Second trimester uterine incarceration in monochorionic twins requiring fetal intervention
Courtney T Connolly1, Shriddha Nayak2, Lauren N Meiss2
1Johns Hopkins Center for Fetal Therapy Department of Gynecology and Obstetrics Johns Hopkins University School of Medicine Baltimore Maryland USA.
Background:
Uterine incarceration is a rare occurrence characterized by entrapment of the gravid uterine fundus between the sacral promontory and pubic symphysis. Mid-trimester presentation has additional obstetric and surgical significance.
Case:
We report a patient with second-trimester incarcerated uterus in a complicated monochorionic diamniotic twin pregnancy with a suspected bicornuate uterus. Uterine incarceration distorted the ultrasound appearance of fetal and placental location. Reduction of the incarcerated fundus was required to restore the abdominopelvic and intrauterine anatomy prior to fetal intervention. Selective reduction of the growth-restricted, anomalous fetus was then successfully performed.
Conclusion:
Uterine incarceration distorts the maternal-pelvic anatomy as well as the perceived location of intrauterine contents. Recognition of altered intrauterine landmarks is critical when obstetric or surgical management is indicated. Our case highlights the distortion of intrauterine contents associated with uterine incarceration and the potential impact on obstetric and surgical management.
