Pregnancy, delivery, and neonatal outcomes among women with incarcerated uteri: A population-based study of a large US database

OBJECTIVE: Incarcerated uterus occurs at a rate of 1:3000 pregnancies. Previous studies focused on risk factors and management options, providing limited information about pregnancy outcomes. This study evaluates the effect of incarcerated uterus on pregnancy, delivery, and neonatal outcomes. METHODS: Retrospective study using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample from 2004 to 2014. Incarcerated uterus was identified using ICD-9 code 654.3X. Multivariate logistic regression analysis was used to compare maternal and neonatal outcomes among women with and without incarcerated uterus while adjusting for confounders. RESULTS: Incarcerated uteri were identified in 370 pregnancies, and 9,096,418 pregnancies were control cases. Compared to controls, women with incarcerated uterus were more likely to be Caucasian, have smoked during pregnancy, have had a previous caesarean section, have thyroid disease, endometriosis, leiomyomas, pelvic inflammatory disease and adhesions, and ovarian cyst (P-value < 0.05 all). Women with incarcerated uterus were more likely to have placenta previa (aOR 3.1, 95% CI 1.3-7.4), deliver by caesarean section (aOR 2.4, 95% CI 1.8-3.1), have postpartum hemorrhage (aOR 2.8, 95% CI 1.8-4.4), and require blood transfusion (aOR 5.2, 95% CI 3.1-8.8). Hydronephrosis occurred more often in women with incarcerated uterus (0.8% versus 0.1%). Moreover, they were more likely to have infants with congenital anomalies (aOR 4.0, 95% CI 1.5-10.6). Rates of preeclampsia, preterm birth, and small for gestational age were similar between the two groups (P-value > 0.05, all). CONCLUSION: Women with incarcerated uterus were more likely to encounter adverse delivery and neonatal outcomes compared to the general population. These findings may help guide prenatal counseling and prenatal surveillance.