Efficacy of well-planned management in patients with incarcerated gravid uterus: A case series and literature review.

OBJECTIVE: Incarcerated gravid uterus is a condition in which uterine myoma and intraperitoneal adhesion lead to persistent uterine retroversion. Accurate diagnosis before cesarean section is crucial so that the procedure can be planned with regard to the spatial relationship between the uterine incision and other organs. This study investigated the effects of well-planned management on the outcome of cesarean sections. MATERIALS AND METHODS: Four patients with incarcerated gravid uterus who received well-planned management and preoperative magnetic resonance imaging were compared with three unexpected patients who were operated without preoperative diagnosis. RESULTS: In the preoperatively diagnosed group, compared with the non-preoperatively diagnosed group, the frequency of cervical canal damage tended to be lower (0% vs. 100%), blood loss tended to be less (1171 ± 290 mL vs. 2000 ± 300 mL), and surgery duration tended to be shorter (82 ± 17 min vs. 147 ± 84 min). None of the preoperatively diagnosed cases required allogeneic blood transfusion, and no organ damage was observed. CONCLUSION: The early detection of a suspected incarcerated uterus, and a thorough understanding of diagnostic methods and the use of preoperative magnetic resonance imaging and ultrasonography facilitate the safe performance of a cesarean section.

Incarceration of the Gravid Uterus.

OBJECTIVE: The aim of this review was to describe the risk factors, clinical and radiographic criteria, and management of this rare complication of pregnancy. METHODS: A PubMed, Web of Science, and CINAHL search was undertaken with no limitations on the number of years searched. RESULTS: There were 60 articles identified, with 53 articles being the basis of this review. Multiple risk factors have been suggested in the literature including retroverted uterus in the first trimester, deep sacral concavity with an overlying sacral promontory, endometriosis, previous abdominal or pelvic surgery, pelvic or uterine adhesions, ovarian cysts, leiomyomas, multifetal gestation, uterine anomalies, uterine prolapse, and uterine incarceration in a prior pregnancy. The diagnosis is difficult to make owing to the nonspecific presenting symptoms. The diagnosis is clinical and confirmed by imaging. Magnetic resonance imaging is superior to ultrasound to accurately diagnose and elucidate the distorted maternal anatomy. Treatment is dictated by gestational age at diagnosis based on risks and benefits. The recommended route of delivery is cesarean delivery when uterine polarity cannot be corrected. CONCLUSIONS: Incarceration of the gravid uterus is a rare but serious complication of pregnancy. The diagnosis is clinical and confirmed with imaging, with magnetic resonance imaging being superior to delineate the distorted maternal anatomy. Reduction of the incarcerated uterus should be attempted to restore polarity and avoid unnecessary cesarean delivery.

Anteverted retroflexed uterus: a common consequence of cesarean delivery.

OBJECTIVE: The purpose of this study was to determine in a sequential unselected sample of nonpregnant women whether an anteverted retroflexed uterine position develops after cesarean delivery and to see whether the amount of myometrial thinning related to cesarean delivery affects the development of an anteverted retroflexed uterine position. MATERIALS AND METHODS: Images from 641 consecutive transvaginal ultrasound examinations performed between 2008 and 2011 in which a uterus was present were reviewed and archived. The series was analyzed in three groups: patients who underwent cesarean delivery, patients who were parous but had not undergone cesarean delivery, and patients who were nulliparous. The uterine axis was categorized as anteverted, anteverted and anteflexed, retroverted, retroverted and retroflexed, anteverted and retroflexed, retroverted and anteflexed, and axial, that is, in the same axis as the vagina. RESULTS: An anteverted retroflexed uterine position was found in 27% of women after cesarean delivery. It was rare when no cesarean section had been performed, being found in 1% of those women, and was not seen in nulliparous women. CONCLUSION: An anteverted retroflexed uterine position is a common consequence of cesarean delivery but is rarely seen in other parous women.