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Re: Incarcerated uterus From: fuf (fuf@ix.netcom.com) Fri Jun 30 23:06:45 2000 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: fuf: "Re: Going Bare on Malpractice Insurance" Previous message: M.S : "Complex Hyperplasia With atypia in a 29 years old!" In reply to: Rupak Ranjan Roy: "Re: Incarcerated uterus" Next in thread: Efrain Ramirez: "Re: Incarcerated uterus" Jane. Its easy to tell if the uterus moved. The cervix will be anterior under the symphysis and the fundus will fill the uterus in an incarcerated uterus. When the uterus is anteverted (or ante-displaced) the cervix will then lie much more posterior and the fundus will no longer fill the hollow of the sacrum. Anesthesia is often necessary. I have not found ultrasound to be of much help. The anterior wall of the incarcerated uterus will look like an anteverted fundus on abdominal scan. Incomplete bladder emptying may be apparent on ultrasound. Vaginal ultrasound may show the cervix to be anterior, against the maternal urethra. An ultrasound after the procedure will show that the cervix is no longer under the symphisis and against the urethra. Sometimes exercises (lying in knee chest for 1/2 hour bid or falling forwards into pillows on a bed several times a day) will help but not always. Leaving a Foley in for a day has been recommended to allow the uterus space to fall forward. I really doubt that this helps in addition to the exercises. I wouldn't leave the uterus retroverted too long. The risk of spontaneous abortion, preterm labor and uterine sacculation are increased when the condition persists. Some cases are associated with prior surgery, adhesions or endometriosis. These may be difficult to push up. If you can get a hold of my usual kit for uterine anteversion (Foley, condoms and 150 ml of quicksilver) e-mail me and I will tell you how to non-invasively treat the most difficult cases. BTW: Any chance your patient is Swedish? Gary Kleinman Disclaimer: Any suggestions stated in this document should be ignored and not used by employers who insist on noncompete clauses. > >> ----- Original Message ----- > From: Jane Helwig, MD <jane@seasonedsystems.com> > To: Multiple recipients of list OB-GYN-L <ob-gyn-l@forum.obgyn.net> > Sent: 01 July 2000 10:09 > Subject: Incarcerated uterus > >> G3P2 at 11 weeks presents with urinary retention. She says this >> happened in each of her previous pregnancies and both times her OB >> pushed on her uterus from below to resolve the problem. On exam, the >> uterus is so retroflexed as to be almost horizontal, with the cervix >> under the symphysis. Foley was inserted for 24 hours and urinary >> retention has resolved. >> >> I tried to push the uterus up vaginally while the patient was in >> lithotomy position and again while she was in knee-chest position, but >> didn't feel any change in its position. >> >> Questions for those who have successfully pushed the uterus up, with or >> without anesthesia: could you tell from movement of the uterus that you >> had succeeded? Did you monitor with ultrasound? How did you know it >> worked? >> >> Since she's now asymptomatic, do I need to do anything more? If urinary >> retention or pain returns, I have Plans B, C, D: pushing from below >> rectally, pushing from below under spinal anesthesia, colonoscopy a la >> recent article. Don't have any elemental mercury on hand for Plan E. >> >> Any comments? >> >> -- >> Jane Helwig, MD, FACOG >> Private practice >> Nassawadox, VA >> > Next message: fuf: "Re: Going Bare on Malpractice Insurance" Previous message: M.S : "Complex Hyperplasia With atypia in a 29 years old!" In reply to: Rupak Ranjan Roy: "Re: Incarcerated uterus" Next in thread: Efrain Ramirez: "Re: Incarcerated uterus"

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