Antenatal Diagnosis of Uterine Incarceration: Surgical Role of MRI and Intraoperative Transmyometrium Ultrasound

Uterine incarceration is a rare condition thought to result from incarceration of a retroverted uterus in the small pelvis. The present case report describes a case of uterine incarceration caused by extensive pelvic adhesions after appendectomy for perforated appendicitis. A 39-year-old primigravida woman was referred to our obstetric unit for follow-up after successful in vitro fertilization. The symptoms related to uterine incarceration included anuria at 15 weeks of gestation and uterine contractions starting at 28 weeks of gestation. The absence of a cervical canal on ultrasonography is a key finding required to diagnose this rare condition. In the present case, the incision for uterotomy was determined by prenatal magnetic resonance imaging and transmyometrium ultrasonography during cesarean section. Both MRI and ultrasound images clearly showed anatomical relationships between the bladder, cervical canal and uterine wall. Clinicians need to know how the incision for uterotomy should be made and to avoid serious complications during cesarean section.