Incarcerated uterus means that the uterus is trapped in the
pelvic cavity and cannot be released freely into the abdominal cavity. It often
occurs in a retrovert uterus state. The uterus, which is normally already in
the pelvis cavity, grows as the weeks of gestation progresses, rises upward and
exits the pelvis and continues to grow in the abdominal cavity. Incarcerated
uterus occurs once in 3000 to 10000 pregnancies.
Normally, if the retrovert uterus, that is, if the uterus is
turned backwards from the cervix, the uterus bends forward as the pregnancy
months progress and becomes normal flat. In this way, it can grow from the
pelvis up to the abdominal cavity. Rarely, the retrovert uterus cannot make a
healing movement with the growth of pregnancy and grows back and squeezed in
the pelvis. It is trapped in the pelvis between the promontorium and the
symphysis pubis. In this case, as the uterus continues to grow, the cervix
continues to extend upward from the front and rise. The bladder, which is stuck
first, also extends upwards. In about 14 weeks, the uterus fills the entire
pelvis.
Although uterine incarceration is traditionally seen as a
retrovert uterus, more rarely, cases of antevert uterus have also been
reported. There is a case report in the literature where antevert incarceration
was observed in the first pregnancy and recurrent with retrovert incarceration
in the second pregnancy. It is also called anterior uterine incarceration.
Symptoms:
The uterus, trapped in the pelvis and filling it, compresses
the bladder and rectum. Difficulty in urination, frequent and small amounts of
urination, constipation, low back pain, pelvic pain may occur.
Rarely, there may be cases of uterine incarceration that
progress without any symptoms until the term.
Risk
factors:
Risk factors involved in the formation of uterine
incarceration: Uterus being retrovert, promontorium too protruding, deep sacral
concaveitis, pelvic adhesions, endometriosis, previous pelvic surgery, PID,
large myomas, uterine malformation, uterine prolapse. In some incarceration
cases, no risk factors are encountered.
Diagnosis:
In the second trimester of pregnancy, especially with the
symptoms described above, pelvic pain and difficulty urinating may cause
uterine incarceration. In ultrasonography, the retrovert image of the uterus
and the upwardly pushed obstructed image of the bladder are important in
diagnosis. MR can also be used as an aid in diagnosis.
Follow-up
and Treatment:
It can be seen that uterine incarceration heals spontaneously.
Manual correction can be applied, if necessary correction is performed under
general or spinal anesthesia. Manual correction, that is, placing the uterus
into the abdominal cavity is not always possible. In persistent cases where
correction is not possible, complications such as vaginal bleeding, excessive
pain, preterm labor, retarded growth (due to impaired uterine bleeding) may
occur. In the correction attempts applied after 20 weeks, the chance of success
decreases and the risk of developing complications such as preterm labor and
membrane rupture increases. In order to bring the uterus back to normal
position, gas swelling by rectosigmoidoscopy has been reported in some cases.
In a uterine incarceration postpartum pulmonary embolism has
been reported, and it has been noted that this may be due to venous stasis
caused by the position of the uterus.
Rarely, bladder rupture may occur as a result of obstruction
and excessive enlargement of the bladder.
There are also cases of uterine incarceration, which rarely
progresses completely asymptomatic to term.
Normal vaginal delivery is not possible in uterine
incarceration in the unreserved persis and cesarean delivery is performed.
Uterine incision area can vary widely due to excessive displacement of the
cervix and vagina. It is recommended to enter the abdomen through a median
incision.
Uterine
sacculation:
In the case of uterine incarceration in the persis, part of
the anterior wall may show sacculation (aneurysm-like enlargement, ballooning,
diverticula) and the fetus from this area can progress into the abdomen.
Rarely, uterine rupture may occur from this uterine sacculation site.
In literature, rarely sacculation has been reported in normal
pregnancies without uterine incarceration, and it has been reported that
placenta retention is mostly accompanied. Because of the risk of placental
retention and rupture, cesarean delivery was recommended in cases where uterine
sacculation was detected before delivery.
Incarceration
in hernia sac:
Although uterine incarceration, i.e. imprisonment, and
compression, can be defined as incarceration in the hernia sac, which is a
similar situation, although it can be understood as a compression in the
pelvis. Here, the uterus enters the hernial sac and is imprisoned so that it
cannot come out again, where it continues to grow.
-OVERDUE PREGNANCY
-INTRAUTERINE GROWTH RETARDATION IN PREGNANCY
-BLOOD INCOMPATIBILITY
-CHORIOAMNIONITIS
-STILLBIRTH
