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

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          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.

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          Most cited references13

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          Incarceration of the retroverted gravid uterus--a review.

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            Recurrent incarceration and/or sacculation of the gravid uterus: a review.

            Retroverted uterine incarceration with sacculation of the anterior wall is reported to occur approximately in 1/3000 pregnancies. A literature search identified only one case report of incarceration of an anteflexed gravid uterus and six reported cases of recurrent incarceration and/or sacculation. We present a case of an incarceration of an anteflexed uterus in the first pregnancy, followed by a retroflexed incarceration in the second pregnancy. From this, a review is presented on recurrent uterine incarceration and/or sacculation.
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              Prenatal sonographic and MRI findings in a pregnancy complicated by uterine sacculation: case report and review of the literature.

              Approximately 15% of women have a retroverted uterus prior to pregnancy, and retroversion occurs in 11% of women in the first trimester of pregnancy. However, the uterus usually moves to an upward position before 14 weeks' gestation. Incarceration and sacculation of a retroverted uterus occur in 1 in 3000 pregnancies and are difficult to diagnose. They have often been missed until shortly before delivery and can lead to serious obstetric emergencies such as labor dystocia, uterine rupture, retained placenta and uncontrollable postpartum hemorrhage. Performing a Cesarean section without correct diagnosis may cause difficulties in identifying the bladder and the cervix, and therefore in opening the lower uterine segment. This leads to bladder injuries, vaginal transsection and trans- or supracervical hysterectomy. Early diagnosis and detailed scanning are crucial for the obstetric management and operative approach.We report a case of an incarcerated uterus in a patient presenting at 24 weeks' gestation with severe bilateral flank and lower abdominal pain. The symptoms were misdiagnosed as appendicitis. Digital examination revealed a ventralized vaginal axis. The cervix was not palpable. The clinical course, and two- and three-dimensional ultrasound and magnetic resonance imaging findings, are presented. The delivery was performed by midline laparotomy Cesarean section. The management for different gestational ages and a review of the literature are discussed.
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                Author and article information

                Journal
                Obstet Gynecol Sci
                Obstet Gynecol Sci
                OGS
                Obstetrics & Gynecology Science
                Korean Society of Obstetrics and Gynecology; Korean Society of Contraception and Reproductive Health; Korean Society of Gynecologic Endocrinology; Korean Society of Gynecologic Endoscopy and Minimal Invasive Surgery; Korean Society of Maternal Fetal Medicine; Korean Society of Ultrasound in Obstetrics and Gynecology; Korean Urogynecologic Society
                2287-8572
                2287-8580
                September 2018
                02 August 2018
                : 61
                : 5
                : 621-625
                Affiliations
                [1 ]Department of Obstetrics and Gynecology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.
                [2 ]Department of Obstetrics and Gynecology, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea.
                Author notes
                Corresponding author: Han-Sung Kwon. Department of Obstetrics and Gynecology, Research Institute of Medical Science, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 05030, Korea. 20050024@ 123456kuh.ac.kr
                Author information
                https://orcid.org/0000-0002-4449-0481
                Article
                10.5468/ogs.2018.61.5.621
                6137016
                30254999
                069abd0d-a600-4824-a17d-9466cd06e986
                Copyright © 2018 Korean Society of Obstetrics and Gynecology

                Articles published in Obstet Gynecol Sci are open-access, distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 26 June 2017
                : 31 August 2017
                : 13 October 2017
                Categories
                Case Report
                Maternal-Fetal Medicine

                uterine disease,myoma,retroversion,pregnancy
                uterine disease, myoma, retroversion, pregnancy

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