A new technique to reposition an incarcerated gravid uterus based on a biomechanical concept

INTRODUCTION: An incarcerated gravid uterus (IGU) is a rare but serious obstetrical complication. Currently, there is no consensus on the optimal treatment when conservative reduction techniques have failed. Often, maneuvers with increased force are applied or a surgical intervention is the final reserved measure. Both are associated with an increased risk for the mother and child. In this technical report, we present a novel, minimally invasive technique to reduce an incarcerated uterus based on a biomechanical concept. METHOD: To reduce an IGU, we apply saline fluid intraabdominally under sonographic guidance, while the patient is under peridural anesthesia. This not only increases the space in the abdomen necessary for repositioning, but also negates the negative pressure in the pouch of Douglas created when removing the uterine fundus from the true pelvis. RESULTS: The author's experience with this method is limited to two cases, both resulting in successful uterine repositioning after failure of the usual conservative reduction techniques. CONCLUSION: This procedure provides a viable alternative for reducing an IGU, thereby minimizing the need for more invasive measures that carry considerably higher maternal and fetal risks.