Definition A retroverted uterus* that doesn’t move forward by the second trimester of pregnancy, but rather locks into the pubic bone, preventing the growing uterus from expanding into the abdomen and blocking the outlet to the bladder.
*15% of uteri are retroverted at the onset of pregnancy; as pregnancy progresses, most uteri spontaneously antevert, leaving the cervix in a (normal) inferior and posterior position, allowing the pregnant uterus to expand into the abdomen.
Aetiology (mechanical) Pelvic adhesions, endometriosis, uterine malformations, leiomyomata, pelvic tumours
Epidemiology 1:3000 pregnancies
• Presentation Second semester pain (lower abdominal, pelvic, back), difficulty in voiding, as the bladder is pushed upward, constipation
• Clinical exam Cervix is anterior and superior; pelvis is filled by the soft mass of the body of the pregnant uterus
• Imaging Ultrasound; MRI may be useful.
Complications Pain, vaginal bleeding, pregnancy loss, premature delivery, uterine sacculation with risk of uterine rupture, cystitis, and bladder distention and risk of rupture.
Management Bladder decompression with a Foley catheter; mechanical respositioning of the uterus under general or local (epidural) anaesthesia.
Synonym Uterine incarceration
Reference http://en.wikipedia.org/wiki/Uterine_incarceration [/fusion_builder_column][/fusion_builder_row][/fusion_builder_container]