Uterine incarceration

Uterine incarceration may be a rare complication of pregnancy that typically presents within the late first or early trimester but are often seen later in gestation. The growing uterus may become wedged between the sacral promontory and pubic symphysis, preventing the expected transition to an abdominal organ. This compression leads to symptoms of urinary retention, abdominal pain, constipation, and rectal pressure. A high index of suspicion is essential; these symptoms should be evaluated with a pelvic examination and an ultrasound or resonance imaging (MRI).

Early diagnosis and treatment are critical to optimize pregnancy outcomes. Management becomes harder as pregnancy progresses thanks to increased maternal and fetal risks. Early pregnancy management is nonsurgical and includes knee to chest maneuvers or manual reduction through the vagina or rectum. Colonoscopic reduction has been described. When less invasive options fail, surgical reduction may be required. If the pregnancy has progressed to term, cesarean delivery is recommended. Obstetric complications include preterm labor, premature rupture of membranes, labor dystocia, spontaneous abortion, and intrauterine fetal demise. At the time of caesarean delivery , failure to acknowledge uterine incarceration may end in inadvertent injury to the vagina, cervix, or bladder. Non-obstetric complications include venous stasis secondary to compression, hypertension, edema, and increased risk of venous thromboembolism and pulmonary embolus. Urinary obstruction may be a frequent finding and should require urologic consult and intervention. Reviewed here are the key clinical findings, diagnostic adjuncts, and treatment strategies to care for these patients and minimize maternal and fetal morbidity and mortality.

Causes

A number of situations may interfere with the natural action that might antevert a retroverted uterus during pregnancy. Such situations include pelvic adhesions, endometriosis, uterine malformations, leiomyomata, and pelvic tumors.

Diagnosis

In a pregnant woman who is entering her trimester , the mixture of urinary difficulties and pelvic pain may alert the physician to think about uterine incarceration as an opportunity . On physical examination, the cervix is pushed up and anterior, and therefore the pelvis entirely filled by the soft mass of the body of the pregnant uterus. Sonography may indicate the retroverted position of the uterus, check on the viability of the fetus, and demonstrate the situation of the bladder being pushed cranially and unable to be emptied.[4] Also resonance imaging has been found to be helpful within the diagnosis of the condition.

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