This is an uncommon presentation and is said to occur in 1 in 3000 pregnancies. Uncomplicated retroversion may be seen in as many as 9% of the pregnancies.
- diffuse pain
- in the first trimester may result in transient urinary retention
- rectal pressure or constipation
Entrapment of a portion of a gravid retroverted uterus. As the the gravid uterus increases in size, it may get caught at the sacral promontory, bending the gravid retroverted uterus.
Associated with posterior or fundal fibroids, endometriosis, uterine structural abnormalities such as didelphic or a bicornuate uterus, previous gynecologic surgery resulting in adhesions, and a spectrum of abnormal placental villous adherence. The incarcerated uterus is prone to uterine rupture.
- cervix may be difficult to identify
- cervix is anterior and superior to the gravid uterus
- the fetus is positioned deep within the cul-de-sac
- the maternal urinary bladder is malpositioned and lies anterior, rather than inferior to the products of conception
- the lower uterine segment is displaced anteriorly giving an appearance of a myometrium with central cavity between the urinary bladder and the fetus and may be mistaken for an ectopic or an abdominal pregnancy
History and etymology
The first case of incarceration of the gravid uterus was described by William Hunter in 1754.
On imaging consider
- 1. Grossenburg NJ, Delaney AA, Berg TG. Treatment of a late second-trimester incarcerated uterus using ultrasound-guided manual reduction. Obstet Gynecol. 2011;118 (2 Pt 2): 436-9. doi:10.1097/AOG.0b013e3182164864 - Pubmed citation
- 2. Singh MN, Payappagoudar J, Lo J et-al. Incarcerated retroverted uterus in the third trimester complicated by postpartum pulmonary embolism. Obstet Gynecol. 2007;109 (2 Pt2): 498-501. doi:10.1097/01.AOG.0000218695.71256.cf - Pubmed citation
- 3. Inaba F, Kawatu T, Masaoka K et-al. Incarceration of the retroverted gravid uterus: the key to successful treatment. Arch. Gynecol. Obstet. 2005;273 (1): 55-7. doi:10.1007/s00404-004-0681-3 - Pubmed citation
- 4. Sweigart AN, Matteucci MJ. Fever, sacral pain, and pregnancy: an incarcerated uterus. West J Emerg Med. 2011;9 (4): 232-4. Free text at pubmed - Pubmed citation
- 5. Gerscovich EO, Maslen L. The retroverted incarcerated uterus in pregnancy: imagers beware. J Ultrasound Med. 2009;28 (10): 1425-7. J Ultrasound Med (full text) - Pubmed citation