ﺑﺎﺯﮔﺸﺖ ﺑﻪ ﺻﻔﺤﻪ ﻗﺒﻠﯽ
خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
نسخه الکترونیک
medimedia.ir

Incarcerated gravid uterus

Incarcerated gravid uterus
Literature review current through: Jan 2024.
This topic last updated: Nov 23, 2022.

INTRODUCTION — The term "incarcerated gravid uterus" refers to a pregnant uterus that is trapped between the sacral promontory and pubic symphysis. This topic will discuss the pathophysiology, risk factors, clinical presentation, diagnosis, complications, and management of this rare condition. The literature about incarcerated pregnant uterus consists primarily of single case reports; thus, there is a lack of high-quality evidence to guide management.

PREVALENCE — Incarcerated uterus has been reported to occur in 1 in 3000 to 10,000 pregnancies [1].

PATHOPHYSIOLOGY — The uterus is retroverted (and/or retroflexed) in up to 20 percent of pregnancies [2]. As the uterus enlarges during pregnancy, the retroverted/retroflexed fundus normally rises from the hollow of the sacrum to an anterior ventral position, spontaneously correcting any retroposition. In rare cases, however, the fundus becomes wedged below the sacral promontory, where it can continue to enlarge for a period of time [3]. The cervix becomes displaced cephalad against or above the symphysis pubis and pushes against the urethra and bladder, which can interfere with normal voiding.

As the pregnancy progresses beyond 20 weeks of gestation, the posterior pelvis becomes too small to allow further fundal enlargement, so the anterior lower uterine wall begins to thin and balloon into the upper abdomen, developing a sacculation to accommodate the products of conception [4]. This is termed "inverted polarity" because the anterior lower uterine wall becomes cephalad to the fundus, which is posterior-caudal. Concomitantly, both the bladder and the cervix are pulled up into the abdominal cavity toward the umbilicus. The cervix can stretch to 10 cm or more in length, such that the internal os becomes located above the symphysis pubis and occasionally above the bladder [5]. Normal and incarcerated anatomy are shown in the figures (figure 1A-B).

RISK FACTORS — Any condition that may inhibit the fundus of the enlarging uterus from ascending out of the sacral hollow is a risk factor for incarceration. The most common of these conditions include [4,6-8]:

Persistent retroflexion leading to entrapment of the fundus.

Fixation of the uterus posteriorly due to adhesions related to previous pelvic surgery, pelvic inflammatory disease, or endometriosis.

Large fibroids (typically fundal or posterior).

Uterine malformation (eg, uterus didelphys, bicornuate uterus).

Deep sacral concavity with an overhanging sacral promontory.

Multifetal gestation.

Ovarian cysts.

Prior uterine incarceration.

Incarceration can also occur in the absence of risk factors [3].

CLINICAL FEATURES

Early suggestive findings — One or more of the following clinical findings should raise suspicion of an incarcerated uterus [9]:

A first-trimester uterus that is difficult to palpate abdominally

A second-trimester uterus in which the fundal height lags behind that expected for gestational age

Difficulty identifying the cervix on a routine transabdominal ultrasound examination  

Urinary retention (See 'Urinary tract obstruction' below.)

Patient presentation

Timing – Most patients present at 14 to 16 weeks of gestation with symptoms, often vague, related to pressure on the anatomic structures adjacent to the entrapped enlarging uterus. Initial presentation in the third trimester is rare; only a few dozen cases have been reported [10]. Cases of asymptomatic uterine incarceration are even rarer [11-14]. Postpartum presentation is also rare and has been attributed to uterine enlargement combined with flaccid supporting tissues and other unknown factors [15].

Symptoms

Pain and urinary symptoms are the most common symptoms.

-Pain may be abdominal, suprapubic, or in the back. It may be severe or limited to pelvic discomfort or a feeling of pelvic fullness. It may be continuous or intermittent, resolving and then returning weeks later.

-Urinary symptoms tend to become progressively worse, and eventually, urinary retention occurs. Urinary symptoms include frequency, dysuria, sensation of incomplete emptying, and dribbling small volumes due to overflow incontinence. (See 'Urinary tract obstruction' below.)

Gastrointestinal symptoms are due to rectal compression and include rectal pressure, tenesmus, and worsening constipation [4,6].

Vaginal bleeding may occur.

Physical examination — The key finding on physical examination is severe anterior displacement of the cervix behind the pubic symphysis, such that the clinician may not be able to visualize the cervix with a speculum or palpate the external os on vaginal examination [2]. The vagina is angulated anteriorly (instead of the normal posterior angulation), and a large, soft, smooth, nontender mass (the incarcerated uterus) fills the cul-de-sac.

The fundus is not palpable abdominally, but the abdomen may appear to be distended due to an overdistended bladder. (See 'Urinary tract obstruction' below.)

DIAGNOSIS — A clinical diagnosis of incarcerated uterus can be made based on symptoms (pain, difficulty voiding) and physical examination (severe anterior displacement of the cervix behind the pubic symphysis combined with a mass in the cul-de-sac). A definitive diagnosis is made when the characteristic constellation of anatomic findings depicted in the figure (figure 1B) and described below is documented on transabdominal ultrasound examination in the second (or third) trimester [2,16].

Magnetic resonance imaging (MRI) with either T1- or T2-weighted images can be used to confirm uterine incarceration in cases of diagnostic uncertainty, especially later in pregnancy [1,17]. It also clarifies anatomic relationships, which can be severely distorted, and may suggest the etiology of the incarceration.

Findings on ultrasound — The following findings are diagnostic of incarcerated uterus; all should be present:

The cervix is obscured or appears thin and elongated, and is pulled anterior to the uterus (image 1 and image 2) so that it is between the bladder and the pregnancy.

The bladder is displaced superiorly and elongated from compression by the cervix and uterus; thus, it lies anterior rather than inferior to the uterine corpus.

The fundus is located in the hollow of the sacrum, filling the posterior pelvis below the sacral promontory.

Sonographic pitfalls

The abnormally located cervix may be mistaken for an empty uterus associated with an ectopic or abdominal pregnancy in which the fetus is posterior and against the sacrum deep in the pelvis.

Because the fundus is located in the hollow of the sacrum, a fundal placenta may be mistaken for a low-lying placenta.

Findings on magnetic resonance imaging — The multiplanar imaging capabilities and excellent tissue contrast with MRI provide excellent images of the bladder, uterine walls, and cervix with respect to the bony pelvis. On T2-weighted imaging, the incarcerated uterus has the following findings [9,16,18]:

The fundus is a multilayered structure located deep in the posterior pelvis, below the sacral promontory.

The cervix is a hypointense linear, thinned, elongated structure positioned cranially and ventrally along the anterior aspect of the retropositioned uterus and parallel to the vagina.

The bladder is displaced anteriorly or superiorly and may be positioned above the pubic symphysis.

DIFFERENTIAL DIAGNOSIS — Differential diagnosis of the physical findings includes [19]:

A pelvic or adnexal mass extending into the cul-de-sac (eg, extrauterine pregnancy, adnexal torsion, appendiceal abscess).

A posterior fibroid.

Uterine anomaly (eg, uterus didelphys, unconnected rudimentary horn).

These conditions are generally excluded by transabdominal and transvaginal ultrasound examination. Magnetic resonance imaging is helpful when anatomic findings are uncertain on ultrasound imaging.

COMPLICATIONS

Urinary tract obstruction — It is important that any patient presenting with urinary retention in the second trimester undergo a pelvic examination to exclude incarcerated uterus. Cephalad displacement of the cervix and upper vagina lifts the bladder neck and compresses the urethra, frequently causing urinary retention, sometimes with hydronephrosis. Urinary retention can lead to urinary tract infection and, rarely, bladder rupture [6].

The ureters can also be compressed between the incarcerated gravid uterus and the psoas muscles. In an historic 1894 review, Gottschalk described 67 cases of incarcerated sacculated uterus resulting in uremia, sepsis, peritonitis, and, ultimately, maternal death [20]; however, such severe outcomes would be rare in contemporary practice. In a 2014 case report in which the presenting symptom of uterine incarceration was urinary retention at 17 weeks, the patient went on to develop hypertension (170/110 mmHg), renal insufficiency (creatinine 2.4 mg/dL), and severe lower leg edema that impaired ambulation before the uterus was disimpacted at 23 weeks of gestation [21].

Other complications

Obstetric – Malposition of the uterus can compromise uterine arterial blood flow, increasing the risk for decidual hemorrhage, miscarriage, oligohydramnios, fetal growth restriction, and fetal demise [11]. The rate of second-trimester pregnancy loss has been reported to be as high as 33 percent [3,4]. There also appears to be increased risks of prelabor rupture of membranes and preterm birth [11].

Other obstetric complications described in case reports include uterine wall necrosis, uterine rupture, development of a cervicovaginal fistula, and placenta accreta spectrum [6,8].

Dystocia during labor inevitably occurs. (See 'Delivery' below.)

Vascular – Compression of pelvic veins may promote thrombosis, resulting in postpartum pulmonary embolism in the absence of thrombosis in the deep veins of the lower limbs [10].

Urinary tract – Bladder ischemia, atony [8] and rupture, hydronephrosis, and renal failure.

Gastrointestinal – Rectal ischemia and gangrene, peritonitis.

MANAGEMENT

Uterine retroversion before 14 weeks: Expectant management and follow-up — When we identify retroposition of the uterus in the first trimester (when retroversion/retroflexion can be normal), we repeat the bimanual examination at 16 weeks to determine whether the fundus has ascended into the abdominal cavity.

Uterine incarceration at 14 to 20 weeks of gestation: Reduction — A uterus that remains retropositioned into the second trimester is abnormal (incarcerated). We perform reduction in these cases between 16 and 20 weeks for relief of maternal symptoms, if present, and to prevent future symptoms and complications related to the incarcerated uterus. (See 'Complications' above.)

Choosing a reduction technique — Many techniques have been utilized for freeing the uterus: the simplest maneuvers should be attempted first, progressing to more invasive techniques, if required. Because uterine incarceration is rare, particularly late in pregnancy, options for management are based on the approaches described in case reports. Thus, it is not possible to quantify the risk to the pregnancy from these procedures, but it is probably low.

Passive reduction — The patient is instructed to empty their bladder and assume the knee-chest position for 10 minutes at least three times per day for one week. If spontaneous voiding is impaired, a catheter is placed to decompress the bladder until the incarceration is resolved.

Although described in the literature, this approach is unlikely to be successful in symptomatic cases. If it fails to relieve the incarceration within one week, we attempt manual reduction [22]. If the patient's symptoms are too bothersome to allow waiting a full week for a trial of passive reduction, then manual reduction can be attempted without waiting.

Manual reduction — Manual reduction can be attempted in the office or performed in a setting where moderate procedural sedation (the patient responds purposefully to verbal commands alone or when accompanied by light touch), regional, or general anesthesia can be administered if pain management is needed [23]. Disadvantages of anesthesia are that it precludes use of some maternal positions and removes pain as a sign of excessive force during the reduction. Some clinicians administer a uterine relaxant drug (eg, nitroglycerin) before the procedure. (See "Procedural sedation in adults in the emergency department: General considerations, preparation, monitoring, and mitigating complications".)

The procedure is described below; use of sonographic guidance during manipulation of the uterus may be helpful [24]:

The patient empties their bladder, or a catheter is used to empty the bladder.

The patient is placed in the dorsal lithotomy position with feet in stirrups.

The clinician uses their fingertips to apply mild-to-moderate cephalad pressure to the uterine fundus through the posterior fornix until the fundus is released from the cul-de-sac; a finger in the rectum can also be used to apply pressure.

If feasible, a ring forceps can be applied to the cervix and gently pulled toward the introitus to provide countertraction while the fundus is being pushed cephalad.

If these maneuvers are unsuccessful, the patient is placed in knee-chest (Sims) or all fours position, and the procedure is repeated.

If still unsuccessful, the maneuvers can be repeated in one week [4,6].

Colonoscopic/sigmoidoscopic reduction — If manual reduction fails, a colonoscope or flexible sigmoidoscope can be used to reduce uterine incarceration, but data are limited to nine cases of which eight were successful [25,26]. Colonoscopic reduction should only be performed by an experienced endoscopist.

The procedure has been described as follows [25,26]:

The bowel is evacuated with one or two enemas.

Procedural sedation is administered.

The patient is placed in the left lateral decubitus position.

A colonoscope or flexible sigmoidoscope is passed through the sigmoid colon to above the level of the uterine fundus, which releases the incarceration.

The authors of the case reports hypothesized that air insufflation during the procedure, together with the formation of the loop (which routinely occurs as the instrument is advanced through the sigmoid colon), have a synergistic effect by creating sufficient anterior pressure through the wall of the rectum and onto the uterine fundus to dislodge it from beneath the sacral promontory, thus facilitating the reposition.

Balloon — In a single case report, the combination of an intravaginal balloon filled with 300 mL of saline and manual cephalad-directed pressure on the balloon liberated an incarcerated uterus at 14 weeks gestation in a patient with urinary retention and acute renal failure [27]. The clinicians used real-time ultrasound imaging during the procedure to make adjustments to the balloon's position and volume. The balloon, deflated to 250 mL, was left in place for two hours postprocedure. No recurrence occurred. Although the other options in this topic are based on series with multiple successful cases, some clinicians might consider a trial of a vaginal balloon, which is unlikely to be harmful.

Laparoscopic reduction — If the techniques described above fail, a more invasive approach will be necessary. Release of the incarcerated uterus can be approached laparoscopically under general anesthesia.

After pneumoperitoneum is achieved, vaginal maneuvers for manual reduction are again attempted. (See 'Manual reduction' above.)

If unsuccessful, the round ligaments are grasped with atraumatic instruments by an assistant and pulled to free the fundus, concurrently with manual pressure on the fundus from below. (See "Laparoscopic surgery in pregnancy".)

Laparotomy is rarely needed. However, if incarceration is due to the presence of dense adhesions, treatment must be individualized.

Postreduction care — A postprocedure ultrasound examination is useful to confirm uterine position and fetal well-being.

Once the uterus is freed, it almost always remains in the correct abdominal location without further support; however, some authors suggest placing a Hodge pessary in the vagina for five to seven days to help ensure that the uterus maintains its upright anterior position [4,6]. Recurrence at 15 weeks after successful colonoscopic reduction at 13 weeks has been reported [25].

Uterine incarceration after 20 weeks of gestation — When the diagnosis of uterine incarceration is initially made after 20 weeks of gestation and the patient is asymptomatic or has only mild symptoms, reduction is generally avoided because attempts at uterine release in the second half of pregnancy are unlikely to be successful and can cause serious complications (eg, pregnancy loss [3,22]), although at least two successful cases have been reported at 21 and 22 weeks (one via colonoscopy, one via manual reduction under general anesthesia) [24,26]. Spontaneous resolution rarely occurs [28].

Management includes:

Supportive care – Urinary retention commonly occurs and is treated by intermittent self-catheterization, if possible [5,29]. Otherwise, an indwelling catheter is placed.

Analgesia can be provided as a comfort measure to enable prolongation of the pregnancy. Acetaminophen is the preferred analgesic as use of nonsteroidal anti-inflammatory drugs for over 48 hours can be associated with adverse fetal effects, particularly in the third trimester (see "Inhibition of acute preterm labor", section on 'Fetal side effects'). The patient should be evaluated if severe pain develops as this may be indicative of a serious complication, such as uterine wall necrosis, impending uterine rupture, or rectal gangrene, and thus may require prompt laparotomy. On the other hand, case reports have described sudden onset of severe lower abdominal pain in the third trimester related to spontaneous resolution of the incarceration [28].

Monitoring for pregnancy complications – The pregnancy is monitored for development of complications, such as preterm labor, prelabor rupture of membranes, oligohydramnios, and fetal growth restriction, which are more common with an incarcerated uterus and often lead to early delivery [4]. In one review, only 21 percent of persistent cases reached term [30].

DELIVERY

Route — Vaginal birth is always contraindicated when the uterus is incarcerated since displacement of the cervix impedes normal progression of labor and increases the risk for intrapartum uterine rupture [10,12].

Timing — For the rare cases that persist to the third trimester, we suggest cesarean birth at 36 weeks of gestation to avoid exposing the uterus to labor [11].

Procedure — Anatomic relationships at cesarean birth are severely distorted [6,14]. The anatomic posterior uterine wall may be located ventrally. The bladder, vagina, and elongated cervix are stretched ventrally and cephalad; thus, if the uterine incision is made where the lower uterine segment is normally located, the surgeon can transect the bladder, cervix, or vagina, resulting in supracervical hysterectomy. Preoperative magnetic resonance imaging provides detailed images of the pelvic anatomy and thus may facilitate surgical planning [14,17].

We suggest a vertical supraumbilical skin incision rather than a low vertical or Pfannenstiel incision. It can be extended caudally after entering the peritoneal cavity, if needed, to allow adequate exposure of the distorted anatomy. The uterus should not be incised before the anatomic relationships are ascertained and restored to normal, if possible, by manual mobilization of the uterus from the pelvic cavity; however, use of an assistant who exerts upward pressure on the uterus transvaginally may be helpful. In preterm gestations, where there is still a relatively large amount of amniotic fluid present, amnioreduction by amniocentesis may facilitate repositioning of the uterus.

If the fundus cannot be released and restored to its correct position, the uterine incision should be made as cephalad as possible on the anterior wall of the uterus, where the uterus bends back on itself, so as not to enter the bladder, vagina, or cervix.

RECURRENCE RISK IN SUBSEQUENT PREGNANCIES — Recurrence in subsequent pregnancies has been reported [4,31]. Persistence of predisposing conditions, such as uterine abnormalities or pelvic adhesions, may confer a higher risk of recurrence. Clinical and ultrasound examinations in the early second trimester may detect recurrence before symptoms become bothersome.

SUMMARY AND RECOMMENDATIONS

Definition – An incarcerated gravid uterus is a rare complication of pregnancy in which the uterine fundus remains retroverted and entrapped below the sacral promontory after the first trimester. (See 'Introduction' above.)

Risk factors – Risk factors for incarcerated uterus include retroverted uterus, pelvic adhesions, and anatomic abnormalities. (See 'Risk factors' above.)

Clinical findings – Clinical manifestations are due to pressure on the anatomic structures adjacent to the entrapped enlarging uterus. The most common symptoms are pain and voiding problems. Urinary retention is a frequent complication. Rectal pressure may cause worsening constipation and tenesmus. (See 'Clinical features' above and 'Complications' above.)

Diagnosis – The diagnosis is based on physical and ultrasound findings. In addition to palpation of a large, firm mass in the cul-de-sac, a key finding is severe anterior displacement of the cervix so that it is located behind the pubic symphysis. (See 'Diagnosis' above and 'Physical examination' above.)

Management – Diagnosis and treatment of uterine incarceration before 20 weeks of gestation are important for successful management.

First trimester retroversion – When a retroverted or retroflexed uterus is noted during the first trimester, bimanual examination should be repeated at 16 weeks to determine whether the fundus has ascended into the abdominal cavity. (See 'Uterine retroversion before 14 weeks: Expectant management and follow-up' above.)

Reduce at 16 to 20 weeks – If the uterus remains retropositioned (incarcerated), we suggest reduction between 16 and 20 weeks rather than expectant management (Grade 2C). Reduction is indicated for relief of maternal symptoms, if present, and to prevent future symptoms and complications related to the incarcerated uterus. (See 'Uterine incarceration at 14 to 20 weeks of gestation: Reduction' above.)

Reduction procedures – We first attempt uterine replacement with simple methods (trial of knee-chest position, manual reduction) before moving on to more invasive methods (colonoscopy/flexible sigmoidoscopy, laparoscopy). (See 'Choosing a reduction technique' above.)

Delivery

Displacement of the cervix impedes normal progression of labor and increases the risk of intrapartum uterine rupture. For the very rare cases of incarcerated uterus that progress to the third trimester, we suggest cesarean birth at 36 weeks of gestation rather than at term to avoid exposing the uterus to labor (Grade 2C). (See 'Route' above and 'Timing' above.)

The uterus should not be incised before the anatomic relationships are ascertained. If the fundus cannot be released and restored to its correct position, the uterine incision should be made as cephalad as possible on the anterior wall of the uterus, where the uterus bends back on itself, so as not to enter the bladder, vagina, or cervix. (See 'Procedure' above.)

  1. van Beekhuizen HJ, Bodewes HW, Tepe EM, et al. Role of magnetic resonance imaging in the diagnosis of incarceration of the gravid uterus. Obstet Gynecol 2003; 102:1134.
  2. Feusner AH, Mueller PD. Incarceration of a gravid fibroid uterus. Ann Emerg Med 1997; 30:821.
  3. Gibbons JM Jr, Paley WB. The incarcerated gravid uterus. Obstet Gynecol 1969; 33:842.
  4. Jacobsson B, Wide-Swensson D. Incarceration of the retroverted gravid uterus--a review. Acta Obstet Gynecol Scand 1999; 78:665.
  5. Gottschalk EM, Siedentopf JP, Schoenborn I, et al. Prenatal sonographic and MRI findings in a pregnancy complicated by uterine sacculation: case report and review of the literature. Ultrasound Obstet Gynecol 2008; 32:582.
  6. Lettieri L, Rodis JF, McLean DA, et al. Incarceration of the gravid uterus. Obstet Gynecol Surv 1994; 49:642.
  7. Han C, Wang C, Han L, et al. Incarceration of the gravid uterus: a case report and literature review. BMC Pregnancy Childbirth 2019; 19:408.
  8. Shnaekel KL, Wendel MP, Rabie NZ, Magann EF. Incarceration of the Gravid Uterus. Obstet Gynecol Surv 2016; 71:613.
  9. Fernandes DD, Sadow CA, Economy KE, Benson CB. Sonographic and magnetic resonance imaging findings in uterine incarceration. J Ultrasound Med 2012; 31:645.
  10. Singh MN, Payappagoudar J, Lo J, Prashar S. Incarcerated retroverted uterus in the third trimester complicated by postpartum pulmonary embolism. Obstet Gynecol 2007; 109:498.
  11. Van Winter JT, Ogburn PL Jr, Ney JA, Hetzel DJ. Uterine incarceration during the third trimester: a rare complication of pregnancy. Mayo Clin Proc 1991; 66:608.
  12. Renaud MC, Bazin S, Blanchet P. Asymptomatic uterine incarceration at term. Obstet Gynecol 1996; 88:721.
  13. Matsushita H, Kurabayashi T, Higashino M, et al. Incarceration of the retroverted uterus at term gestation. Am J Perinatol 2004; 21:387.
  14. Al Wadi K, Helewa M, Sabeski L. Asymptomatic uterine incarceration at term: a rare complication of pregnancy. J Obstet Gynaecol Can 2011; 33:729.
  15. Haylen BT, Cerqui AJ. Postpartum uterine retroversion causing bladder outflow obstruction: cure by laparoscopic ventrosuspension. Int Urogynecol J Pelvic Floor Dysfunct 1999; 10:353.
  16. Gardner CS, Jaffe TA, Hertzberg BS, et al. The incarcerated uterus: a review of MRI and ultrasound imaging appearances. AJR Am J Roentgenol 2013; 201:223.
  17. Hachisuga N, Hidaka N, Fujita Y, 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; 57:77.
  18. Dierickx I, Meylaerts LJ, Van Holsbeke CD, et al. Incarceration of the gravid uterus: diagnosis and preoperative evaluation by magnetic resonance imaging. Eur J Obstet Gynecol Reprod Biol 2014; 179:191.
  19. Gerscovich EO, Maslen L. The retroverted incarcerated uterus in pregnancy: imagers beware. J Ultrasound Med 2009; 28:1425.
  20. Gottschalk S. Zur Lehre von der Retroversio uteri gravidi. Arch Gynecol Obstet 1894; 46:358.
  21. Newell SD, Crofts JF, Grant SR. The incarcerated gravid uterus: complications and lessons learned. Obstet Gynecol 2014; 123:423.
  22. Hess LW, Nolan TE, Martin RW, et al. Incarceration of the retroverted gravid uterus: report of four patients managed with uterine reduction. South Med J 1989; 82:310.
  23. Algra LJ, Fogel ST, Norris MC. Anesthesia for reduction of uterine incarceration: report of two cases. Int J Obstet Anesth 1999; 8:142.
  24. Grossenburg NJ, Delaney AA, Berg TG. Treatment of a late second-trimester incarcerated uterus using ultrasound-guided manual reduction. Obstet Gynecol 2011; 118:436.
  25. Seubert DE, Puder KS, Goldmeier P, Gonik B. Colonoscopic release of the incarcerated gravid uterus. Obstet Gynecol 1999; 94:792.
  26. Dierickx I, Van Holsbeke C, Mesens T, et al. Colonoscopy-assisted reposition of the incarcerated uterus in mid-pregnancy: a report of four cases and a literature review. Eur J Obstet Gynecol Reprod Biol 2011; 158:153.
  27. Abelman SH, Jayakumaran JS, Sigdel M, Baxter JK. Incarcerated Gravid Uterus Liberated by Placement of a Vaginal Balloon. Obstet Gynecol 2022; 140:898.
  28. Takami M, Hasegawa Y, Seki K, et al. Spontaneous reduction of an incarcerated gravid uterus in the third trimester. Clin Case Rep 2016; 4:605.
  29. Hamoda H, Chamberlain PF, Moore NR, Mackenzie IZ. Conservative treatment of an incarcerated gravid uterus. BJOG 2002; 109:1074.
  30. Lacoste CR, Seffert P, Chauleur C. [Acute urinary retention and retroverted uterus during pregnancy]. Gynecol Obstet Fertil 2013; 41:265.
  31. van der Tuuk K, Krenning RA, Krenning G, Monincx WM. Recurrent incarceration of the retroverted gravid uterus at term - two times transvaginal caesarean section: a case report. J Med Case Rep 2009; 3:103.
Topic 6747 Version 23.0

References

آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟