Diagnostic Pitfalls of Incarcerated Gravid Uterus: Report of Two Cases and Literature Review

Background : Incarcerated gravid uterus (IGU), which is characterized by entrapment of the retroverted uterus within the pelvis during the gestational period, is an uncommon condition but might potentially lead to serious maternal-fetal outcomes. Delayed recognition may result in maternal and fetal morbidity. Case Presentations : In this article, we describe two IGU cases diagnosed in the second trimester of gestation but initially considered as placenta previa. Case 1 was a 33-year-old woman who conceived through IVF measures but experienced repeated episodes of vaginal bleeding during pregnancy. At 23+6 weeks, ultrasonography revealed IGU, which initially was misdiagnosed as central placenta previa. Her worsening hemorrhage at 24+3 weeks of gestation necessitated urgent cesarean delivery. In the process of the procedure, it was found that the uterus was severely retroverted and densely adherent to the rectovaginal space. Case 2 was also about a patient conceived through IVF-ET who was complicated with adenomyosis and uterine fibroid. She presented with recurrent abdominal pain from 20 weeks onwards. The ultrasound and MRI imaging examination also detected placenta previa initially. Afterwards, the ultrasound revealed IGU with an elongated cervix. Persistent exacerbating pain led to cesarean section at 32+6 weeks, which confirmed IGU during the procedure. Conclusion : One of the significant diagnostic pitfalls for IGU is the early misreading of imaging investigations, particularly the incorrect diagnosis of placenta previa. For prompt diagnosis and better maternal-fetal outcomes, patients who arrive with unusual pain or aberrant cervical findings should have a high index of suspicion for IGU.