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Kantorowska A, Patberg ET, Ali F, Suhag A, Rekawek P, Vintzileos AM, Chavez MR. Incarcerated gravid uterus: a new treatment using the transvaginal ultrasound probe and narrative literature review. Am J Obstet Gynecol 2024:S0002-9378(24)00866-4. [PMID: 39181496 DOI: 10.1016/j.ajog.2024.08.026] [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: 06/04/2024] [Revised: 08/14/2024] [Accepted: 08/15/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND 'Incarcerated gravid uterus' is a morbid complication that occurs in 1 in 3000 pregnancies. It is characterized by failure of a retropositioned uterus to become an abdominal organ between 12 to 14 weeks of gestation. If maternal symptoms develop or gestational age surpasses 14 to 16 weeks, replacement of a retropositioned uterus is recommended to reduce adverse outcomes. Previously described techniques for management include passive reduction, digital replacement, or more invasive methods such as laparoscopy, laparotomy, or sigmoidoscopy. These methods are either minimally effective, painful, or risky. OBJECTIVE The objective of this report is to describe our clinical experience with a new minimally invasive technique that uses the transvaginal ultrasound probe for uterine replacement in cases of incarceration, to conduct a narrative literature review on 'incarcerated gravid uterus,' and to propose an algorithm for management of this condition. STUDY DESIGN This is a case series of 8 patients with an incarcerated gravid uterus who were managed with the transvaginal ultrasound probe technique at one academic medical institution between March 2020 and July 2023, as well as a narrative review of the literature on 'incarcerated gravid uterus.' PubMed, Google Scholar, and Ovid MEDLINE databases were searched for the terms "incarcerated gravid uterus," "uterine incarceration," "uterine sacculation," and "retroverted uterus" up to April 2024. RESULTS The transvaginal ultrasound probe technique resulted in successful uterine replacement, with resolution of symptoms, in all 8 patients. All pregnancies resulted in live births with good neonatal outcomes-7 out of 8 patients delivered at term, and 1 delivered in the late preterm period. CONCLUSION Our proposed technique for treatment of an incarcerated gravid uterus with the transvaginal ultrasound probe is simple, minimally invasive and effective. Based on our experience and the narrative literature review, an algorithm for the management of an incarcerated gravid uterus is proposed.
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Affiliation(s)
- Agata Kantorowska
- Department of Obstetrics and Gynecology, NYU Langone Hospital-Long Island, NYU Grossman Long Island School of Medicine, Mineola, NY.
| | - Elizabeth T Patberg
- Department of Obstetrics, Gynecology and Reproductive Services, University of California San Francisco, San Francisco, CA
| | - Fatima Ali
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine/Detroit Medical Center, Detroit, MI
| | - Anju Suhag
- Department of Obstetrics and Gynecology, NYU Langone Hospital-Long Island, NYU Grossman Long Island School of Medicine, Mineola, NY
| | - Patricia Rekawek
- Department of Obstetrics and Gynecology, NYU Langone Hospital-Long Island, NYU Grossman Long Island School of Medicine, Mineola, NY
| | - Anthony M Vintzileos
- Department of Obstetrics and Gynecology, Northwell, New Hyde Park, NY; Department of Obstetrics and Gynecology, Lenox Hill Hospital, New York, NY; Zucker School of Medicine, Uniondale, NY
| | - Martin R Chavez
- Department of Obstetrics and Gynecology, NYU Langone Hospital-Long Island, NYU Grossman Long Island School of Medicine, Mineola, NY
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Taylor AKL, Bartels HC, Brophy DP, O'Brien D, Corcoran SM. Imaging and video of late preterm delivery by midline laparotomy due to incarcerated uterus: A case report and literature review of a rare but morbid condition. Int J Gynaecol Obstet 2024. [PMID: 38610116 DOI: 10.1002/ijgo.15536] [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: 02/09/2024] [Revised: 03/23/2024] [Accepted: 04/02/2024] [Indexed: 04/14/2024]
Abstract
Incarcerated gravid uterus (IGU) is a rare and serious obstetric complication. IGU is defined as the entrapment of the gravid uterus between the pubic symphysis and the sacral promontory. The incidence of IGU is 1 in 3000-10 000 cases. IGU is associated with significant obstetric complications, including preterm labor, intrauterine fetal death, growth restriction, renal failure, uterine ischemia/rupture and thrombosis. Here, we present the case of a primigravida with urinary retention at 14 weeks. On transabdominal ultrasound at 19+5/7 weeks the cervix was difficult to visualize, and the anterior uterine wall appeared thickened. The bladder was elongated superior to the uterus and the placenta was low-lying. Initially the patient was managed with intermittent self-catheterization, and subsequently indwelling catheterization was required from 22 weeks. At 30 weeks, the patient was transferred to a tertiary center and magnetic resonance imaging (MRI) was preformed due to challenging visualization of the cervix on ultrasound and the patient's continued symptoms of constipation and recurrent urinary infections. The MRI found a retroflexed gravid uterus, with vagina and endocervix displaced anteriorly and compressed by the gravid uterus. The findings were consistent with an incarcerated uterus. The patient subsequently had positive urinary cultures for Pseudomonas and rising creatinine. Given the obstructive uropathy and associated morbidity and mortality, a plan for elective pre-term delivery at 33+6/7 weeks was made. Delivery was by midline laparotomy, normal anatomy was restored after manual evacuation of the fundus from below the sacral promontory, and an uncomplicated lower segment transverse uterine cesarean section was performed.
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Affiliation(s)
- A K L Taylor
- Obstetrics and Gynaecology Department, National Maternity Hospital, Dublin, Ireland
| | - H C Bartels
- Obstetrics and Gynaecology Department, National Maternity Hospital, Dublin, Ireland
- Gynaecology Department, St Vincent's University Hospital, Dublin, Ireland
| | - D P Brophy
- Radiology Department, St Vincent's University Hospital, Dublin, Ireland
| | - D O'Brien
- Obstetrics and Gynaecology Department, National Maternity Hospital, Dublin, Ireland
- Gynaecology Department, St Vincent's University Hospital, Dublin, Ireland
| | - S M Corcoran
- Obstetrics and Gynaecology Department, National Maternity Hospital, Dublin, Ireland
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Grosse N, Liem S, Miller E, Möller G, Weidemann J, Morfeld CA, Schild R, Oehler-Rahman K. Incarceration of the Gravid Uterus - a Rare Condition not to be Missed. Z Geburtshilfe Neonatol 2023; 227:302-306. [PMID: 37044115 DOI: 10.1055/a-2042-9930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
BACKGROUND Incarceration of a gravid uterus (IGU) is a rare manifestation in obstetrics that may be associated with serious complications. CASE We report on a 29-year-old patient at 34+2 weeks' gestation who presented with HELLP syndrome. IGU had been initially diagnosed in our department at 23+6 weeks' gestation. Urgent cesarean section was performed taking into account the specific characteristics of IGU. A healthy premature child was born. With the prior knowledge of IGU no complications during delivery occurred and mother and child had favorable outcomes. CONCLUSION IGU is a rare condition in pregnancy that should not be overlooked. Early diagnosis and treatment of IGU can prevent serious complications to the mother and child during pregnancy and delivery. In this report, we discuss the specific peculiarities of an incarcerated uterus that need to be considered in this regard. HINTERGRUND Ein Uterus incarceratus ist eine seltene Manifestation in der Geburtshilfe, welche mit schwerwiegenden Komplikationen einhergehen kann. FALL: Wir berichten über eine 29-jährige Patientin, die sich mit 34+2 Schwangerschaftswochen (SSW) mit einem HELLP-Syndrom in unserer Klinik vorgestellt hat. Die Erstdiagnose des inkarzerierten Uterus wurde in unserer Klinik mit 23+6 SSW gestellt. Aufgrund unserer Vorkenntnis über diese Diagnose konnte nun die dringend indizierte Sectio caesarea unter Berücksichtigung der spezifischen Merkmale in modifizierter Technik durchgeführt werden. Es wurde ein gesundes Frühgeborenes geboren. Es traten während der Geburt keine Komplikationen auf und Mutter und Kind hatten einen günstigen Verlauf. SCHLUSSFOLGERUNG Ein Uterus incarceratus ist eine seltene Manifestation in der Schwangerschaft, welche nicht übersehen werden sollte. Eine frühzeitige Diagnose und Behandlung kann schwerwiegende Komplikationen für Mutter und Kind während der Schwangerschaft und unter der Geburt verhindern. Wir diskutieren die spezifischen Besonderheiten eines Uterus incarceratus, die hierbei zu berücksichtigen sind.
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Affiliation(s)
- Nadja Grosse
- Perinatalzentrum Hannover, DIAKOVERE gGmbH, Hannover, Germany
| | - Sandy Liem
- Perinatalzentrum Hannover, DIAKOVERE gGmbH, Hannover, Germany
| | - Elvira Miller
- Perinatalzentrum Hannover, DIAKOVERE gGmbH, Hannover, Germany
| | | | | | | | - Ralf Schild
- Perinatalzentrum Hannover, DIAKOVERE gGmbH, Hannover, Germany
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Prochnow CL, Hilbert ML, Bickett CR, Boyd JS. Incarcerated Gravid Uterus in a Nulliparous Female Presenting With Urinary Hesitancy and Rectal Pressure: A Case Report. Cureus 2023; 15:e41289. [PMID: 37539421 PMCID: PMC10395658 DOI: 10.7759/cureus.41289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2023] [Indexed: 08/05/2023] Open
Abstract
Incarcerated gravid uterus (IGU) is a rare condition that is associated with urinary obstruction, sepsis, peritonitis, and ultimately maternal death. IGU occurs when the retroverted uterus in a gravid patient becomes trapped in the pelvis during the second trimester. We present the case of a nulliparous female who came to our emergency department (ED) at 14 weeks and five days gestation with new onset intermittent urinary hesitancy and rectal pressure starting approximately 10 days prior to presentation. IGU was diagnosed based on pelvic examination and ultrasound in the ED. Emergency physicians should have a high index of suspicion for IGU in their differential diagnosis for pregnant females with urinary and rectal complaints. Point-of-care ultrasound (POCUS) should be used as an adjunct in identifying this condition.
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Affiliation(s)
| | - Megan L Hilbert
- Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, USA
| | | | - Jeremy S Boyd
- Emergency Medicine, Veterans Affairs Tennessee Valley Health Services, Nashville, USA
- Emergency Medicine, Vanderbilt University Medical Center, Nashville, USA
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Pina Moreno JM, Ruiz Minaya M, Fraile López A, Feltrer Hidalgo M, Ortega Abad V, García-Tizón Larroca S. Importance of the early diagnosis of incarcerated gravid uterus: Case report and systematic review. Int J Gynaecol Obstet 2022. [PMID: 36495234 DOI: 10.1002/ijgo.14615] [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: 09/15/2022] [Revised: 11/18/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To examine whether the early diagnosis of uterine incarceration before 20 weeks of gestation improves maternal-perinatal prognoses. METHODS A systematic review of all of the cases published in the past 30 years that met the inclusion and exclusion criteria was performed and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. A comparative analysis of diagnoses before and after 20 weeks of gestation was performed. RESULTS Eighty-nine studies with a total of 146 cases of uterine incarceration during pregnancy were included. For cases of incarceration diagnosed before 20 weeks of gestation, a higher proportion of clinical symptoms was observed; however, a lower proportion of complications, such as premature delivery, need for cesarean section, and poor perinatal outcomes, were observed (P < 0.05). The proportion of spontaneous resolution and minimally invasive techniques for the treatment of incarceration was significantly higher among patients diagnosed with this pathology before 20 weeks (P < 0.05). CONCLUSION The literature indicates that uterine incarceration is a rare complication during pregnancy with better maternal-perinatal results if diagnosed earlier than 20 weeks.
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Affiliation(s)
- Juan Manuel Pina Moreno
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, Madrid, Spain
| | - María Ruiz Minaya
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, Madrid, Spain
| | - Andrea Fraile López
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, Madrid, Spain
| | - Marta Feltrer Hidalgo
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, Madrid, Spain
| | - Virginia Ortega Abad
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, Madrid, Spain
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Morais M, Moura M, Correia A, Fan Y. Urinary tract obstruction in the second trimester: a report of an incarcerated gravid uterus. BMJ Case Rep 2022; 15:15/9/e249986. [PMID: 36175041 PMCID: PMC9528483 DOI: 10.1136/bcr-2022-249986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Incarceration of the gravid uterus (IGU) is a rare obstetric disorder that may lead to pregnancy-related complications. Acute urinary retention (AUR) is one of the associated symptoms in IGU and it is mostly observed in the first semester and early second trimester. A case of a woman, in her 30s, is described, who presented AUR and lower abdominal pain in the early second trimester. The diagnosis was confirmed upon pelvic examination, and abdominal and transvaginal ultrasound. Management included long-term bladder catheterisation, manual reduction manoeuvres and passive positioning manoeuvres at home. At 24 weeks of gestation, the uterus returned in its correct polarity, the Foley catheter was removed and the patient was able to void spontaneously. A healthy infant was delivered vaginally at term. No specific guidelines have been published for IGU treatment. However, prompt diagnosis and tight follow-up of these patients are essential to define strategies, reduce complications and prevent recurrences.
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Affiliation(s)
- Mariana Morais
- Obstetrics and Gynecology, Centro Hospitalar de Trás-os-montes e Alto Douro EPE, Vila Real, Portugal
| | - Mário Moura
- Obstetrics and Gynecology, Centro Hospitalar de Trás-os-montes e Alto Douro EPE, Vila Real, Portugal
| | - Ana Correia
- Obstetrics and Gynecology, Centro Hospitalar de Trás-os-montes e Alto Douro EPE, Vila Real, Portugal
| | - Yida Fan
- Obstetrics and Gynecology, Centro Hospitalar de Trás-os-montes e Alto Douro EPE, Vila Real, Portugal
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Tachibana D, Misugi T, Kitada K, Kurihara Y, Tahara M, Hamuro A, Nakano A, Yamamoto A, Koyama M. Reply to Orsi, M.; Somigliana, E. Incarceration of the Gravid Uterus: Proposal for a Shared Definition. Comment on “Tachibana et al. Incarcerated Gravid Uterus: Spontaneous Resolution Is Not Rare. Diagnostics 2021, 11, 1544”. Diagnostics (Basel) 2021; 12:diagnostics12010030. [PMID: 35054197 PMCID: PMC8774808 DOI: 10.3390/diagnostics12010030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 12/17/2021] [Indexed: 11/16/2022] Open
Abstract
We appreciate the interest in our paper, and we are grateful for the comment by Orsi et al. [...]
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Affiliation(s)
- Daisuke Tachibana
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan; (T.M.); (K.K.); (Y.K.); (M.T.); (A.H.); (A.N.); (M.K.)
- Correspondence: ; Tel.: +81-6-6645-3862; Fax: +81-6-6646-5800
| | - Takuya Misugi
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan; (T.M.); (K.K.); (Y.K.); (M.T.); (A.H.); (A.N.); (M.K.)
| | - Kohei Kitada
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan; (T.M.); (K.K.); (Y.K.); (M.T.); (A.H.); (A.N.); (M.K.)
| | - Yasushi Kurihara
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan; (T.M.); (K.K.); (Y.K.); (M.T.); (A.H.); (A.N.); (M.K.)
| | - Mie Tahara
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan; (T.M.); (K.K.); (Y.K.); (M.T.); (A.H.); (A.N.); (M.K.)
| | - Akihiro Hamuro
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan; (T.M.); (K.K.); (Y.K.); (M.T.); (A.H.); (A.N.); (M.K.)
| | - Akemi Nakano
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan; (T.M.); (K.K.); (Y.K.); (M.T.); (A.H.); (A.N.); (M.K.)
| | - Akira Yamamoto
- Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan;
| | - Masayasu Koyama
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan; (T.M.); (K.K.); (Y.K.); (M.T.); (A.H.); (A.N.); (M.K.)
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Orsi M, Somigliana E. Incarceration of the Gravid Uterus: Proposal for a Shared Definition. Comment on Tachibana et al. Incarcerated Gravid Uterus: Spontaneous Resolution Is Not Rare. Diagnostics 2021, 11, 1544. Diagnostics (Basel) 2021; 12:diagnostics12010021. [PMID: 35054188 PMCID: PMC8775067 DOI: 10.3390/diagnostics12010021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 12/17/2021] [Indexed: 11/16/2022] Open
Abstract
We read with great interest the paper entitled “Incarcerated gravid uterus: spontaneous resolution is not rare” by Tachibana et al. [...]
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Affiliation(s)
- Michele Orsi
- Maternal-Infant Department, A.S.S.T. Rhodense, Garbagnate Milanese, Via Carlo Forlanini, 95, 20024 Milan, Italy
- Correspondence:
| | - Edgardo Somigliana
- Department of Woman, New-Born and Child, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Mangiagalli Centre, Via della Commenda, 12, 20122 Milan, Italy;
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122 Milan, Italy
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