Uterine incarceration is an obstetric complication in which the retroverted uterus becomes squashed into the pelvis after the first trimester of pregnancy.
Video Uterine incarceration
Cause
A number of situations can interfere with the natural process that will retroverted uterine antibates during pregnancy. Such situations include pelvic adhesions, endometriosis, uterine malformations, leiomyomata, and pelvic tumors.
Maps Uterine incarceration
Development
When the uterus tilts backward, it is considered retrovert; this situation is common and is considered a normal variation. It is estimated that about 15% of pregnancies begin in the retroverted uterus. Usually, during the first trimester, the developing uterus changes spontaneously to the anteverted position, allowing the expansion of the uterus to enlarge into the abdomen. The cervix is ​​then lower than the body of the uterus. Thus, the presence of early pregnancy in the retroverted uterus is not considered a problem.
On rare occasions the uterus fails to be anteverted, and the pregnancy continues to expand the retrovert uterus within the pelvic boundaries. About 14 weeks the size of the uterus fills most of the pelvis, pushing the cervix. At this point the uterus may be trapped under a sacred and symphysis promontory. With further growth, pregnant women may experience lower abdominal and pelvic pain, back pain, and difficulty, even the inability to cancel, because the bladder is pushed upwards and the flow becomes blocked. Constipation may be encountered. The frequency of these complications is estimated to be about 1 in 3,000 pregnancies.
Diagnosis
In pregnant women entering the second trimester, a combination of urinary difficulty and pelvic pain may remind doctors to consider holding the uterus as a possibility. On physical examination, the cervix is ​​pushed up and anterior, and the pelvis is entirely filled by the soft mass of the pregnant uterine body. Sonography may indicate retroved uterine position, examine fetal survival, and indicate cranial driven bladder location and can not be emptied. Magnetic resonance imaging has also been found to aid in the diagnosis of this condition.
Sequelae
Spontaneous resolution of this condition may occur during the second trimester. Unresolved incarcerated uterus may cause further pain, vaginal bleeding, loss of pregnancy or premature labor. In addition, the uterus may develop uterine sacculation , which is part of the back wall softening like an aneurysm and allows expansion of the fetus into the stomach at risk of uterine rupture. Further, bladder complications can develop like cystitis, and bladder distention may eventually lead to bladder rupture.
Management
A pregnant woman with an incarcerated uterus may be present in the emergency room because of pain, bleeding, inability to urinate and constipation. After diagnostic steps can be taken to manually position the uterus to the anteverted position. The bladder is decompressed by the Foley catheter and the obstetrician may attempt to manipulate the uterus if necessary using general or spinal anesthesia. Rarely a woman with imprisoned womb reaches term, - if so, cesarean delivery is called for.
References
Source of the article : Wikipedia
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