The incarcerated gravid uterus: complications and lessons learned.

BACKGROUND: Incarcerated uterus is a rare but serious complication. CASES: Two women presented with second trimester urinary retention. Neither received a pelvic examination at presentation, which led to a delay in diagnosing the incarcerated uterus. Patient 1 had development of acute renal failure, hypertension, and edema. After uterine reduction there was rapid normalization of renal function, hypertension, and edema, but spontaneous rupture of membranes and intrauterine death occurred 12 hours later. Patient 2 had reduction under anesthetic and subsequently underwent cesarean delivery at term. However, at 7 months postpartum, the patient continued to have high postvoid residual volumes. CONCLUSION: Women presenting with urinary retention in the second trimester should have a pelvic examination performed to exclude uterine incarceration. Earlier recognition and appropriate treatment may have altered the outcome for the two patients presented.

Quantification of free fetal DNA in multiple pregnancies and relationship with chorionicity.

OBJECTIVE: Free fetal DNA (ffDNA) in the maternal plasma appears to originate mainly from the trophoblast. We tested the hypothesis that ffDNA concentration is increased in multiple pregnancies where trophoblastic mass has been shown to be increased. METHODS: Quantitative real-time PCR was used to measure the plasma concentration of DYS14 in singleton and twin pregnancies with one or two male fetuses. Royston and Wright's regression method was used to relate ffDNA to gestational age in singleton controls; z-scores were calculated for the multiple pregnancy subgroups. RESULTS: Fifty-five singleton and 65 twin pregnancies (36 with one and 29 with two male fetuses) were analysed. There was significantly higher ffDNA concentration in twin pregnancies with two male fetuses compared with pregnancies with one male fetus. In cases with two male fetuses, there was no statistically significant difference between monochorionic and dichorionic pregnancies. CONCLUSIONS: There is higher ffDNA concentration in multiple pregnancies, and this must be taken into account for future quantitative ffDNA applications.