Monday, March 19, 2012

Jailbreak

This patient has had surgery for endometriosis in the past as well as a history of pelvic inflammatory disease. She presented, however, at 14 weeks gestation with abdominal and back pain as well as urinary retention, frequency, and the sensation of incomplete emptying. Symptoms started a few weeks prior, but resolved, and now have returned. She has no vaginal bleeding, discharge, or contractions. Pelvic exam shows anterior displacement of the cervix behind the symphysis pubis; the cervix cannot be visualized and the external os is not palpable. There is a large mass in the cul-de-sac and the uterus is difficult to palpate on bimanual exam. Ultrasound done at 16 weeks confirms the diagnosis and an intervention is planned.

Challenge: What's the diagnosis?

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3 comments:

Reflex Hammer said...

Placenta previa???

our.man.jonesy said...

Hum. Ectopic placement of the pregnancy with internal bleeding orrrrr incarcerated gravid uterus?

Craig Chen said...

good call jonesy - this is incarcerated gravid uterus
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Jailbreak

This is an incarcerated gravid uterus. Normally, the uterus is retroverted or retroflexed in 20% of women in early pregnancy which corrects itself by 14 weeks gestation with growth of the gravid uterus. Rarely, however, the fundus of a retroverted uterus remains entrapped in the pelvic cavity creating an incarcerated uterus where the fundus remains below the sacral promontory after 16 weeks gestation.

Source: UpToDate.