We read with great interest the paper entitled “Incarcerated gravid uterus: spontaneous resolution is not rare” by Tachibana et al. [1]. The report is relevant for at least three aspects. First, the case series is the largest reported for this infrequent clinical entity. Second, it underlines that a “wait and see” approach must be the first choice in the absence of severe complications. Third, the hospital-based framework and the 10-year study period allowed calculation of the incidence, which revealed higher frequency compared with previous reports [2]. However, the definition adopted could lead to underestimation of the phenomenon. The choice of 16 weeks of gestation as inclusion threshold is restrictive, since numerous reports have described incarceration of the retroverted gravid uterus associated with severe symptoms at a lower gestational age. Threatened miscarriage, acute urinary retention requiring bladder catheterization, manual repositioning of the uterus and hospitalization have even been reported in the first trimester of pregnancy [3,4].
As appropriately stated by the authors, a shared definition of uterine incarceration should include symptomatic cases, as asymptomatic cases could be considered variations of the normal anatomy and spontaneous repositioning has been reported even in the third trimester of pregnancy [1,5,6,7]. However, insidious cases with asymptomatic and unrecognized incarceration at term (i.e., Case 14) could experience sudden and severe obstetric complications, such as obstructed labour, cervical or vaginal incision at caesarean section, bladder injury and massive haemorrhage [1,8,9,10,11].
On these bases, we believe that the definition should include both symptomatic cases at any gestational age and asymptomatic cases at birth potentially at risk of catastrophic complications. This option would take into account early-onset cases, as well as the possibility of spontaneous repositioning at any gestation age.
Author Contributions
Conceptualization, M.O.; writing—original draft preparation, M.O.; writing—review and editing, E.S. All authors have read and agreed to the published version of the manuscript.
Funding
This research received no external funding.
Conflicts of Interest
The authors declare no conflict of interest.
Footnotes
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.
References
- 1.Tachibana D., Misugi T., Kitada K., Kurihara Y., Tahara M., Hamuro A., Nakano A., Yamamoto A., Koyama M. Incarcerated Gravid Uterus: Spontaneous Resolution Is Not Rare. Diagnostics. 2021;11:1544. doi: 10.3390/diagnostics11091544. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.O’Connell M.P., Ivory C.M., Hunter R.W. Incarcerated Retroverted Uterus-a Non Recurring Complication of Pregnancy. J. Obs. Gynaecol. J. Inst. Obs. Gynaecol. 1999;19:84–85. doi: 10.1080/01443619966092. [DOI] [PubMed] [Google Scholar]
- 3.Han C., Wang C., Han L., Liu G., Li H., She F., Xue F., Wang Y. Incarceration of the Gravid Uterus: A Case Report and Literature Review. BMC Pregnancy Childbirth. 2019;19:408. doi: 10.1186/s12884-019-2549-3. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Kim Y.S., Kwon B.S., Lee Y.J. Clinical Approach and Management of Uterine Incarceration According to Trimester of Pregnancy: Case Report and Literature Review. Taiwan J. Obs. Gynecol. 2021;60:911–915. doi: 10.1016/j.tjog.2021.07.023. [DOI] [PubMed] [Google Scholar]
- 5.Smalbraak I., Bleker O.P., Schutte M.F., Treffers P.E. Incarceration of the Retroverted Gravid Uterus: A Report of Four Cases. Eur. J. Obs. Gynecol. Reprod Biol. 1991;39:151–155. doi: 10.1016/0028-2243(91)90080-5. [DOI] [PubMed] [Google Scholar]
- 6.Hamoda H., Chamberlain P.F., Moore N.R., Mackenzie I.Z. Conservative Treatment of an Incarcerated Gravid Uterus. BJOG Int. J. Obs. Gynaecol. 2002;109:1074–1075. doi: 10.1111/j.1471-0528.2002.01124.x. [DOI] [PubMed] [Google Scholar]
- 7.Takami M., Hasegawa Y., Seki K., Hirahara F., Aoki S. Spontaneous Reduction of an Incarcerated Gravid Uterus in the Third Trimester. Clin. Case Rep. 2016;4:605–610. doi: 10.1002/ccr3.577. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Evans A.J., Anthony J., Masson G.M. Incarceration of the Retroverted Gravid Uterus at Term. Case Report. BJOG: Int. J. Obstet. Gynaecol. 1986;93:883–885. doi: 10.1111/j.1471-0528.1986.tb07999.x. [DOI] [PubMed] [Google Scholar]
- 9.Al Wadi K., Helewa M., Sabeski L. Asymptomatic Uterine Incarceration at Term: A Rare Complication of Pregnancy. J. Obs. Gynaecol. Can. 2011;33:729–732. doi: 10.1016/S1701-2163(16)34959-3. [DOI] [PubMed] [Google Scholar]
- 10.Hsu P.C., Yu M.H., Wang C.Y., Wang Y.K., Wang C.K., Su H.Y. Asymptomatic Uterine Incarceration at Term: Successful Management of a Rare Complication in Pregnancy. Taiwan J. Obs. Gynecol. 2018;57:745–749. doi: 10.1016/j.tjog.2018.08.025. [DOI] [PubMed] [Google Scholar]
- 11.van der Tuuk K., Krenning R.A., Krenning G., Monincx W.M. Recurrent Incarceration of the Retroverted Gravid Uterus at Term-Two Times Transvaginal Caesarean Section: A Case Report. J. Med. Case Rep. 2009;3:103. doi: 10.1186/1752-1947-3-103. [DOI] [PMC free article] [PubMed] [Google Scholar]