Kantorowska Agata, Patberg Elizabeth T, Ali Fatima, Suhag Anju, Rekawek Patricia, Vintzileos Anthony M, Chavez Martin R
Department of Obstetrics and Gynecology, NYU Langone Hospital-Long Island, NYU Grossman Long Island School of Medicine, Mineola, NY.
Department of Obstetrics, Gynecology and Reproductive Services, University of California San Francisco, San Francisco, CA.
Am J Obstet Gynecol. 2025 Apr;232(4):390.e1-390.e12. doi: 10.1016/j.ajog.2024.08.026. Epub 2024 Aug 22.
'Incarcerated gravid uterus' is a morbid complication that occurs in 1 in 3000 pregnancies. It is characterized by failure of a retropositioned uterus to become an abdominal organ between 12 to 14 weeks of gestation. If maternal symptoms develop or gestational age surpasses 14 to 16 weeks, replacement of a retropositioned uterus is recommended to reduce adverse outcomes. Previously described techniques for management include passive reduction, digital replacement, or more invasive methods such as laparoscopy, laparotomy, or sigmoidoscopy. These methods are either minimally effective, painful, or risky.
The objective of this report is to describe our clinical experience with a new minimally invasive technique that uses the transvaginal ultrasound probe for uterine replacement in cases of incarceration, to conduct a narrative literature review on 'incarcerated gravid uterus,' and to propose an algorithm for management of this condition.
This is a case series of 8 patients with an incarcerated gravid uterus who were managed with the transvaginal ultrasound probe technique at one academic medical institution between March 2020 and July 2023, as well as a narrative review of the literature on 'incarcerated gravid uterus.' PubMed, Google Scholar, and Ovid MEDLINE databases were searched for the terms "incarcerated gravid uterus," "uterine incarceration," "uterine sacculation," and "retroverted uterus" up to April 2024.
The transvaginal ultrasound probe technique resulted in successful uterine replacement, with resolution of symptoms, in all 8 patients. All pregnancies resulted in live births with good neonatal outcomes-7 out of 8 patients delivered at term, and 1 delivered in the late preterm period.
Our proposed technique for treatment of an incarcerated gravid uterus with the transvaginal ultrasound probe is simple, minimally invasive and effective. Based on our experience and the narrative literature review, an algorithm for the management of an incarcerated gravid uterus is proposed.
“嵌顿妊娠子宫”是一种罕见的并发症，发生率约为千分之一。其特征为妊娠12至14周时后位子宫未能升入腹腔。若出现母体症状或孕周超过14至16周，建议复位后位子宫以降低不良结局。既往描述的处理方法包括被动复位、手指复位或更具侵入性的方法，如腹腔镜检查、剖腹手术或乙状结肠镜检查。这些方法要么效果不佳，要么疼痛，要么风险较大。
本报告旨在描述我们使用经阴道超声探头对嵌顿子宫进行复位的新微创技术的临床经验，对“嵌顿妊娠子宫”进行文献综述，并提出该疾病的处理流程。
这是一个病例系列研究，纳入了2020年3月至2023年7月期间在一家学术医疗机构接受经阴道超声探头技术治疗的8例嵌顿妊娠子宫患者，并对“嵌顿妊娠子宫”的文献进行了叙述性综述。截至2024年4月，在PubMed、谷歌学术和Ovid MEDLINE数据库中检索了“嵌顿妊娠子宫”、“子宫嵌顿”、“子宫囊袋形成”和“子宫后倾”等术语。
经阴道超声探头技术使所有8例患者的子宫成功复位，症状缓解。所有妊娠均顺利分娩，新生儿结局良好——8例患者中有7例足月分娩，1例早产。
我们提出的经阴道超声探头治疗嵌顿妊娠子宫的技术简单、微创且有效。基于我们的经验和文献综述，提出了嵌顿妊娠子宫的处理流程。
