Obstet Gynecol Sci.  2018 Sep;61(5):621-625. 10.5468/ogs.2018.61.5.621.

Incarceration of early gravid uterus with adenomyosis and myoma: report of two patients managed with uterine reduction

• Kim HS
• Park JE
• Kim SY
• Kim JE
• Chae SH
• Sohn IS
• Hwang HS
• Kwon HS

• KMID: 2426028
• DOI: http://doi.org/10.5468/ogs.2018.61.5.621

Abstract

Although gravid uterine incarceration is typically diagnosed during the early second trimester, we encountered two unusual cases in early pregnancy. A 34-year-old multiparous woman with adenomyosis presented at 7 + 2 weeks of gestation with increased urinary frequency and a sensation of incomplete bladder emptying. The uterine incarceration was successfully reduced by manual reduction and pessary insertion, and she delivered a normal infant at term. In the second case, a 31-year-old nulliparous woman with a large myoma complained of dysuria, acute urinary retention, and intense back pain at 6 weeks of gestation. Manual reduction was successful in the knee-chest position. Subsequent pessary insertion failed; however, a slight reduction in pain was achieved. After a week, the fetus spontaneously aborted. In summary, gravid uterine incarceration is a rare but potentially fatal condition for the fetus, and a suspicion of this condition in patients with urinary symptoms, especially urinary retention and pelvic pain, is important in the early gestation period.

Keyword

Uterine disease; Myoma; Retroversion; Pregnancy

MeSH Terms

Adenomyosis*
Adult
Back Pain
Dysuria
Female
Fetus
Humans
Infant
Knee-Chest Position
Myoma*
Pelvic Pain
Pessaries
Pregnancy
Pregnancy Trimester, Second
Sensation
Urinary Bladder
Urinary Retention
Uterine Diseases
Uterus*

Figure

• 

  Fig. 1 Transvaginal ultrasound demonstrates (A) a retroverted gravid uterus with the gestational sac and; (B) anteverted gravid uterus after manual reduction. (C) Abdominal magnetic resonance imaging shows a retroverted gravid uterus. The cervix is elongated (arrows) and anteriorly displaced behind the pubic symphysis. (D) Retroverted uterus after vaginal delivery at 38 weeks with adenomyosis and a slightly thickened wall.

• 

  Fig. 2 (A) The uterus remained entrapped in the pelvis in the hollow of the sacrum with a posterior myoma. (B) Ultrasonography shows a large myoma after reduction (arrow: sacral promontory).

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