Surgical Management of Uterine Incarceration At 10 Weeks Gestation

Objective: To present a rare case of incarcerated gravid uterus in the first trimester that presented with acute urinary retention and outline a minimally invasive surgical strategy that achieved immediate symptom relief and prevented recurrence. Methods: Video case report with stepwise demonstration of laparoscopic reduction of a 41year old patient at 10 weeks gestation with acute urinary retention secondary to uterine incarceration. Results: The patient presented with acute urinary retention and a retroverted uterus impacted in the posterior pelvis. Transvaginal ultrasound was inconclusive; MRI confirmed uterine incarceration. Conservative measures, including bladder decompression, positional changes, and manual reduction, were unsuccessful. Given the early presentation, laparoscopy was performed to assess for possible anatomic factors contributing to incarceration. Intraoperative inspection demonstrated the uterus impacted against the sacrum. Gentle cephalad traction restored normal positioning, and a vaginal pessary was inserted to prevent retroflexion. The procedure was completed with minimal blood loss (<5 mL) and no intraoperative complications. Urinary retention resolved immediately. The pessary remained in place until 16 weeks gestation, with no recurrence after removal. The pregnancy resulted in a term uncomplicated vaginal delivery without recurrence uterine incarceration to date. Conclusion: Uterine incarceration should be considered in patients presenting with urinary retention during the first trimester. MRI can aid diagnosis when ultrasound findings are equivocal. In early presentations, laparoscopic inspection may be useful to identify contributing factors, such as abnormal anatomy and adhesions, that could predispose to incarceration.