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Novel Approach to Reduction of an Incarcerated Uterus

Gardner, Bennett, MD; Kozakiewicz, Melissa L., MD; Whitecar, Paul W., MD; Nitsche, Joshua F., MD, PhD; Brost, Brian C., MD

doi: 10.1097/AOG.0000000000002934
Obstetric Complications of Pregnancy: Procedures and Instruments: PDF Only

BACKGROUND: Incarceration of the pregnant uterus is a rare condition and can lead to bladder obstruction, renal failure, or uterine rupture. We present a novel, noninvasive technique to reduce an incarcerated uterus.

METHOD: With conscious sedation, the patient was placed in all-fours position. The physician's hands were placed on the patient's abdomen and pressure applied until the uterine fundus was palpated. Gentle, steady fundal pressure on both sides was directed toward the maternal chest (bilateral mediocephalad pressure) elevating the uterus out of the pelvis. This approach successfully reduced the gravid incarcerated uterus and was well tolerated by the patient and fetus.

EXPERIENCE: The author's experience with this method is limited to this case. Prior experience with reduction of the incarcerated uterus has been with methods previously described in the literature.

CONCLUSION: In conjunction with conscious sedation and all-fours positioning, transabdominal manipulation of the uterine fundus with bilateral mediocephalad pressure may facilitate reduction of an incarcerated uterus. This method may obviate the need for more invasive procedures.

Transabdominal manipulation of the uterine fundus with bilateral mediocephalad pressure may facilitate reduction of an incarcerated uterus and obviate the need for more invasive procedures.

Department of Obstetrics and Gynecology, Wake Forest University School of Medicine, Winston-Salem, North Carolina.

Corresponding author: Brian C. Brost, MD, One Medical Center Boulevard, Wake Forest School of Medicine, Winston Salem, NC 27157; email: bbrost@wakehealth.edu.

Financial Disclosure The authors did not report any potential conflicts of interest.

Each author has indicated that he or she has met the journal's requirements for authorship.

Received May 03, 2018

Received in revised form August 07, 2018

Accepted August 16, 2018

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.