Incarcerated uterus

Case contributed by Glenna Gibson

Presentation

19/40. Pelvic discomfort increasing during gestation. Some difficulty passing urine. Cervix unable to be palpated, not visualised on speculum examination or seen on ultrasound scan.

Patient Data

Age: 30 years
Gender: Female
MRI

The vagina is seen to extend anteriorly behind the bladder with the cervix quite high (90mm) from the vestibule to the internal os. The cervix is elongated behind the upper bladder and measures 30mm in sagittal length x 15mm in depth. The fundus of the uterus is pushing against the rectum. The uterus is incarcerated within the pelvis with the lower segment ballooning into the maternal abdomen. Incidental finding of synechiae over the right lower uterus.

Case Discussion

The treating clinicians were unable to feel or visualise the patient's cervix which led to ultrasound examination which could not identify the cervix. A smooth "bulge" in the expected region of the cervix was palpated which raised suspicion for a dilated cervix and presenting membranes (although these could not be visualised), and MRI was performed. In retrospect these clinical findings were typical for uterine incarceration and the MRI confirmed this diagnosis. This patient had undergone pelvic surgery for fibroids in the past which may have led to the development of this condition. 

An incarcerated uterus often resolves without intervention, as it did in this case. There have been reports of the uterus freeing itself from the sacral hollow with an audible "pop" similar to a champagne cork being removed. If the uterus does not return to the abdomen in the third trimester, it is extremely important to be aware of the position of the cervix and vagina before mode of delivery is determined - if a standard lower segment caesarean section was performed, the cervix and anterior vagina wall are at risk of injury and the surgical approach should be altered.

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Case information

rID: 54739
Case created: 26th Jul 2017
Last edited: 24th Oct 2017
System: Obstetrics
Inclusion in quiz mode: Included

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