Purpose: To discuss the management of the rare complication of uterine sacculation
Material and methods: Case Report and Review of Literature
Case report: The 30-year old primigravid was referred to our centre at 25 weeks with persistend
lower abdominal pain and suspected risk of preterm delivery and placenta praevia as
the cervix was not visible on speculum exam. This findings where confirmed at our
centre. The patient also mentioned difficulties when emptying her bladder and a previously
retroflected uterus. Rectal palpation revealed a big, even-surfaced tumor in the area
of the posterior vaginal wall. At this point, uterine sacculation was suspected, and
the patient underwent MRI to confirm this diagnosis. The uterus was in a fixed retroflexed
position, the bladder and the cervix were stretched long on the anterior wall of the
uterus to the level of the umbilicus. The suspected placenta praevia could now be
interpreted as a posterior/fundal placenta.
The patient was hospitalized, and received steroids for lung maturation. She presented
repeatedly with abdominal pain and contractions, which were difficult to evaluate,
as no cervical length evaluation could be done, and received two courses of atosiban.
A planned cesarean section was performed at 34+5 weeks of gestation, as the risk of
uterine rupture was judged to be high with a very stretched and thin lower uterine
segment. A healthy baby girl was born (birth weight 2000 g, pH 7.28, Apgar 3/7/8).
Conclusions: Uterine sacculation is a rare complication of pregnancy, which here presented with
typical symptoms. If the diagnosis is missed, there is a high risk of damaging the
bladder and the cervix during a cesarean section, as the surgeon might not be aware
of the anatomical situation. If the patient is stable, the pregnancy might be prolonged
until a late preterm gestational age.
