| Uterine incarceration during pregnancy | |
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| Specialty | Obstetrics |
Uterine incarceration is an obstetrical complication whereby a growing retroverted uterus becomes wedged into the pelvis after the first trimester of pregnancy. [1]
| Uterine incarceration during pregnancy | |
|---|---|
| | |
| Specialty | Obstetrics |
Uterine incarceration is an obstetrical complication whereby a growing retroverted uterus becomes wedged into the pelvis after the first trimester of pregnancy. [1]
A number of situations may interfere with the natural process that would antevert a retroverted uterus during pregnancy. Such situations include pelvic adhesions, endometriosis, uterine malformations, leiomyomata, and pelvic tumors. [2]
When the uterus is tilted backwards, it is considered to be retroverted; this situation is common and regarded a normal variation. It has been estimated that about 15% of pregnancies begin in a retroverted uterus. [3] Normally, during the first trimester, the growing uterus changes spontaneously to an anteverted position, thus allowing expansion of the enlarging uterus into the abdomen. The cervix is then inferior to the body of the uterus. Thus, the presence of an early pregnancy in a retroverted uterus is not considered a problem. [1]
On rare occasions the uterus fails to become anteverted, and the pregnancy continues to expand the retroverted uterus within the confines of the pelvis. By about 14 weeks the size of the uterus fills out most of the pelvis, pushing up the cervix. At this point the uterus may get trapped below the sacral promontory and symphysis. With further growth the pregnant woman may experience lower abdominal and pelvic pain, back pain, and difficulty, even inability to void, as the bladder is pushed upward and its outflow becomes obstructed. Constipation may be encountered. The frequency of this complication has been estimated to be about 1 in 3,000 pregnancies. [2]
In a pregnant woman who is entering her second trimester, the combination of urinary difficulties and pelvic pain may alert the physician to consider uterine incarceration as a possibility. On physical examination, the cervix is pushed up and anterior, and the pelvis entirely filled by the soft mass of the body of the pregnant uterus. Sonography may indicate the retroverted position of the uterus, check on the viability of the fetus, and demonstrate the location of the bladder being pushed cranially and unable to be emptied. [4] Also magnetic resonance imaging has been found to be helpful in the diagnosis of the condition. [4] [5]
Spontaneous resolution of the condition can occur during the second trimester. [6] An unresolved incarcerated uterus can lead to further pain, vaginal bleeding, loss of pregnancy or premature delivery. Also, the uterus may develop a uterine sacculation, that is a part of its back wall softens like an aneurysm and allows expansion of the fetus into the abdomen with a risk of uterine rupture. [3] Further, urinary complications may develop such as cystitis, and bladder distention could eventually lead to rupture of the bladder. [7]
A pregnant woman with an incarcerated uterus may present in the emergency room because of pain, bleeding, inability to void and constipation. Upon diagnosis steps can be taken to manually position the uterus into an anteverted position. The bladder is decompressed by a Foley catheter and the obstetrician may attempt to manipulate the uterus if necessary using general or spinal anesthesia. [3] Rarely will a woman with an incarcerated uterus reach term; if so, a cesarean delivery is called for. [8]
Dilationand curettage (D&C) refers to the dilation of the cervix and surgical removal of part of the lining of the uterus or contents of the uterus by scraping and scooping (curettage). It is a gynecologic procedure used for diagnostic and therapeutic purposes, and is the most commonly used method for first-trimester miscarriage or abortion.
The uterus or womb is the organ in the reproductive system of most female mammals, including humans, that accommodates the embryonic and fetal development of one or more embryos until birth. The uterus is a hormone-responsive sex organ that contains glands in its lining that secrete uterine milk for embryonic nourishment.
Dyspareunia is painful sexual intercourse due to medical or psychological causes. The term dyspareunia covers both female dyspareunia and male dyspareunia, but many discussions that use the term without further specification concern the female type, which is more common than the male type. In females, the pain can primarily be on the external surface of the genitalia, or deeper in the pelvis upon deep pressure against the cervix. Medically, dyspareunia is a pelvic floor dysfunction and is frequently underdiagnosed. It can affect a small portion of the vulva or vagina or be felt all over the surface. Understanding the duration, location, and nature of the pain is important in identifying the causes of the pain.
A pessary is a prosthetic device inserted into the vagina for structural and pharmaceutical purposes. It is most commonly used to treat stress urinary incontinence to stop urinary leakage and to treat pelvic organ prolapse to maintain the location of organs in the pelvic region. It can also be used to administer medications locally in the vagina or as a method of contraception.
A hysterotomy is an incision made in the uterus. This surgical incision is used in several medical procedures, including during termination of pregnancy in the second trimester and delivering the fetus during caesarean section. It is also used to gain access and perform surgery on a fetus during pregnancy to correct birth defects, and it is an option to achieve resuscitation if cardiac arrest occurs during pregnancy and it is necessary to remove the fetus from the uterus.
Adenomyosis is a medical condition characterized by the growth of cells that proliferate on the inside of the uterus (endometrium) atypically located among the cells of the uterine wall (myometrium), as a result, thickening of the uterus occurs. As well as being misplaced in patients with this condition, endometrial tissue is completely functional. The tissue thickens, sheds and bleeds during every menstrual cycle.
Vaginal bleeding is any expulsion of blood from the vagina. This bleeding may originate from the uterus, vaginal wall, or cervix. Generally, it is either part of a normal menstrual cycle or is caused by hormonal or other problems of the reproductive system, such as abnormal uterine bleeding.
Vacuum or suction aspiration is a procedure that uses a vacuum source to remove an embryo or fetus through the cervix. The procedure is performed to induce abortion, as a treatment for incomplete spontaneous abortion or retained fetal and placental tissue, or to obtain a sample of uterine lining. It is generally safe, and serious complications rarely occur.
A retroverted uterus is a uterus that is oriented posteriorly, towards the rectum in the back of the body. This is in contrast to the typical uterus, which is oriented forward toward the bladder, with the anterior part slightly concave. Depending on the source, one in three to five uteruses is retroverted, or oriented backwards towards the spine. Generally, a retroverted uterus does not cause any problems, nor does it interfere with pregnancy or fertility. Most people with retroverted uteruses will not know they have the condition.
Placenta accreta occurs when all or part of the placenta attaches abnormally to the myometrium. Three grades of abnormal placental attachment are defined according to the depth of attachment and invasion into the muscular layers of the uterus:
The arcuate uterus is a form of a uterine anomaly or variation where the uterine cavity displays a concave contour towards the fundus. Normally the uterine cavity is straight or convex towards the fundus on anterior-posterior imaging, but in the arcuate uterus the myometrium of the fundus dips into the cavity and may form a small septation. The distinction between an arcuate uterus and a septate uterus is not standardized.
A uterine septum is a congenital uterine malformation where the uterine cavity is partitioned by a longitudinal septum; the outside of the uterus has a normal typical shape. The wedge-like partition may involve only the superior part of the cavity resulting in an incomplete septum or a subseptate uterus, or less frequently the total length of the cavity and the cervix resulting in a double cervix. The septation may also continue caudally into the vagina resulting in a "double vagina".
In human female anatomy, the vesicouterine pouch, also uterovesicle pouch, is a fold of peritoneum over the uterus and the bladder. Like the rectouterine pouch, it is a female pelvic recess, but shallower and closer to the anterior fornix of the vagina.
Pelvic girdle pain can be described as a pregnancy discomfort for some women and a severe disability for others. PGP can cause pain, instability and limitation of mobility and functioning in any of the three pelvic joints. PGP has a long history of recognition, mentioned by Hippocrates and later described in medical literature by Snelling.
The affection appears to consist of relaxation of the pelvic articulations, becoming apparent suddenly after parturition or gradually during pregnancy and permitting a degree of mobility of the pelvic bones which effectively hinders locomotion and gives rise to the most peculiar and alarming sensations.
A shoulder presentation is a malpresentation at childbirth where the baby is in a transverse lie, thus the leading part is an arm, a shoulder, or the trunk. While a baby can be delivered vaginally when either the head or the feet/buttocks are the leading part, it usually cannot be expected to be delivered successfully with a shoulder presentation unless a cesarean section (C/S) is performed.
A cephalic presentation or head presentation or head-first presentation is a situation at childbirth where the fetus is in a longitudinal lie and the head enters the pelvis first; the most common form of cephalic presentation is the vertex presentation, where the occiput is the leading part. All other presentations are abnormal (malpresentations) and are either more difficult to deliver or not deliverable by natural means.
A cervical pregnancy is an ectopic pregnancy that has implanted in the uterine endocervix. Such a pregnancy typically aborts within the first trimester, however, if it is implanted closer to the uterine cavity – a so-called cervico-isthmic pregnancy – it may continue longer. Placental removal in a cervical pregnancy may result in major hemorrhage.
Round ligament pain (RLP) is pain associated with the round ligament of the uterus, usually during pregnancy. RLP is one of the most common discomforts of pregnancy and usually starts at the second trimester of gestation and continues until delivery. It usually resolves completely after delivery although cases of postpartum RLP have been reported. RLP also occurs in nonpregnant women.
Early pregnancy bleeding refers to vaginal bleeding before 14 weeks of gestational age. If the bleeding is significant, hemorrhagic shock may occur. Concern for shock is increased in those who have loss of consciousness, chest pain, shortness of breath, or shoulder pain.
A t-shaped uterus is a type of uterine malformation wherein the uterus is shaped resembling the letter T. This is typically observed in DES-exposed women. It is recognised in the ESHRE/ESGE classification, and is associated with failed implantation, increased risk of ectopic pregnancy, miscarriage and preterm delivery. There is a surgical procedure to correct the malformation.