Recurrent incarceration and/or sacculation of the gravid uterus: A review

Abstract

Retroverted uterine incarceration with sacculation of the anterior wall is reported to occur approximately in 1/3000 pregnancies. A literature search identified only 1 case report of incarceration of an anteflexed gravid uterus and 6 reported cases of recurrent incarceration and/or sacculation. We present a case of an incarceration of an anteflexed uterus in the first pregnancy, followed by a retroflexed incarceration in the second pregnancy. From this, a review is presented on recurrent uterine incarceration and/or sacculation.

Unexpected Gynecologic Findings During Abdominal Surgery

“…Risk factors for retroverted uterus include adhesions between the uterine fundus and pouch of Douglas (due to pelvic inflammatory disease, endometriosis, or previous abdominal surgery), uterine malformations (didelphys or bicornuate), uterine prolapse, and pelvic tumors. 80, 81 …”

“…The uterine fundus may fail to increase in size, with resultant intrauterine growth restriction. 3, 80, 81 …”

“…The cervix is typically displaced anteriorly and may be difficult to locate. 80, 81 Haylen et al recommend transvaginal ultrasound with an empty bladder as an accurate method of diagnosis of retroverted gravid uterus. 79 MRI may also be useful in the diagnosis, on which a stretched cervix, thickened posterior uterine wall and thinned anterior wall may be visualized.…”

“…79 MRI may also be useful in the diagnosis, on which a stretched cervix, thickened posterior uterine wall and thinned anterior wall may be visualized. 80 …”

“…Patients with retroverted gravid uterus should be delivered by cesarean section, and the surgeon should be sure to make the incision high in order to avoid injury to the bladder, cervix, or vagina. 80, 81 These procedures should be deferred to a gynecologic surgeon whenever possible.…”