.CrossRefPubMed
90.
Dierickx I, Delens F, Backaert T, Pauwels W, Gyselaers W. Case report: incarceration of the gravid uterus: a radiologic and obstetric challenge. J Radiol Case Rep. 2014;8:28–36.PubMedPubMedCentral
91.
Policiano C, Araújo C, Santo S, Centeno M, Pinto L. Incarcerated gravid uterus: early manual reduction vs. late spontaneous resolution. Eur J Obstet Gynecol Reprod Biol. 2014;180:201–2.CrossRefPubMed
92.
Newell SD, Crofts JF, Grant SR. The incarcerated gravid uterus: complications and lessons learned. Obstet Gynecol. 2014;123:423–7.CrossRefPubMed
93.
Matsushita H, Watanabe K, Wakatsuki A. Management of a second trimester miscarriage in a woman with an incarcerated retroverted uterus. J Obstet Gynaecol. 2014;34:272–3.CrossRefPubMed
94.
Slama R, Barry M, McManus K, Latham D, Berniard M. Uterine incarceration: rare cause of urinary retention in healthy pregnant patients. West J Emerg Med. 2015;16:790–2.CrossRefPubMedPubMedCentral
95.
Díaz EG, Olivas PO, Fernández CF, González NG, Corona AF. Acute urinary retention due to an incarcerated Retroverted gravid uterus. J Health Med Informat. 2015;6:193.CrossRef
96.
Ozyurek ES, Kahraman AA, Yildirim D, Karacaoglu UM. Clinical presentation of placenta percreta with uterine incarceration in the second trimester. J Obstet Gynaecol. 2015;35(6):641–3.CrossRefPubMed
97.
Hassanin IH, Helmy YA, Abbas AM, Shaaban OM, Khalaf M, Ahmed SR, et al. Incarcerated gravid uterus through a rectal prolapse: first case report. Eur J Obstet Gynecol Reprod Biol. 2016;204:127–8.CrossRefPubMed
98.
99.
Takami M, Hasegawa Y, Seki K, Hirahara F, Aoki S. Spontaneous reduction of an incarcerated gravid uterus in the third trimester. Clin Case Rep. 2016;4:605–10.CrossRefPubMedPubMedCentral
100.
Kim SC, Lee YJ, Jeong JE, Joo JK, Lee KS. Incarceration of gravid uterus by growing subserosal myoma: case report. Clin Exp Obstet Gynecol. 2016;43:131–3.CrossRefPubMed
101.
Pabuçcu EG, Kiseli M, Yarci Gursoy A, Bostanci A, Caglar GS, Dincer CS. Successful vaginal delivery at term following ventro-fixation procedure for uterine incarceration. J Obstet Gynaecol. 2016;36(7):869–72.CrossRefPubMed
102.
Schwope RB, Ritter JL, Lisanti CJ, Reiter MJ. Uterine incarceration: imaging findings on magnetic resonance imaging. J Emerg Med. 2016;51(3):e49–50.CrossRefPubMed
103.
Gardner CS, Jaffe TA, Hertzberg BS, Javan R, Ho LM. The incarcerated uterus: a review of MRI and ultrasound imaging appearances. AJR Am J Roentgenol. 2013;201:223–9.CrossRefPubMed
104.
Dierickx I, Meylaerts LJ, Van Holsbeke CD, et al. Incarceration of the gravid uterus: diagnosis and preoperative evaluation by magnetic resonance imaging. Eur J Obstet Gynecol Reprod Biol. 2014;179:191–7.CrossRefPubMed
105.
Jacobsson B, Wide-Swensson D. Incarceration of the retroverted gravid uterus: a review. Acta Obstet Gynecol Scand. 1999;78:665–8.PubMed
Metadata
Title
Incarceration of the gravid uterus: a case report and literature review
Authors
Cha Han
Chen Wang
Lulu Han
Guoyan Liu
Huiyang Li
Fuman She
Fengxia Xue
Yingmei Wang
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2019
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-019-2549-3

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