Uterine incarceration is an

obstetrical Obstetrics is the field of study concentrated on pregnancy, childbirth and the postpartum period. As a medical specialty, obstetrics is combined with gynecology under the discipline known as obstetrics and gynecology (OB/GYN), which is a surg ...

complication whereby a growing

retroverted uterus A retroverted uterus (tilted uterus, tipped uterus) is a uterus that is oriented posteriorly, towards the back of the body. This is in contrast to the typical uterus, which is oriented forward (slightly "Anteversion, anteverted") toward the Urinar ...

becomes wedged into the

pelvis The pelvis (plural pelves or pelvises) is the lower part of the trunk, between the abdomen and the thighs (sometimes also called pelvic region), together with its embedded skeleton (sometimes also called bony pelvis, or pelvic skeleton). The ...

after the

first trimester Pregnancy is the time during which one or more offspring develops ( gestates) inside a woman's uterus (womb). A multiple pregnancy involves more than one offspring, such as with twins. Pregnancy usually occurs by sexual intercourse, but ca ...

pregnancy Pregnancy is the time during which one or more offspring develops ( gestates) inside a woman's uterus (womb). A multiple pregnancy involves more than one offspring, such as with twins. Pregnancy usually occurs by sexual intercourse, but ca ...

Causes

A number of situations may interfere with the natural process that would antevert a retroverted uterus during pregnancy. Such situations include pelvic adhesions,

endometriosis Endometriosis is a disease of the female reproductive system in which cells similar to those in the endometrium, the layer of tissue that normally covers the inside of the uterus, grow outside the uterus. Most often this is on the ovaries, f ...

uterine malformation A uterine malformation is a type of female genital malformation resulting from an abnormal development of the Müllerian duct(s) during embryogenesis. Symptoms range from amenorrhea, infertility, recurrent pregnancy loss, and pain, to normal funct ...

leiomyomata A leiomyoma, also known as a fibroid, is a benign smooth muscle tumor that very rarely becomes cancer (0.1%). They can occur in any organ, but the most common forms occur in the uterus, small bowel, and the esophagus. Polycythemia may occur due to ...

, and pelvic tumors.

Development

When the uterus is tilted backwards, it is considered to be retroverted; this situation is common and regarded a normal variation. It has been estimated that about 15% of pregnancies begin in a retroverted uterus. Normally, during the first trimester, the growing uterus changes spontaneously to an anteverted position, thus allowing expansion of the enlarging uterus into the abdomen. The

cervix The cervix or cervix uteri (Latin, 'neck of the uterus') is the lower part of the uterus (womb) in the human female reproductive system. The cervix is usually 2 to 3 cm long (~1 inch) and roughly cylindrical in shape, which changes during ...

is then inferior to the body of the uterus. Thus, the presence of an early pregnancy in a retroverted uterus is not considered a problem. On rare occasions the uterus fails to become anteverted, and the pregnancy continues to expand the retroverted uterus within the confines of the pelvis. By about 14 weeks the size of the uterus fills out most of the pelvis, pushing up the cervix. At this point the uterus may get trapped below the

sacral promontory The sacrum (plural: ''sacra'' or ''sacrums''), in human anatomy, is a large, triangular bone at the base of the spine that forms by the fusing of the sacral vertebrae (S1S5) between ages 18 and 30. The sacrum situates at the upper, back part ...

and

symphysis A symphysis (, pl. symphyses) is a fibrocartilaginous fusion between two bones. It is a type of cartilaginous joint, specifically a secondary cartilaginous joint. # A symphysis is an amphiarthrosis, a slightly movable joint. # A growing together ...

. With further growth the pregnant woman may experience lower abdominal and

pelvic pain Pelvic pain is pain in the area of the pelvis. Acute pain is more common than chronic pain. If the pain lasts for more than six months, it is deemed to be chronic pelvic pain. It can affect both the male and female pelvis. Common causes in include ...

back pain Back pain is pain felt in the back. It may be classified as neck pain (cervical), middle back pain (thoracic), lower back pain (lumbar) or coccydynia (tailbone or sacral pain) based on the segment affected. The lumbar area is the most common area ...

, and difficulty, even inability to void, as the bladder is pushed upward and its outflow becomes obstructed.

Constipation Constipation is a bowel dysfunction that makes bowel movements infrequent or hard to pass. The stool is often hard and dry. Other symptoms may include abdominal pain, bloating, and feeling as if one has not completely passed the bowel movement ...

may be encountered. The frequency of this complication has been estimated to be about 1 in 3,000 pregnancies.

Diagnosis

In a pregnant woman who is entering her second trimester, the combination of urinary difficulties and pelvic pain may alert the physician to consider uterine incarceration as a possibility. On physical examination, the cervix is pushed up and anterior, and the pelvis entirely filled by the soft mass of the body of the pregnant uterus.

Sonography Medical ultrasound includes diagnostic techniques (mainly medical imaging, imaging techniques) using ultrasound, as well as therapeutic ultrasound, therapeutic applications of ultrasound. In diagnosis, it is used to create an image of internal ...

may indicate the retroverted position of the uterus, check on the viability of the fetus, and demonstrate the location of the bladder being pushed cranially and unable to be emptied. Also

magnetic resonance imaging Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to form pictures of the anatomy and the physiological processes of the body. MRI scanners use strong magnetic fields, magnetic field gradients, and radio wave ...

has been found to be helpful in the diagnosis of the condition.

Sequelae

Spontaneous resolution of the condition can occur during the second trimester. An unresolved incarcerated uterus can lead to further pain, vaginal bleeding, loss of pregnancy or

premature delivery Preterm birth, also known as premature birth, is the birth of a baby at fewer than 37 weeks gestational age, as opposed to full-term delivery at approximately 40 weeks. Extreme preterm is less than 28 weeks, very early preterm birth is between 2 ...

. Also, the uterus may develop a uterine sacculation, that is a part of its back wall softens like an

aneurysm An aneurysm is an outward bulging, likened to a bubble or balloon, caused by a localized, abnormal, weak spot on a blood vessel wall. Aneurysms may be a result of a hereditary condition or an acquired disease. Aneurysms can also be a nidus (s ...

and allows expansion of the fetus into the abdomen with a risk of

uterine rupture Uterine rupture is when the muscular wall of the uterus tears during pregnancy or childbirth. Symptoms, while classically including increased pain, vaginal bleeding, or a change in contractions, are not always present. Disability or death of the ...

. Further, urinary complications may develop such as

cystitis A urinary tract infection (UTI) is an infection that affects part of the urinary tract. When it affects the lower urinary tract it is known as a bladder infection (cystitis) and when it affects the upper urinary tract it is known as a kidney ...

, and bladder distention could eventually lead to rupture of the bladder.

Management

A pregnant woman with an incarcerated uterus may present in the

emergency room An emergency department (ED), also known as an accident and emergency department (A&E), emergency room (ER), emergency ward (EW) or casualty department, is a medical treatment facility specializing in emergency medicine, the acute care of pati ...

because of pain, bleeding, inability to void and constipation. Upon diagnosis steps can be taken to manually position the uterus into an anteverted position. The bladder is decompressed by a

Foley catheter In urology, a Foley catheter (named for Frederic Foley, who produced the original design in 1929) is a flexible tube that a clinician passes through the urethra and into the bladder to drain urine. It is the most common type of indwelling urina ...

and the obstetrician may attempt to manipulate the uterus if necessary using general or spinal anesthesia. Rarely will a woman with an incarcerated uterus reach term; if so, a

cesarean delivery Caesarean section, also known as C-section or caesarean delivery, is the surgical procedure by which one or more babies are delivered through an incision in the mother's abdomen, often performed because vaginal delivery would put the baby or mo ...

is called for.

References

External links

{{Medical resources , ICD10 = {{ICD10, O, 34, 5, 13} , ICD9 = {{ICD9, 654.3 Pathology of pregnancy, childbirth and the puerperium Medical emergencies