Get a Group Membership for your Organization. Free Trial
Pricing
Free TrialLogin

Uterine Incarceration

HIDE
PrevNext

0:00

This is an MRI of the abdomen and

0:02

pelvis in a patient referred at

0:05

19 weeks' gestation from the Maternal Fetal

0:07

Medicine Clinic after abnormal ultrasound.

0:11

The notes that were sent by the referring

0:13

clinician specifically indicated that

0:16

they were having trouble visualizing

0:17

the cervix on the patient's ultrasound.

0:20

Here we have sagittal T2-weighted

0:22

images of the abdomen and pelvis.

0:24

Again, our steady-state free precession

0:26

images are on the left, and our

0:28

turbospin echo images are on the right.

0:32

As we scroll through the images, we can

0:34

see almost immediately why the providers

0:36

in clinic were having difficulty evaluating

0:39

the cervix, which is elongated and

0:42

anteriorly displaced for this patient.

0:45

So all of this T2 brightness is a small

0:47

amount of fluid within the cervical

0:49

canal, and this is the anterior lip

0:51

and posterior lip of the cervix.

0:53

Up here is the internal cervical

0:55

os, and we can see abutment of the

0:58

os by the edge of the placenta.

1:01

So this patient has a marginal placenta previa.

1:05

When we evaluate the uterus, it's in an odd

1:09

configuration, certainly different from what

1:11

we've seen previously with pregnant patients.

1:14

We can trace our T2 heterogeneous myometrium

1:18

all the way around the uterus for this patient,

1:21

and we can note that there is bulging of the

1:27

low anterior uterine segment of the placenta,

1:29

and displacement of the fundus, which is located

1:32

in the presacral space within the pelvis.

1:36

We see similar findings on the

1:38

steady-state free precession images.

1:41

I'd also like to point out that this

1:42

patient has had a kidney transplant, which

1:45

we can see in the right lower quadrant.

1:48

Let's look at the axial images for this patient.

1:50

Again, steady-state free precession images on

1:53

the left, turbo spin echo images on the right.

1:56

We see the kidney transplant

1:58

in the right iliac fossa.

1:59

Here's the gravid uterus.

2:03

And, again, we can see that the fundus of

2:05

the uterus is within the presacral space.

2:09

The placenta is visualized here.

2:13

It's minimally heterogeneous, and so even

2:17

though we are seeing the placenta inferior

2:19

and deep in the pelvis on these images,

2:22

it is technically a fundal placenta.

2:25

Returning to the sagittal images, we can once

2:29

again evaluate the orientation of the uterus.

2:32

And so if we're discussing or describing

2:34

version and flexion, this patient is markedly

2:37

anteverted in terms of the orientation of

2:39

the cervix and markedly retroflexed with the

2:42

uterine fundus located in the presacral space.

2:46

This patient is presenting in the

2:48

second trimester of pregnancy.

2:50

We can see that the fetus is fairly

2:52

developed, and because of the size of the

2:54

uterus and its orientation, a diagnosis

2:57

of uterine incarceration was made.

3:00

Uterine incarceration is a term

3:02

that describes entrapment of a

3:04

retroverted uterus in the pelvis.

3:06

It's fairly rare, estimated to

3:08

occur in 1 in 3,000 pregnancies.

3:11

Patients often present early in the second

3:13

trimester, and on exam, these patients will have

3:16

a fundal height that's discordant with dates.

3:19

On ultrasound, they may also see anterior

3:22

location or displacement of the cervix.

3:25

There are multiple potential methods

3:26

of reduction, some of which are manual

3:29

and can be done in the office or in the

3:31

operating room with or without anesthesia.

3:35

It's important to attempt reduction

3:37

for these patients as complications

3:39

can include uterine or bladder rupture.

3:42

For the case that we previously described,

3:44

the patient presented to the clinic one month

3:47

later with acute onset abdominal pain.

3:50

When we did follow-up MRI for her, we saw

3:52

that the uterus had corrected itself and

3:55

had moved from the presacral space into

3:58

the expected location in the abdomen.

Report

Faculty

Erin Gomez, MD

Assistant Professor of Radiology

Johns Hopkins Hospital

Tags

Women's Health

Uterus

MRI

Gynecologic (Gyn)

Gynecologic (GYN)

Genitourinary (GU)

Cervix

Body

© 2024 MRI Online. All Rights Reserved.

Contact UsTerms of UsePrivacy Policy