Results of literature search on
condition known as
Incarcerated Uterus
Literature search terms: (incarcerated OR incarceration
OR retroverted OR retroversion OR retroflexed OR retropositioned OR retroposition
OR retrodeviation OR retrodeviated OR retroposed OR retroflected OR sacculation
OR sacculated OR tipped) AND (uterus OR uterine OR uteri)
Excerpts from literature:
Cunningham FC. MacDonald PC. Gant NF. Leveno
KJ. Gilstrap LC. William's Obstetrics 20th ed. Norwalk, CT. Appleton &
Lange. p 646-7, 1997
"Retroversion of the uterus is occasionally encountered
during the first trimester, occurring in about 11 percent of women."
"Most authorities no longer regard the retroverted
uterus per se to be a pathological finding. Thus, it needs no treatment
during pregnancy, except in the rare circumstance in which the growing
retroverted uterus does not rise out of the pelvis by the end of the first
trimester, but rather remains incarcerated in the hollow of the sacrum."
Danforth WC. Galloway CE. Retrodisplacement
of uterus during pregnancy and puerperium; analysis of 1000 cases. Journal
of the American Medical Association. 87:826, 1926
"Women with a retroverted uterus should be evaluated
frequently early in the second trimester, to make sure that the uterus
is not incarcerated."
"In all cases in which a retrodisplacement was found,
subsequent examinations have been made, in order that we might know whether
the uterus had spontaneously corrected its position and risen above the
promotory. It is extremely important that one should know this, as incarceration
of the uterus below the promotory must inevitably lead to abortion or to
serious discomfort or possibly danger to the prospective mother."
"Retrodisplacement during pregnancy, provided an
intelligent vigilance is exercised, need cause little trouble."
William Hunter, Medical Observations and Inquiries,
vol. 4, 1771, p. 400. Reprinted in American Journal of Obstetrics and Gynecology,
May 1, 1978; p. 95.
" ....it happens frequently, and yet that a number
of practitioners know of little of it; so little indeed, that, as you well
know, in this town, within these two years last past, two pregnant women
lost their lives by this accident, without the cause of their complaints
being discovered till after death...in both of these instances, experienced
practitioners failed; and saw with regret in the dead body, what they might
have easily cured in the living, if they had made a very obvious discovery
in proper time.
...must we not presume that every woman is in danger,
who has a retroverted uterus?"
Obstetrics and Gynecology, 9th edition, 1991,
Willson, Carrington et al, p. 303.
"Manual replacement is indicated early in pregnancy
if symptoms arise or after the twelfth week if spontaneous correction has
not taken place."
Gibbons et al, Obstetrics and Gynecology, vol.
33, no 6, June 1969, p. 842.
"Our study essentially confirms the classically quoted
frequency of about 1 in 3000 pregnancies."
"The key to successful management of incarceration
is early recognition."
"It is suggested therefore that all patients with
a retrodisplaced uterus presenting during the first trimester of pregnancy
be examined again during the twelfth or thirteenth week. If retroversion
still persists, the uterus should be repositioned and supported by a pessary."
"The retrodisplaced uterus during early pregnancy
is almost invariably innocuous, but in about 1 in 3000 pregnancies such
an organ will become incarcerated in the pelvis, resulting in considerable
maternal morbidity and frequent fetal mortality."
Swartz et al, The Journal of Reproductive Medicine,
vol. 19, no 5, November 1977, p. 262.
"Early recognition and correction of the incarcerated
gravid uterus are necessary for prevention of complications. A patient
with a retroflexed gravid uterus should be followed carefully in early
gestation. If at the end of 12 weeks, the uterus has not risen out of the
pelvis, consideration should be given to repositioning it to a normal position
and supporting it in place with a pessary."
"Once the uterus is incarcerated, replacement to
normal position may be difficult and dangerous."
Danforth's Obstetrics and Gynecology, 5th ed.,
1986, p. 562.
"Although retrodisplacement of the uterus has been
implicated in spontaneous abortion, there is no clear evidence of a causal
relationship, except in neglected cases of incarceration."
Edminster et al, Annals of Emergency Medicine,
August 1987, p. 910.
"The key to successful outcome is early recognition."
Smalbraak et al, European Journal of Obstetrics
& Gynecology, 1991, 19: p. 151.
"Before the 14th week of gestation retroversion is
encountered in approximately 11% of women. Usually, spontaneous correction
of the uterus to the anterior position does occur between 12 and 16 weeks,
but in 1.4% (1 in 70) of those cases this does not occur. The retroverted
uterus subsequently becomes impacted in the pelvic cavity."
Lettieri L, Rodis JF, McLean DA, Campbell WA,
Vintzileos AM, Incarceration of the gravid uterus. Obstetrical and Gynecological
Survey. 49(9):642-6, 1994 Sep
"Such patients have a history of a known retroverted,
retroflexed uterus. A repeat pelvic examination should be performed at
14 weeks of gestation to ensure that the uterus has indeed ascended into
the abdominal cavity."
"Early recognition of an incarcerated uterus is the
cornerstone of successful management."
Doring, Fortschr Med, September 1978, 96(33):1660-2
(German)
"Because of our good results, we make a plea for
expectant managment of retroflexion of the pregnant uterus. Regular control
examinations are necessary so that the lack of spontaneous anteflexion
is not overlooked."
Jackson D, Obstetrics & Gynecology, March
1988, vol. 71, p. 466
"The highest success in avoiding fetal wastage and
maternal operation is found with early detection and manual replacement
before 15 weeks gestation."
"The absence of symtoms, as demonstrated by this
case, does not exclude persistent gestational retroversion."
Percival R, Holland and Brews Manual of Obstetrics,
14th edition, 1980, p. 247
"In rare instances no urgent symptoms occur at all
even at the critical period - the end of the third month - and the uterus
continues its development in its abnormal position, giving rise to the
condition known as anterior sacculation. This has been known to persist
until term. More commonly abortion takes place if the displacement remains
uncorrected."
Gant NF. Cunningham FG. Basic Gynecology and
Obstetrics, 1995, p 375 - chapter 48
"Persistent retroflexion of the pregnant uterus is
incompatible with advanced pregnancy. If spontaneous or artifical reposistion
does not occur, the patient either aborts or develops symptoms caused by
incarceration of the uterus before the end of the forth month. In exceptional
instances, however, pregnancy may proceed, resulting in uterine sacculation.
Spontaneous delivery is impossible, and rupture of the uterus may occur."
Gant NF. Cunningham FG. Basic Gynecology and
Obstetrics, 1995, p 258 - chapter 34
"By twelve weeks of gestation, the uterus usually
can be felt through the abdominal wall just above the symphysis pubis,
as a tumor, therafter, the uterus gradually increases in size to the end
of the pregnancy"
Plauche WC, Surgical Obstetrics, 1992, chapter
10 p 187
"The highest success is acheived by manual replacement
before 16 weeks gestation."
Buchsbaum HJ, Schimidt JD, Gynecologic and
Obstetric Urology, 2nd ed, 1982, chapter 33 p 501
"A retroflexed and retroverted uterus can become
incarcerated in the true pelvis and in the third month of gestation markedly
displace the bladder anteriorly."
Thomson JD, Malpositions of the Uterus, in
Operative Gynecology, 7th ed, p. 819
"Sometimes retrodisplacement resulted in incarceration,
abortion, and secondary infection and caused death. Death also resulted
from fatal injuries during forceful attempts at displacement."
"In the rare case in which the uterus remains incarcerated
in the pelvis as pregnancy advances, careful and frequent observation of
the patient is essential to prevent fixation and sacculation of the pregnant
uterus. Rarely, a pelvic examination under anesthesia or laparotomy may
be required to release the incarcerated uterus from the cul-de-sac and
avoid complications of abortion, premature delivery, fetal death in utero,
fetal malformation, or uterine rupture."
Pope CS, O'Grady JP, Hoffman D Malposition
of the Uterus http://www.emedicine.com June, 2002
"Uterine retroversion with incarceration is an infrequent
but by no means rare obstetrical condition"
Love JN, Howell JM, Urinary retention
resulting from incarceration of a retroverted, gravid uterus. J of Emergency
Medicine. 2000 Nov, 19:4
Li YT, Tsui MS, Yin CS, Lin HM, Chan CC
, Asymptomatic uterine incarceration at term gestation: a case report.
J Obstet Gynaecol Res 2000 Feb;26(1):31-3
Seubert DE, Puder KS, Goldmeier P,Gonik
B. Colonoscopic Release of the Incarcerated Gravid Uterus. Obstetrics &
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Jacobsson B, Wide-Swensson D Incarceration
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Sep;78(8):665-8
Jacobsson B, Wide-Swensson D Recurrent
incarceration of the retroverted gravid uterus--a case report. Acta Obstet
Gynecol Scand 1999 Sep;78(8):737
O'Connell MP, Ivory CM, Hunter
RW, Incarcerated retroverted uterus- a non recurring complication of pregnancy.
Journal of Obstetrics & Gynaecology 1999 Jan;19(1) 792
The Merck Manual of Diagnosis and Therapy.
Section 18, Chapter 237 Merck & Co., Inc., Whitehouse Station,
NJ, USA
Feusner AH, Mueller PD Incarceration of
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Hirsch E. Anterior uterine incarceration.
International Journal of Gynecology and Obstetrics. 57:195 1997 May
Patterson E. Herd AM. Incarceration of
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1997 Jan
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Leveno KJ. Gilstrap LC. William's Obstetrics 20th ed. Norwalk, CT. Appleton
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Renaud MC. Bazin S. Blanchet P. Asymptomatic
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Oct
Carlson KJ. Eisenstat TZ. Ziporyn TD.
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Adu SA. Uterine sacculation: myth, reality
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Myers DL. Scotti RJ. Acute urinary retention
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Weinberger MW. Julian TM. Voiding dysfunction
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