Incarcerated Gravid Uterus: Spontaneous Resolution Is Not Rare.

Daisuke Tachibana,Yasushi Kurihara,Kohei Kitada,Mie Tahara,Masayasu Koyama,Akemi Nakano,Takuya Misugi,Akira Yamamoto,Akihiro Hamuro

doi:10.3390/diagnostics11091544

Daisuke Tachibana, Yasushi Kurihara + Show 7 more

Open Access

https://doi.org/10.3390/diagnostics11091544

Copy DOI

Journal: Diagnostics	Publication Date: Aug 25, 2021
Citations: 9	License type: CC BY 4.0

Affiliation: Osaka City University

Abstract

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.

Highlights

Uterine retroversion or retroflex is observed in 15% of pregnant women during the first trimester, and a majority will spontaneously resolve before 14 weeks of gestation [1]
Incarcerated gravid uterus after 16 gestational weeks was diagnosed in 14 cases, and spontaneous resolution was recognized in 11 cases
Our study demonstrated that roughly one pregnancy in 2300 deliveries remained complicated with incarcerated uterus, at term or near term, if manual reduction was not performed

Summary

Introduction

Uterine retroversion or retroflex is observed in 15% of pregnant women during the first trimester, and a majority will spontaneously resolve before 14 weeks of gestation [1]. If the uterine fundus remains in the pelvic cavity without self-correction after 16 weeks, the condition is said to be incarcerated. Incarcerated gravid uterus is a rare condition, occurring in approximately 1 in 3000 pregnancies [2]. Proposed risk factors are endometriosis, pelvic inflammatory disease, previous abdominal or pelvic surgery, fibroid, uterine anomaly, and uterine retroversion prior to pregnancy [1,2]. Symptoms of uterine incarceration during pregnancy are thought to be non-specific, such as pelvic discomfort, urinary retention, and gastrointestinal symptoms, and some patients are asymptomatic altogether [1,3,4]. If a gravid uterus remains to be incarcerated, adverse outcomes, such as urinary retention, renal failure, miscarriage, preterm labor, and thrombosis, can be anticipated [3,5,6,7,8]

Objectives

Methods

Results

Conclusion