Incarcerated uterus in pregnancy – pitfalls of diagnosis, clinical course and therapy: two case reports

Česká verze

Authors: Lukáš Hruban ¹ ; Petr Janků ¹ ; P. Ventruba ¹; Romana Gerychová ¹; Vít Weinberger ¹ ; M. Pastorčáková ¹; A. Šprláková ²
Authors place of work: Gynekologicko-porodnická klinika MU a FN, Brno, přednosta prof. MUDr. P. Ventruba, DrSc., MBA ¹; Radiologická klinika MU a FN, Brno, přednosta prof. MUDr. V. Válek, CSc., MBA ²
Published in the journal: Ceska Gynekol 2013; 78(5): 427-431
Category: Původní práce

Summary

Objective:
Analysis of two cases of incarcerated uterus during pregnancy.

Design:
Two case reports.

Setting:
Department of Gynecology and Obstetrics, Masaryk University, University Hospital Brno.

Methods and results:
In two cases of incarcerated uterus, which were resolved on Department of Gynaecology and Obstetrics, University Hospital Brno is shown a different clinical course, leading to the detection and solutions at different gestational weeks. The first case was detected in 31st week of pregnancy and was characterized by nearly asymptomatic course in a pregnant woman with a scar in the lower uterine segment after a previous caesarean section. The delivery was scheduled for the end of the 36th week of pregnancy by iterative caesarean section. The second case was detected on the 27th week of pregnancy due to significant subjective difficulties of pregnant woman that impressed as acute event of abdomen. Despite all attempts at conservative therapy was necessary to terminate the pregnancy by caesarean section at 28 week of pregnancy due to the high risk of uterine rupture.

Conclusion:
Incarcerated uterus is a rare complication of pregnancy. Diagnostics complains varied clinical picture of the nonspecific subjective difficulties. Missed diagnosis can lead to a number of serious obstetric complications. In case of failure of conservative therapy and progression of difficulties is necessary to think about the real risk of uterine rupture. Before performing a caesarean section is essential knowledge of the mutual position of the lower uterine segment, urinary bladder and cervix.

Keywords:
retroverted uterus –⁠ uterine incarceration –⁠ uterine rupture –⁠ magnetic resonance imaging

Zdroje

1. Al Wadi, K., et al. Asymptomatic uterine incarceration at term: a rare complication of pregnancy. J Obstet Gynaecol Can, 2011, 33(7), p. 729–732.

2. Dierickx, I., et al. Colonoscopy-assisted reposition of the incarcerated uterus in mid-pregnancy: a report of four CASE and literature review. Eur J Obstet Gynecol Repris Biol, 2011, 158(2), p. 153–158.

3. Fernandes, D., et al. Sonographic and magnetic resonance imaging findings in uterine incarceration. J Ultrasound Med, 2012, 31, p. 645–650.

4. Frei, KA., et al. Posterior sacculation of the uterus in a patient presenting with flank pain at 29 weeks of gestation. Obstet Gynecol, 2005, 105, p. 639–641.

5. Gottschalk, EM., et al. Prenatal sonographic and MRI findings in pregnancy complicated by sterine sacculation: case report and review of the literature. Ultrasound Obstet Gynecol, 2008, 32, p. 582–586.

6. Hachisuga, N., et al. Significance of pelvic magnetic resonance imaging in preoperative diagnosis of incarcerated retroverted gravid uterus with a large anterior leiomyoma: a case report.J Reprod Med, 2012, 57(1–2), p. 77–80.

7. Hamoda, H. Conservative treatment of incarcerated gravid uterus. BJOG, 2002, 109, p. 1074–1075.

8. Inaba, F. Incarceration of the retroverted gravid uterus: the key to successful treatment. Arch Gynecol Obstet, 2005, 273, p. 55–57.

9. Rose, CH., et al. Expectant management of uterine incarceration from an anterior uterine myoma: a case report. J Reprod Med, 2008, 53(1), p. 65–66.

10. Yohannes, P. Ultrasound in acute urinary retention and retroverted gravid uterus. Ultrasound Obstet Gynecol, 2004, 23, p. 427.