{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T00:10:43Z","timestamp":1771459843114,"version":"3.50.1"},"reference-count":16,"publisher":"Georg Thieme Verlag KG","issue":"04","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Incarceration of the gravid uterus is a rare obstetric complication in which the retroverted uterus becomes trapped in the pelvis, often resulting in maternal and fetal morbidity if not recognized and managed early.<\/jats:p>\n                  <jats:p>We present the case of a 36-year-old multigravida at 15 weeks' gestation with no prior abdominal surgeries who initially presented with urinary retention and was diagnosed with an incarcerated gravid uterus. Multiple attempts at manual reduction under spinal and general anesthesia were unsuccessful. Intraoperative transabdominal ultrasound demonstrated a live intrauterine pregnancy with normal fetal heart rate, a uterine fundus wedged behind the sacral promontory consistent with persistent incarceration, and raised concern for a Grade 1 (minor) placenta previa. Diagnostic laparoscopy revealed dense posterior adhesions between the uterus and sigmoid mesentery. Adhesiolysis was performed, resulting in successful uterine repositioning and symptom resolution. Although the patient initially recovered well, she re-presented with vaginal bleeding with resolution of her previa but with evidence of chorion\u2013amnion separation. Ultimately, she experienced previable preterm premature rupture of membranes and was subsequently diagnosed with intrauterine fetal demise at 22 weeks and 4 days. Placental pathology demonstrated severe acute chorioamnionitis, funisitis, umbilical vasculitis, and features of uteroplacental underperfusion.<\/jats:p>\n                  <jats:p>Laparoscopy allowed for successful uterine reduction through adhesiolysis. Despite technical success, the patient experienced chorion\u2013amnion separation, preterm premature rupture of membranes, and intrauterine fetal demise. Placental pathology indicated infectious and vascular findings.<\/jats:p>\n                  <jats:p>This case demonstrates the role of laparoscopy in management of gravid uterine incarceration refractory to manual reduction. It also underscores that technically successful surgical intervention may not preclude adverse pregnancy outcomes, emphasizing the importance of close antenatal surveillance.<\/jats:p>","DOI":"10.1055\/a-2640-3131","type":"journal-article","created":{"date-parts":[[2025,7,17]],"date-time":"2025-07-17T00:05:48Z","timestamp":1752710748000},"page":"484-488","source":"Crossref","is-referenced-by-count":0,"title":["Minimally Invasive Adhesiolysis for the Incarcerated Gravid Uterus: A Case Report of Early Second Trimester Intervention"],"prefix":"10.1055","volume":"43","author":[{"given":"Michelle Wenjing","family":"Hsia","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Wake Forest University School of Medicine, Winston-Salem, North Carolina"},{"name":"Department of Obstetrics and Gynecology, Atrium Health Wake Forest Baptist Hospital, Winston-Salem, North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Greene","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Atrium Health Wake Forest Baptist Hospital, Winston-Salem, North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"White","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Atrium Health Wake Forest Baptist Hospital, Winston-Salem, North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sierra","family":"Mims","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Atrium Health Wake Forest Baptist Hospital, Winston-Salem, North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eva","family":"Reina","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Atrium Health Wake Forest Baptist Hospital, Winston-Salem, North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2025,7,30]]},"reference":[{"issue":"05","key":"ref1","first-page":"555","article-title":"Incidence and outcomes of incarcerated gravid uterus: a systematic review","volume":"33","author":"J P O'Grady","year":"2020","journal-title":"J Matern Fetal Med"},{"issue":"03","key":"ref2","first-page":"120","article-title":"The trapped retroverted uterus: an overview","volume":"28","author":"J Bonnar","year":"2019","journal-title":"Obstet Gynecol Res"},{"issue":"04","key":"ref3","first-page":"345","article-title":"Incarceration of the gravid uterus: diagnostic challenges and management strategies","volume":"219","author":"W R Cohen","year":"2018","journal-title":"Am J Obstet Gynecol"},{"issue":"06","key":"ref4","first-page":"734","article-title":"Complications of untreated incarcerated uterus in pregnancy","volume":"136","author":"B M Sibai","year":"2017","journal-title":"Int J Gynaecol Obstet"},{"issue":"01","key":"ref5","first-page":"101","article-title":"Maternal and fetal risks associated with incarcerated gravid uterus","volume":"64","author":"J L Lowder","year":"2021","journal-title":"Clin Obstet Gynecol"},{"key":"ref6","first-page":"345","volume-title":"Manual Reduction of Incarcerated Uterus: Techniques and Success Rates","author":"F G Cunningham","year":"2020","edition":"25th ed."},{"issue":"03","key":"ref7","doi-asserted-by":"crossref","first-page":"S1296","DOI":"10.1016\/j.ajog.2021.12.048","article-title":"Identifying risk factors for abdominal adhesions: preliminary findings of a prospective study","volume":"226","author":"S L Raissier","year":"2022","journal-title":"Am J Obstet Gynecol"},{"issue":"299","key":"ref8","first-page":"20","article-title":"[Surgical treatments for endometriosis]","volume":"73","author":"A Fazel","year":"2024","journal-title":"Rev Infirm"},{"issue":"02","key":"ref9","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1007\/s13244-017-0591-0","article-title":"Endometriosis: clinical features, MR imaging findings and pathologic correlation","volume":"9","author":"P V Foti","year":"2018","journal-title":"Insights Imaging"},{"issue":"05","key":"ref10","doi-asserted-by":"crossref","first-page":"898","DOI":"10.1097\/AOG.0000000000004964","article-title":"Incarcerated gravid uterus liberated by placement of a vaginal balloon","volume":"140","author":"S H Abelman","year":"2022","journal-title":"Obstet Gynecol"},{"issue":"11","key":"ref11","doi-asserted-by":"crossref","first-page":"e255799","DOI":"10.1136\/bcr-2023-255799","article-title":"Uterine incarceration: a rare diagnosis in non-pregnant women","volume":"16","author":"L T Cruz","year":"2023","journal-title":"BMJ Case Rep"},{"issue":"02","key":"ref12","first-page":"334","article-title":"Laparoscopic management of incarcerated uterus: a review and case report","volume":"29","author":"M G Munro","year":"2022","journal-title":"J Minim Invasive Gynecol"},{"issue":"03","key":"ref13","first-page":"244","article-title":"Uterine incarceration: diagnostic and therapeutic approach","volume":"15","author":"A Sedrati","year":"2020","journal-title":"Gynecol Minimally Invasive Surg"},{"issue":"07","key":"ref14","first-page":"789","article-title":"Laparoscopy in obstetric emergencies: experience and outcomes","volume":"45","author":"T Kearns","year":"2021","journal-title":"J Obstet Surg"},{"issue":"09","key":"ref15","first-page":"1881","article-title":"Posterior adhesions and gravid uterus: a minimally invasive approach","volume":"33","author":"M Franklin","year":"2019","journal-title":"Surg Endosc"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.ejogrb.2022.06.027","article-title":"Pregnancy, delivery, and neonatal outcomes among women with incarcerated uteri: a population-based study of a large US database","volume":"276","author":"A Debay","year":"2022","journal-title":"Eur J Obstet Gynecol Reprod Biol"}],"container-title":["American Journal of 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