EP24.17: Incarceration of the early gravid uterus with adenomyosis and myoma: report of two patients managed with uterine reduction

Uterine incarceration is a rare complication that usually occurs after the first trimester of pregnancy, but serious complication of pregnancy. It leads to increased maternal and/or fetal morbidity and mortality. One of the two cases is a multiparous, 34-year-old woman with known adenomyosis (10.4 x 11.6cm sized). The patient was 7 weeks and 2 days pregnant and presented two week history of urinary frequency and sensation of incomplete bladder emptying. The incarceration was successfully reduced by manual reduction and pessary insertion (74mm). She had a normal infant of appropriate weight at term. The other case is a nulliparous, 31-year-old woman at 6+1 weeks' gestation with known myoma in posterior uterine wall (12.65 x 9.4cm sized). She was also complaining of dysuia and urinary retention with severe back pain. The reduction of uterine incarceration was failed by manual reduction and knee-chest position manual reduction was applied but failed. And then rectum manual reduction and pessary insertion were tried but both were failed. Although it observed by packing a gauze, the fetal heart rate was not checked after one week. Progression from expectant management to intervention is recommended as soon as possible to prevent complications such as uterine incarceration and fetal demise. In subsequent pregnancies, close monitoring with serial ultrasounds is warranted to monitor for recurrence of incarceration or a proper surgical treatment of removable myoma is needed before pregnancy.