Asymptomatic Patient With Incarcerated Gravid Uterus Diagnosed in the Third Trimester: A Case Report of a Rare Potential Obstetric Emergency.

Incarcerated gravid uterus (IGU) is a rare condition that occurs when a retropositioned gravid uterus becomes entrapped within the pelvic cavity. Most patients present around the 17th week of pregnancy with symptoms such as pelvic fullness, urinary incontinence, abdominal pain, constipation, and vaginal bleeding. Rarely, patients are asymptomatic throughout pregnancy, leaving IGU undiagnosed and untreated. Here, we present an asymptomatic 26-year-old female who presented at 30 weeks of gestation with severe intrauterine growth retardation (IUGR) on serial obstetric ultrasounds. Further evaluation with ultrasound and MRI revealed an incarcerated uterus. This was complicated by severe fetal IUGR, abnormal biophysical profile, and oligohydramnios. This case highlights the importance of early diagnosis and treatment of IGU in order to prevent complications associated with the condition. Clinicians should be aware that, although uncommon, patients with IGU may be asymptomatic and that diagnosis should depend primarily on imaging findings rather than symptoms.

Incarcerated gravid uterus - A systematic review.

Incarcerated gravid uterus (IGU) is a serious complication of pregnancy that leads to adverse obstetric outcomes. The aim of this review was to describe this entity in detail. We also aimed to understand if pregnancies with predisposing risk factors that increase the risk of developing IGU had a difference in their clinical manifestations, treatment, and obstetric outcomes. The PubMed, MEDLINE, Embase, Scopus databases and clinicaltrials.gov were searched from inception to July 2023. Case reports and series that provided all the details of the pregnancy and IGU outcome were included. Study quality and risk of bias were assessed using a tool that is an adaptation from criteria listed by Pierson, Bradford Hills and Newcastle Ottawa scale modification. Patients with the condition of interest included in this review were grouped into those with documented, identified risk factors and no risk factors. The two groups were compared to understand the difference in obstetric outcome and presentation of IGU. Data were analyzed and summarized descriptively, categorical variables were assessed by chi-squared test or Fisher's exact test, and continuous variables by the Wilcoxon Mann Whitney test. Of 236 articles found, 62 articles with 80 cases were included in the final analysis. The median age was 32 [27-35] years. The median gestational age of diagnosis was 17 [14-26] weeks. The most common risk factor was fibroids (N = 22, 27.5 %). Most common presentation was urinary complaints and lower abdomen pain (N = 47, 58.6 %). Twenty-seven patients (33.6 %) needed more than one visit for the diagnosis to be made. Conservative management was the first step to treat IGU in most patients. Most common complication was fetal malpresentation (N = 13, 40.6 %). Patients with or without risk factors developing IGU had no statistical difference in- parity, median gestational age of diagnosis, delay in diagnosis, increased chance of misdiagnosis, management of IGU or in obstetric outcome (all p > 0.05). It is important to recognize this entity early to prevent obstetric complications especially when patients report urinary retention and abdomen pain. The presence of risk factors does not change the management course or obstetric outcome in patients with IGU. Hence it is reasonable to start with conservative management of IGU regardless of presence of risk factors or the gestational age of diagnosis, in clinical practice.

Incarcerated Gravid Uterus in a Nulliparous Female Presenting With Urinary Hesitancy and Rectal Pressure: A Case Report.

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.

Pregnancy, delivery, and neonatal outcomes among women with incarcerated uteri: A population-based study of a large US database.

OBJECTIVE: Incarcerated uterus occurs at a rate of 1:3000 pregnancies. Previous studies focused on risk factors and management options, providing limited information about pregnancy outcomes. This study evaluates the effect of incarcerated uterus on pregnancy, delivery, and neonatal outcomes. METHODS: Retrospective study using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample from 2004 to 2014. Incarcerated uterus was identified using ICD-9 code 654.3X. Multivariate logistic regression analysis was used to compare maternal and neonatal outcomes among women with and without incarcerated uterus while adjusting for confounders. RESULTS: Incarcerated uteri were identified in 370 pregnancies, and 9,096,418 pregnancies were control cases. Compared to controls, women with incarcerated uterus were more likely to be Caucasian, have smoked during pregnancy, have had a previous caesarean section, have thyroid disease, endometriosis, leiomyomas, pelvic inflammatory disease and adhesions, and ovarian cyst (P-value < 0.05 all). Women with incarcerated uterus were more likely to have placenta previa (aOR 3.1, 95% CI 1.3-7.4), deliver by caesarean section (aOR 2.4, 95% CI 1.8-3.1), have postpartum hemorrhage (aOR 2.8, 95% CI 1.8-4.4), and require blood transfusion (aOR 5.2, 95% CI 3.1-8.8). Hydronephrosis occurred more often in women with incarcerated uterus (0.8% versus 0.1%). Moreover, they were more likely to have infants with congenital anomalies (aOR 4.0, 95% CI 1.5-10.6). Rates of preeclampsia, preterm birth, and small for gestational age were similar between the two groups (P-value > 0.05, all). CONCLUSION: Women with incarcerated uterus were more likely to encounter adverse delivery and neonatal outcomes compared to the general population. These findings may help guide prenatal counseling and prenatal surveillance.

Clinical Tips of Cesarean Section in Case of Breech, Transverse Presentation, and Incarcerated Uterus.

Cesarean section in breech or transverse presentation involves more complicated procedures than cesarean section in cephalic presentation because the former requires additional manipulations for guiding the presenting part of the fetus, liberation of the arms, and the after-coming head delivery; therefore, those cesarean sections are likely to be more invasive. Making a rather wide uterine incision to prevent uterine injury during delivery of the fetus facilitates smooth delivery of the fetus. Furthermore, in cases of breech or transverse presentation, it is important to initially identify the presenting part of the fetus and guide it to the incision opening in the lower uterine segment, because delivering the presenting part of the fetus first is a basic rule of delivery of the fetus. Smooth delivery of the fetus by means of breech extraction can prevent excessive stress or injury to the fetus. Therefore, it is important to acquire the knowledge and skills necessary to perform these techniques, including the internal version. Smooth delivery of the fetus is also less invasive for the mother because an extension of the uterine excision or injury to arteries and veins in the uterus and parametrium can be avoided. Incarcerated uterus occurring in cases of pregnancy with intrapelvic adhesion, endometriosis, cervical myoma, or extended cervix may result in excessive uterine and cervical injury when a transverse incision of the lower uterine segment is performed without caution. These conditions may result in difficulty in fetal delivery. Therefore, it is important to identify risks in advance and to choose the incision line with great care. Countermeasures for difficult delivery of the fetus need to be mastered by all practitioners of obstetrics. If the transverse incision fails to reach the uterine cavity, an inverted T-shaped or J-shaped incision should be made. Risks of complications such as injury to the cervical canal, the vagina, the bladder or ureter, and massive hemorrhage must be kept in mind.

Surgical management of an incarcerated uterus in a gynecological patient: A case report.

Uterine incarceration is most often described as occurring in pregnancies. Presenting with severe pelvic pain, urinary retention, and in some cases spontaneous abortion, this complication often arises at 12-15 weeks of gestational age. Although usually considered an obstetrical complication, uterine incarceration can occur in nongravid females. This case report presents a gynecological patient with acute urinary retention secondary to uterine incarceration. The patient chose surgical management, and surgery provided immediate symptomatic relief. Our case highlights an uncommon etiology of acute urinary retention and demonstrates the importance of considering the diagnosis of uterine incarceration in nongravid as well as gravid females.

Spontaneous reduction of an incarcerated gravid uterus in the third trimester.

An incarcerated gravid uterus is an uncommon complication of pregnancy. On rare occasions, an incarcerated gravid uterus resolves spontaneously even in the third trimester of pregnancy. Severe abdominal pain might be caused by spontaneous reduction and should be considered as a possible cause.

Unusual complications of incisional hernia.

Incisional hernia represents a breakdown or loss of continuity of a fascial closure. These hernias are of particular concern not only for the high recurrence rates among them but also for the challenges that follow their repair. It is known to occur in 11-23% of laparotomies. This paper presents two unusual complications of incisional hernia managed by the authors. One ruptured incisional hernia with evisceration of gut and a case of incarcerated gravid uterus in a woman in labour. The case records of the two patients with unusual complications of incisional hernia were pooled and presented to highlight the clinical presentation and management options of this condition. The patient with ruptured hernia and eviscerated gut presented immediately and was resuscitated and the hernia repaired with polypropylene mesh. The patient with incarcerated uterus had caesarean section and mesh repair of the hernia. Incisional hernia can present with unusual complications. The management is very challenging. Good knowledge and skills are required to deal with this condition.

Incarcerated fibroid uterus: the role of conservative management.

BACKGROUND: Uterine incarceration occurs when the gravid uterus remains trapped within the sacral hollow and cannot ascend out of the pelvis as it enlarges. Predisposing factors include uterine fibroids. Optimal management of uterine incarceration involves manual reduction of the uterus because of the significant maternal and fetal risks associated with persistent incarceration. CASE: A nulliparous woman with known uterine incarceration secondary to a large anterior uterine fibroid was managed conservatively throughout her pregnancy after attempts at manual reduction were unsuccessful. CONCLUSION: Conservative management of the incarcerated uterus is a reasonable option if attempts at manual reduction are unsuccessful. Magnetic resonance imaging can be helpful in delineating anatomy and planning for delivery.

Contexte : On parle d'incarcération utérine lorsque l'utérus d'une femme enceinte demeure coincé dans le creux du sacrum et ne peut cheminer hors du bassin au fur et à mesure de son expansion. La présence de fibromes utérins fait partie des facteurs prédisposants. La prise en charge optimale de l'incarcération utérine met en jeu la réduction manuelle de l'utérus, et ce, en raison des risques maternels et fœtaux considérables qui sont associés à la persistance de l'incarcération. Cas : Une nullipare, chez qui la présence d'une incarcération utérine attribuable à un gros fibrome utérin antérieur était connue, a fait l'objet d'une prise en charge conservatrice tout au long de sa grossesse, après l'échec de tentatives de réduction manuelle. Conclusion : La prise en charge conservatrice de l'incarcération utérine constitue une option raisonnable à la suite de l'échec de tentatives de réduction manuelle. L'imagerie par résonance magnétique peut s'avérer utile pour situer l'anatomie et planifier l'accouchement.