Photo Credit: Kateryna Kukota
The following is a summary of “Incarcerated Gravid Uterus: A New Treatment Using the Transvaginal Ultrasound Probe and Narrative Literature Review,” published in the August 2024 issue of Obstetrics and Gynecology by KANTOROWSKA et al.
Incarcerated gravid uterus, a rare but serious complication occurring in approximately 1 in 3,000 pregnancies, is characterized by the failure of a retropositioned uterus to ascend into the abdominal cavity between 12 and 14 weeks of gestation. If left unaddressed, this condition can lead to significant maternal symptoms and adverse outcomes, particularly if gestational age exceeds 14 to 16 weeks. Timely intervention to reposition the uterus is recommended to mitigate these risks. Historically, management techniques have included passive reduction, digital manipulation, and more invasive approaches such as laparoscopy, laparotomy, and sigmoidoscopy. However, these methods are often associated with limited effectiveness, significant discomfort, or heightened procedural risk.
The objective of this report is to detail the clinical experience with a new, minimally-invasive technique utilizing a transvaginal ultrasound probe for the replacement of an incarcerated uterus, to provide a narrative review of existing literature on the subject, and to propose a comprehensive management algorithm. This case series encompasses eight patients with an incarcerated gravid uterus who were treated with this novel technique at an academic medical center between March 2020 and July 2023. Additionally, a thorough literature search was conducted using PubMed, Google Scholar, and Ovid MEDLINE databases, focusing on the terms “incarcerated gravid uterus,” “uterine incarceration,” “uterine sacculation,” and “retroverted uterus” up to April 2024.
The findings indicate that the transvaginal ultrasound probe technique successfully achieved uterine replacement and symptom resolution in all eight patients. Notably, all pregnancies resulted in live births with favorable neonatal outcomes; seven patients delivered at term, while one was offered during the late preterm period.
In conclusion, this report introduces a simple, minimally invasive, and effective technique for the management of an incarcerated gravid uterus, utilizing a transvaginal ultrasound probe. The success observed in the clinical practice, combined with insights from the literature, has informed the development of a proposed algorithm for managing this condition, which may enhance clinical outcomes and patient safety in similar cases.
Source: sciencedirect.com/science/article/abs/pii/S0002937824008664
