Minimally Invasive Adhesiolysis for the Incarcerated Gravid Uterus: A Case Report of Early Second Trimester Intervention

Objective Incarceration of the gravid uterus is a rare obstetric complication in which the retroverted uterus becomes trapped in the pelvis, often resulting in maternal and fetal morbidity if not recognized and managed early. Study Design We present the case of a 36-year-old multigravida at 15 weeks' gestation with no prior abdominal surgeries who initially presented with urinary retention and was diagnosed with an incarcerated gravid uterus. Multiple attempts at manual reduction under spinal and general anesthesia were unsuccessful. Intraoperative transabdominal ultrasound demonstrated a live intrauterine pregnancy with normal fetal heart rate, a uterine fundus wedged behind the sacral promontory consistent with persistent incarceration, and raised concern for a Grade 1 (minor) placenta previa. Diagnostic laparoscopy revealed dense posterior adhesions between the uterus and sigmoid mesentery. Adhesiolysis was performed, resulting in successful uterine repositioning and symptom resolution. Although the patient initially recovered well, she re-presented with vaginal bleeding with resolution of her previa but with evidence of chorion–amnion separation. Ultimately, she experienced previable preterm premature rupture of membranes and was subsequently diagnosed with intrauterine fetal demise at 22 weeks and 4 days. Placental pathology demonstrated severe acute chorioamnionitis, funisitis, umbilical vasculitis, and features of uteroplacental underperfusion.

Laparoscopy allowed for successful uterine reduction through adhesiolysis. Despite technical success, the patient experienced chorion–amnion separation, preterm premature rupture of membranes, and intrauterine fetal demise. Placental pathology indicated infectious and vascular findings.

This case demonstrates the role of laparoscopy in management of gravid uterine incarceration refractory to manual reduction. It also underscores that technically successful surgical intervention may not preclude adverse pregnancy outcomes, emphasizing the importance of close antenatal surveillance. Key Points - Laparoscopy enables effective uterine reduction when manual methods are unsuccessful. - Adhesive disease may underlie uterine incarceration even without prior surgical history. - Operative anatomical correction may not prevent complications and continued monitoring is essential.

incarcerated gravid uterus - obstetric complications - pelvic adhesions - laparoscopic adhesiolysis - retrovertedPublication History Received: 18 April 2025 Accepted: 19 June 2025 Accepted Manuscript online: 16 July 2025 Article published online: 30 July 2025 © 2025. Thieme. All rights reserved. Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USA -

- 1 O'Grady JP, Chandraharan E. Incidence and outcomes of incarcerated gravid uterus: a systematic review. J Matern Fetal Med 2020; 33 (05) 555-560 - 2 Bonnar J. The trapped retroverted uterus: an overview. Obstet Gynecol Res 2019; 28 (03) 120-126 - 3 Cohen WR, Friedman EA. Incarceration of the gravid uterus: diagnostic challenges and management strategies. Am J Obstet Gynecol 2018; 219 (04) 345-350 - 4 Sibai BM, Mercer BM. Complications of untreated incarcerated uterus in pregnancy. Int J Gynaecol Obstet 2017; 136 (06) 734-739 - 5 Lowder JL, Parker AS. Maternal and fetal risks associated with incarcerated gravid uterus. Clin Obstet Gynecol 2021; 64 (01) 101-110 - 6 Cunningham FG, Leveno KJ, Bloom SL. Manual Reduction of Incarcerated Uterus: Techniques and Success Rates. Williams Obstetrics. 25th ed.. McGraw Hill; 2020: 345-346 - 7 Raissier SL, Gupta S, Maghsoudlou P. et al. Identifying risk factors for abdominal adhesions: preliminary findings of a prospective study. Am J Obstet Gynecol 2022; 226 (03) S1296-S1297 - 8 Fazel A, Boitard J. [Surgical treatments for endometriosis]. Rev Infirm 2024; 73 (299) 20-22 - 9 Foti PV, Farina R, Palmucci S. et al. Endometriosis: clinical features, MR imaging findings and pathologic correlation. Insights Imaging 2018; 9 (02) 149-172 - 10 Abelman SH, Jayakumaran JS, Sigdel M, Baxter JK. Incarcerated gravid uterus liberated by placement of a vaginal balloon. Obstet Gynecol 2022; 140 (05) 898-900 - 11 Cruz LT, Reis-de-Carvalho C, Ribeirinho AL. Uterine incarceration: a rare diagnosis in non-pregnant women. BMJ Case Rep 2023; 16 (11) e255799 - 12 Munro MG. Laparoscopic management of incarcerated uterus: a review and case report. J Minim Invasive Gynecol 2022; 29 (02) 334-337 - 13 Sedrati A, Tazi Z, Amine H. et al. Uterine incarceration: diagnostic and therapeutic approach. Gynecol Minimally Invasive Surg 2020; 15 (03) 244-249 - 14 Kearns T, Yuill C. Laparoscopy in obstetric emergencies: experience and outcomes. J Obstet Surg 2021; 45 (07) 789-795 - 15 Franklin M, Magee C. Posterior adhesions and gravid uterus: a minimally invasive approach. Surg Endosc 2019; 33 (09) 1881-1887 - 16 Debay A, Badeghiesh A, Baghlaf O. et al. Pregnancy, delivery, and neonatal outcomes among women with incarcerated uteri: a population-based study of a large US database. Eur J Obstet Gynecol Reprod Biol 2022; 276: 21-25