TY - JOUR
T1 - Incarcerated gravid uterus
T2 - a new treatment using the transvaginal ultrasound probe and narrative literature review
AU - Kantorowska, Agata
AU - Patberg, Elizabeth T.
AU - Ali, Fatima
AU - Suhag, Anju
AU - Rekawek, Patricia
AU - Vintzileos, Anthony M.
AU - Chavez, Martin R.
N1 - Publisher Copyright:
© 2024 Elsevier Inc.
PY - 2024
Y1 - 2024
N2 - Background: ‘Incarcerated gravid uterus’ is a morbid complication that occurs in 1 in 3000 pregnancies. It is characterized by failure of a retropositioned uterus to become an abdominal organ between 12 to 14 weeks of gestation. If maternal symptoms develop or gestational age surpasses 14 to 16 weeks, replacement of a retropositioned uterus is recommended to reduce adverse outcomes. Previously described techniques for management include passive reduction, digital replacement, or more invasive methods such as laparoscopy, laparotomy, or sigmoidoscopy. These methods are either minimally effective, painful, or risky. Objective: The objective of this report is to describe our clinical experience with a new minimally invasive technique that uses the transvaginal ultrasound probe for uterine replacement in cases of incarceration, to conduct a narrative literature review on ‘incarcerated gravid uterus,’ and to propose an algorithm for management of this condition. Study Design: This is a case series of 8 patients with an incarcerated gravid uterus who were managed with the transvaginal ultrasound probe technique at one academic medical institution between March 2020 and July 2023, as well as a narrative review of the literature on ‘incarcerated gravid uterus.’ PubMed, Google Scholar, and Ovid MEDLINE databases were searched for the terms “incarcerated gravid uterus,” “uterine incarceration,” “uterine sacculation,” and “retroverted uterus” up to April 2024. Results: The transvaginal ultrasound probe technique resulted in successful uterine replacement, with resolution of symptoms, in all 8 patients. All pregnancies resulted in live births with good neonatal outcomes—7 out of 8 patients delivered at term, and 1 delivered in the late preterm period. Conclusion: Our proposed technique for treatment of an incarcerated gravid uterus with the transvaginal ultrasound probe is simple, minimally invasive and effective. Based on our experience and the narrative literature review, an algorithm for the management of an incarcerated gravid uterus is proposed.
AB - Background: ‘Incarcerated gravid uterus’ is a morbid complication that occurs in 1 in 3000 pregnancies. It is characterized by failure of a retropositioned uterus to become an abdominal organ between 12 to 14 weeks of gestation. If maternal symptoms develop or gestational age surpasses 14 to 16 weeks, replacement of a retropositioned uterus is recommended to reduce adverse outcomes. Previously described techniques for management include passive reduction, digital replacement, or more invasive methods such as laparoscopy, laparotomy, or sigmoidoscopy. These methods are either minimally effective, painful, or risky. Objective: The objective of this report is to describe our clinical experience with a new minimally invasive technique that uses the transvaginal ultrasound probe for uterine replacement in cases of incarceration, to conduct a narrative literature review on ‘incarcerated gravid uterus,’ and to propose an algorithm for management of this condition. Study Design: This is a case series of 8 patients with an incarcerated gravid uterus who were managed with the transvaginal ultrasound probe technique at one academic medical institution between March 2020 and July 2023, as well as a narrative review of the literature on ‘incarcerated gravid uterus.’ PubMed, Google Scholar, and Ovid MEDLINE databases were searched for the terms “incarcerated gravid uterus,” “uterine incarceration,” “uterine sacculation,” and “retroverted uterus” up to April 2024. Results: The transvaginal ultrasound probe technique resulted in successful uterine replacement, with resolution of symptoms, in all 8 patients. All pregnancies resulted in live births with good neonatal outcomes—7 out of 8 patients delivered at term, and 1 delivered in the late preterm period. Conclusion: Our proposed technique for treatment of an incarcerated gravid uterus with the transvaginal ultrasound probe is simple, minimally invasive and effective. Based on our experience and the narrative literature review, an algorithm for the management of an incarcerated gravid uterus is proposed.
KW - adverse pregnancy outcomes
KW - impacted uterus
KW - miscarriage
KW - pregnancy complications
KW - retroflexed
KW - retropositioned uterus
KW - retroverted
KW - second trimester intrauterine fetal death
KW - transvaginal ultrasound
KW - ultrasound probe
KW - uterine entrapment
KW - uterine sacculation
UR - http://www.scopus.com/inward/record.url?scp=85204344629&partnerID=8YFLogxK
U2 - 10.1016/j.ajog.2024.08.026
DO - 10.1016/j.ajog.2024.08.026
M3 - Article
C2 - 39181496
AN - SCOPUS:85204344629
SN - 0002-9378
JO - American Journal of Obstetrics and Gynecology
JF - American Journal of Obstetrics and Gynecology
ER -