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Abel JS, Morgenstern B. Incarceration of a gravid uterus with massive placental enlargement and fetal triploidy at 19 weeks of gestation - A case report on the simultaneous presence of two rare conditions. Case Rep Womens Health 2023; 40:e00564. [PMID: 38053987 PMCID: PMC10694561 DOI: 10.1016/j.crwh.2023.e00564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 11/05/2023] [Accepted: 11/13/2023] [Indexed: 12/07/2023] Open
Abstract
This article reports a rare case of uterine incarceration in pregnancy concurrent with nonmolar fetal triploidy and massive placental enlargement in a 35-year-old primigravida. The patient presented with abdominal discomfort and peripheral edema at 19 weeks of gestation. Diagnostic assessments revealed a retroflexed uterus with a massively enlarged placenta and a severely growth-restricted fetus. Uterine repositioning was successfully achieved after rectal filling. However, spontaneous fetal demise led to vaginal delivery. The fetal autopsy confirmed female triploidy. Histopathology of the placenta showed no features of a partial mole. This case highlights the challenges in diagnosing uterine incarceration in pregnancy, the need for early intervention and the complexity of managing multiple concurrent pathologies.
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Affiliation(s)
- Judith Sarah Abel
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Gynecology and Obstetrics, Germany
| | - Bernd Morgenstern
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Gynecology and Obstetrics, Germany
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2
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Narayanamoorthy S, Hillebrand A, Pendam R, McLaren R. Incarcerated gravid uterus - A systematic review. Eur J Obstet Gynecol Reprod Biol X 2023; 19:100227. [PMID: 37664181 PMCID: PMC10471930 DOI: 10.1016/j.eurox.2023.100227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/01/2023] [Accepted: 08/12/2023] [Indexed: 09/05/2023] Open
Abstract
Incarcerated gravid uterus (IGU) is a serious complication of pregnancy that leads to adverse obstetric outcomes. The aim of this review was to describe this entity in detail. We also aimed to understand if pregnancies with predisposing risk factors that increase the risk of developing IGU had a difference in their clinical manifestations, treatment, and obstetric outcomes. The PubMed, MEDLINE, Embase, Scopus databases and clinicaltrials.gov were searched from inception to July 2023. Case reports and series that provided all the details of the pregnancy and IGU outcome were included. Study quality and risk of bias were assessed using a tool that is an adaptation from criteria listed by Pierson, Bradford Hills and Newcastle Ottawa scale modification. Patients with the condition of interest included in this review were grouped into those with documented, identified risk factors and no risk factors. The two groups were compared to understand the difference in obstetric outcome and presentation of IGU. Data were analyzed and summarized descriptively, categorical variables were assessed by chi-squared test or Fisher's exact test, and continuous variables by the Wilcoxon Mann Whitney test. Of 236 articles found, 62 articles with 80 cases were included in the final analysis. The median age was 32 [27-35] years. The median gestational age of diagnosis was 17 [14-26] weeks. The most common risk factor was fibroids (N = 22, 27.5 %). Most common presentation was urinary complaints and lower abdomen pain (N = 47, 58.6 %). Twenty-seven patients (33.6 %) needed more than one visit for the diagnosis to be made. Conservative management was the first step to treat IGU in most patients. Most common complication was fetal malpresentation (N = 13, 40.6 %). Patients with or without risk factors developing IGU had no statistical difference in- parity, median gestational age of diagnosis, delay in diagnosis, increased chance of misdiagnosis, management of IGU or in obstetric outcome (all p > 0.05). It is important to recognize this entity early to prevent obstetric complications especially when patients report urinary retention and abdomen pain. The presence of risk factors does not change the management course or obstetric outcome in patients with IGU. Hence it is reasonable to start with conservative management of IGU regardless of presence of risk factors or the gestational age of diagnosis, in clinical practice.
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Affiliation(s)
| | - Allix Hillebrand
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY 11219, USA
| | | | - Rodney McLaren
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA
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Zhuang L, Wang XY, Sang Y, Xu J, He XL. Acute urinary retention in the first and second-trimester of pregnancy: Three case reports. World J Clin Cases 2021; 9:3130-3139. [PMID: 33969100 PMCID: PMC8080742 DOI: 10.12998/wjcc.v9.i13.3130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/04/2021] [Accepted: 03/03/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Acute urinary retention (AUR) is rare during pregnancy.
CASE SUMMARY We report on three pregnant women with AUR between the 10th and 18th wk of gestation. Case 1 was first diagnosed as urinary tract infection and developed a urinary tract infection due to urinary retention caused by urethral obstruction. Case 2 had a history of previous abdominal surgery for pelvic tuberculosis, leading to severe adhesions and a persistent retroverted uterus. In case 3, healthcare providers focused on the patient’s gastrointestinal symptoms and did not investigate her inability to void. Case 1 required manual disimpaction of the uterus and the knee-chest position. The other cases required immediate catheterization. The condition resolved in cases 1 and 2; these patients had normal pregnancies. Case 3 had severe complications at the time of consultation, leading to an abortion.
CONCLUSION Retroverted uterus is the most common cause of AUR. Prompt recognition and diagnosis are required. Clinicians should be aware of the risk factors, etiology, and clinical presentation of AUR in the first and second trimester of pregnancy.
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Affiliation(s)
- Lin Zhuang
- Department of Obstetrics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610000, Sichuan Province, China
| | - Xiao-Yin Wang
- Department of Obstetrics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610000, Sichuan Province, China
| | - Yan Sang
- Department of Obstetrics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610000, Sichuan Province, China
| | - Jiao Xu
- Department of Obstetrics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610000, Sichuan Province, China
| | - Xue-Lian He
- Department of Obstetrics, Sichuan Provincial Hospital for Women and Children, Chengdu 610000, Sichuan Province, China
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ACAR ÇİMŞİR MT, YILDIZ MS. The Potential Role of Uterine Retroversion in Pelvic Pain Symptoms and Cesarean Delivery. ACTA MEDICA ALANYA 2021. [DOI: 10.30565/medalanya.883872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Le Grand C, Valentin L, Benoist G. [Recurrent incarceration of the gravid uterus, an atypical evolution]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2021; 49:217-219. [PMID: 32916318 DOI: 10.1016/j.gofs.2020.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Indexed: 06/11/2023]
Affiliation(s)
- C Le Grand
- Service de gynécologie-obstétrique, CHU de Caen, Caen, France; Université de Caen, Caen, France
| | - L Valentin
- Service de gynécologie obstétrique, hôpital privé Océane, Vannes, France
| | - G Benoist
- Service de gynécologie-obstétrique, CHU de Caen, Caen, France; Université de Caen, Caen, France.
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Han C, Wang C, Han L, Liu G, Li H, She F, Xue F, Wang Y. Incarceration of the gravid uterus: a case report and literature review. BMC Pregnancy Childbirth 2019; 19:408. [PMID: 31703641 PMCID: PMC6839127 DOI: 10.1186/s12884-019-2549-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 10/04/2019] [Indexed: 12/22/2022] Open
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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Affiliation(s)
- Cha Han
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, No. 154 Anshan Road, Heping District, Tianjin, People's Republic of China, 300052
| | - Chen Wang
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, No. 154 Anshan Road, Heping District, Tianjin, People's Republic of China, 300052
| | - Lulu Han
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, No. 154 Anshan Road, Heping District, Tianjin, People's Republic of China, 300052
| | - Guoyan Liu
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, No. 154 Anshan Road, Heping District, Tianjin, People's Republic of China, 300052
| | - Huiyang Li
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, No. 154 Anshan Road, Heping District, Tianjin, People's Republic of China, 300052
| | - Fuman She
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, No. 154 Anshan Road, Heping District, Tianjin, People's Republic of China, 300052
| | - Fengxia Xue
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, No. 154 Anshan Road, Heping District, Tianjin, People's Republic of China, 300052
| | - Yingmei Wang
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, No. 154 Anshan Road, Heping District, Tianjin, People's Republic of China, 300052.
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Incarcerated Uterus Presenting as Short Cervix and Placenta Previa. Case Rep Obstet Gynecol 2018; 2018:7373507. [PMID: 30254778 PMCID: PMC6142763 DOI: 10.1155/2018/7373507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 08/06/2018] [Accepted: 08/23/2018] [Indexed: 11/30/2022] Open
Abstract
Introduction Incarcerated uterus is a rare complication of pregnancy, usually associated with retroversion. Case A 26-year-old woman presents at 19 4/7 weeks for evaluation of a short cervix and placenta previa. On ultrasound scan, the placenta was considered previa and the cervix was not visualized. The cervix was not identified by pelvic examination and the presumptive diagnosis of short cervix was done. The patient was followed up closely and remained asymptomatic. Retrospective analysis of the ultrasound images showed a retroverted uterus with an elongated cervix compressed towards the anterior vaginal wall. At 26 weeks of gestation, ultrasound showed a cervical length of 41 mm and a fundal placenta and the diagnosis of spontaneous correction of an incarcerated uterus was made. The patient had an uncomplicated vaginal delivery at 39 3/7 weeks. Comment Identification and close follow-up of incarcerated uterus may potentially help in avoiding serious obstetrical and surgical complications.
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Ozyurek ES, Kahraman AA, Yildirim D, Karacaoglu UM. Clinical presentation of placenta percreta with uterine incarceration in the second trimester. J OBSTET GYNAECOL 2014; 35:641-3. [DOI: 10.3109/01443615.2014.990433] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Incarceration of the gravid uterus: diagnosis and preoperative evaluation by magnetic resonance imaging. Eur J Obstet Gynecol Reprod Biol 2014; 179:191-7. [DOI: 10.1016/j.ejogrb.2014.05.037] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 05/07/2014] [Accepted: 05/23/2014] [Indexed: 01/30/2023]
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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. [PMID: 25426237 DOI: 10.3941/jrcr.v8i7.1854] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
We will present the fourth case in the English-language literature of a mid-gestational colonoscopy-assisted manual reposition of an incarcerated uterus. Despite the ready availability of ultrasound, a great number of incarcerations are not recognized before term. Since early diagnosis is the key to a successful treatment, it is important that providers acquire prompt knowledge of this obstetric disorder. Magnetic Resonance Imaging has an important additional value to ultrasound in the detailed scanning of this potentially perilous condition.
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Affiliation(s)
- Inge Dierickx
- Department of Obstetrics and Gynecology, Sint-Lucas Ziekenhuis, Ghent, Belgium
| | - Frédéric Delens
- Department of Radiology, Sint-Lucas Ziekenhuis, Ghent, Belgium
| | - Thomas Backaert
- Department of Radiology, Sint-Lucas Ziekenhuis, Ghent, Belgium
| | - Walter Pauwels
- Department of Gastro-Enterology, Sint-Lucas Ziekenhuis, Ghent, Belgium
| | - Wilfried Gyselaers
- Department of Obstetrics and Gynecology, Ziekenhuis Oost-Limburg, Genk, Belgium ; Department of Physiology, Universiteit Hasselt, Diepenbeek, Belgium
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The Incarcerated Uterus: A Review of MRI and Ultrasound Imaging Appearances. AJR Am J Roentgenol 2013; 201:223-9. [DOI: 10.2214/ajr.12.9473] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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12
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Bultez T, Vincienne M, Noël C. [Incarceration of the retroverted uterus in the third trimester: report of 2 cases]. ACTA ACUST UNITED AC 2013; 41:409-11. [PMID: 23756025 DOI: 10.1016/j.gyobfe.2013.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Incarceration of the retroverted gravid uterus in the third trimester is a rare but distinctive diagnosis. Initial symptoms are more frequently urinary and digestive symptoms which became more acute at the third trimester. Severe abdominal pain associated with bleeding in early labor leads to make the diagnosis during an emergency cesarean section. However, the typical features of the clinical transvaginal exam and the abdominal ultrasound exam can confirm easily this diagnosis. We report two additional cases where Joël-Cohen incision for cesarean section was possible after manual reposition of the uterus. We discuss the diagnostic approach and the management regarding a literature review.
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Affiliation(s)
- T Bultez
- Service de gynécologie obstétrique, centre hospitalier René-Dubos, 6 avenue de l'Île-de-France, Cergy-Pontoise cedex, France.
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Fernandes DD, Sadow CA, Economy KE, Benson CB. Sonographic and magnetic resonance imaging findings in uterine incarceration. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:645-650. [PMID: 22441922 DOI: 10.7863/jum.2012.31.4.645] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We show the sonographic and magnetic resonance imaging features of uterine incarceration. Clinical data and imaging findings were retrospectively reviewed for 8 confirmed cases identified by sonography from 2000 to 2010. Two patients had magnetic resonance imaging. Seven of 8 patients (87.5%) presented with abdominal pain; 4 of 8 (50.0%) also had urinary symptoms. All had a retroverted uterus with an elongated anterosuperiorly displaced or poorly visualized cervix on sonography. Magnetic resonance imaging showed similar features, but in both cases, the placental position was misinterpreted because of severe uterine retroversion. Radiologists should be aware of this condition and its imaging features to reduce associated morbidity and mortality.
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Affiliation(s)
- Dellano D Fernandes
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
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Incarceration of the retroverted uterus in the early second trimester performed by hysterotomy delivery. Arch Gynecol Obstet 2012; 286:267-9. [DOI: 10.1007/s00404-012-2223-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Accepted: 01/05/2012] [Indexed: 12/16/2022]
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