Spontaneous reduction of an incarcerated gravid uterus in the third trimester

Takami, Mio; Hasegawa, Yoshimi; Seki, Kazuhiko; Hirahara, Fumiki; Aoki, Shigeru

doi:10.1002/ccr3.577

Cited by 15 publications

(17 citation statements)

References 20 publications

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“…Four cases of spontaneous resolution in the third trimester have been reported so far [ 5 , 14 , 15 , 16 ]. Their corrections of uterine incarceration were observed between 30 and 36 weeks, and two cases among them were complicated with fibroids.…”

Section: Discussionmentioning

confidence: 99%

Incarcerated Gravid Uterus: Spontaneous Resolution Is Not Rare

et al. 2021

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Aim: Incarcerated gravid uterus is a rare obstetrical complication that leads to adverse outcomes, especially if the uterus remains incarcerated and the condition goes undiagnosed until delivery. However, there is no consensus regarding the optimal management of this complication because of its rarity. In this study, we aimed to elucidate the incidence of incarcerated gravid uterus, as well as its natural courses and perinatal outcomes. Methods: We retrospectively reviewed medical records of patients who had incarcerated gravid uterus and managed at Osaka City University Hospital between April 2011 and March 2021. Incarcerated gravid uterus was defined as a retroverted or retroflexed uterus after 16 weeks of gestation. Results: There were 14 incarcerated cases among 6958 pregnant women, and 13 of them had some kind of gynecological complication and/or history. Spontaneous resolution of incarcerated gravid uterus after 16 gestational weeks was observed in six cases before the late second trimester and five cases at the late second trimester to early third trimester. Three cases remained incarcerated at term or near-term. One case with adenomyosis had severe abdominal pain, although it was difficult to ascertain whether the cause of pain was triggered by adenomyosis and/or incarceration. One case was misdiagnosed as placenta previa, and the uterine cervix was subsequently injured during cesarean delivery, resulting in massive hemorrhaging. Conclusions: Approximately 1 in 2300 pregnancies continued to be in an incarcerated condition at term or near-term, and 78.5% of cases showed a spontaneous resolution after 16 weeks of gestation. Expectant management with careful attention to the incarcerated gravid uterus may be one option in situations where there are no severe symptoms related to the incarceration itself.

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Section: Discussionmentioning

confidence: 99%

Incarcerated Gravid Uterus: Spontaneous Resolution Is Not Rare

et al. 2021

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“…Potential causes of an incarcerated gravid uterus, which is diagnosed in approximately 1 in every 3,000 pregnancies, include uterine anomalies, fibroids, pelvic adhesions, endometriosis or a deep sacral cavity with a prominent promontory [8]. In most cases, a retroverted uterus undergoes spontaneous correction to an anteverted uterus by the first trimester [9]. An incarcerated gravid uterus is generally diagnosed by a pelvic examination and confirmed by transvaginal ultrasound on an empty bladder [6,7].…”

Section: Discussionmentioning

confidence: 99%

The Potential Role of Uterine Retroversion in Pelvic Pain Symptoms and Caesarean Delivery

Cimsir¹,

Yildiz²

2021

Acta Medica Alanya

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Amaç: Uterus Retroversiyonu kadın popülasyonunda yaygın bir durumdur ve pelvik ağrı semptomları ile ilişkili olduğu varsayılmaktadır. Bu çalışmanın amacı, uterus retroversiyonunun pelvik ağrı semptomları ile ilişkili olup olmadığını ve sezaryen doğum nedeni olup olmadığını araştırmaktır. Yöntemler: Üçüncü Basamak Eğitim ve Araştırma Hastanesi Kadın Hastalıkları Kliniği'ne pregestasyonel danışmanlık için başvuran 103 premenopozal kadın, kendi kendine uygulanan anket formu ile pelvik ağrı semptomları açısından değerlendirildi. Uterus pozisyonu pelvik muayene ve transvajinal ultrason ile değerlendirildi. Altmış bir kadında uterusu retroverted (grup 1) ve yetmiş ikisinde ise ileri dönük veya orta uterus (grup 2) vardı. Retroverted grup ile Anteverted veya intermediate grup arasında disparoni, dismenore, ağırlık, Vücut Kitle İndeksi (BMI), döngüsel ağrı, yumurtlama ağrısı, adet öncesi ağrı ve doğum şekli karşılaştırıldı. Başarılı bir gebelik ve gebelik araştırmasından sonra, doğum şekli de karşılaştırıldı. Bulgular: Disparoni, dismenore, kilo, VKİ, döngüsel ağrı, yumurtlama ağrısı, premenstrüel ağrı, disparoni nedeniyle hastaların cinsel aktivitelerinin kısıtlanması, dismenore için hastaların medikal tedavi gereksinimi ve doğum şekli iki grup arasında istatistiksel olarak anlamlıydı. (p <0.05). Bununla birlikte, PMS (adet öncesi sendrom), boy, ağırlık ve parite benzerdi. (p> 0.05) Sonuçlar: Uterin retroversiyonu, seçilmemiş kadınlardan oluşan bir popülasyonda daha yüksek sezaryen oranı prevalansı, pelvik ağrı ve disparoni ve dismenore için görsel analog skala ile ilişkilidir.

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“…An interesting phenomenon appeared after myomectomy, the incarcerated uterus was spontaneously resolved within 3 weeks. According to a report, [6] an incarcerated gravid uterus may spontaneously get corrected in special conditions of incarceration caused by uterine fibroids only in the absence of other facts such as adhesion. We thought that the huge fibroid was the only reason to cause incarceration for this special case, and when the fibroid was removed, the abdominal cavity became empty.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous reduction of an incarcerated gravid uterus after myomectomy in the second trimester

Tong

Wang²,

Liu³

et al. 2019

Medicine

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Rationale:During a normal pregnancy, in the 1st trimester uterus lies in pelvis and enlarges in size as the pregnancy advances. By 14 weeks of gestation, the gravid uterus transforms from a pelvis to an abdominal organ and a retroverted uterus will correct as the fundus rises out of the pelvis and falls forward to its normal anatomical position. If the uterus remains in the pelvic cavity after 14 weeks of gestation, it is referred to as an incarcerated uterus.Patient concerns:A 31-year-old gravida 3 para 0 woman was admitted to our obstetrics unit at 20 weeks’ gestation with the complaint of severe persistent upper abdominal pain for over 12 hours.Diagnosis and interventions:A diagnosis of fibroid degeneration was made through ultrasound and magnetic resonance imaging. The patient was hospitalized with conservative treatment. An abdominal myomectomy was performed at 22 weeks’ gestation because her condition had deteriorated. Incarcerated uterus was not suspected even at the time of myomectomy. But within 24 hours after myomectomy, diagnosis of incarcerated gravid uterus was made by ultrasound.Outcomes:Incarcerated gravid uterus was found spontaneously reduced three weeks after myomectomy by ultrasound. A transverse Cesarean incision was performed at 32 weeks’ gestation. A male infant weighing 2120 g was delivered with Apgar scores of 10 and 10 at 1 and 5 minutes, respectively. Postoperative course was uneventful.Lessons:Incarceration of the gravid uterus is relatively rare and it is difficult to diagnose. This patient's findings suggested the incarceration of gravid uterus can be a transient abnormal position. The results of this study indicates that the incarcerated uterus when associated with fibroid is spontaneously reduced after removal of the fibroid.

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Spontaneous reduction of an incarcerated gravid uterus in the third trimester

Cited by 15 publications

References 20 publications

Incarcerated Gravid Uterus: Spontaneous Resolution Is Not Rare

Incarcerated Gravid Uterus: Spontaneous Resolution Is Not Rare

The Potential Role of Uterine Retroversion in Pelvic Pain Symptoms and Caesarean Delivery

Spontaneous reduction of an incarcerated gravid uterus after myomectomy in the second trimester

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