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Am J Perinatol
DOI: 10.1055/a-2640-3131
Original Article

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

Michelle Wenjing Hsia
1   Department of Obstetrics and Gynecology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
2   Department of Obstetrics and Gynecology, Atrium Health Wake Forest Baptist Hospital, Winston-Salem, North Carolina
,
Andrew Greene
2   Department of Obstetrics and Gynecology, Atrium Health Wake Forest Baptist Hospital, Winston-Salem, North Carolina
,
Sarah White
2   Department of Obstetrics and Gynecology, Atrium Health Wake Forest Baptist Hospital, Winston-Salem, North Carolina
,
Sierra Mims
2   Department of Obstetrics and Gynecology, Atrium Health Wake Forest Baptist Hospital, Winston-Salem, North Carolina
,
Eva Reina
2   Department of Obstetrics and Gynecology, Atrium Health Wake Forest Baptist Hospital, Winston-Salem, North Carolina
› Author Affiliations
Funding None.
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Abstract

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.

Results

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.

Conclusion

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.

Keywords

incarcerated gravid uterus - obstetric complications - pelvic adhesions - laparoscopic adhesiolysis - retroverted


Publication History

Received: 18 April 2025

Accepted: 19 June 2025

Accepted Manuscript online:
16 July 2025

Article published online:
30 July 2025

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