Incarcerated gravid uterus: a new treatment using the transvaginal ultrasound probe and narrative literature review - 18/09/24
, Elizabeth T. Patberg, MD, MA b, Fatima Ali, DO c, Anju Suhag, MD a, Patricia Rekawek, MD a, Anthony M. Vintzileos, MD d, e, f, Martin R. Chavez, MD aAbstract |
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.
Le texte complet de cet article est disponible en PDF.Video |
(38.94 Mo)
Key words : adverse pregnancy outcomes, impacted uterus, miscarriage, pregnancy complications, retroflexed, retropositioned uterus, retroverted, second trimester intrauterine fetal death, transvaginal ultrasound, ultrasound probe, uterine entrapment, uterine sacculation
Plan
| The authors report no conflict of interest. |
|
| Funded by departmental funding. |
|
| One of the cases in this series, along with an explanation of our transvaginal ultrasound probe technique, was presented as an oral presentation at AIUM's UltraCon 2023 in Orlando, FL, March 25 to 29, 2023. |
|
| Cite this article as: Kantorowska A, Patberg ET, Ali F, et al. Incarcerated gravid uterus: a new treatment using the transvaginal ultrasound probe and narrative literature. Am J Obstet Gynecol 2024;XXX:XX–XX. |
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?