Significance of pelvic magnetic resonance imaging in preoperative diagnosis of incarcerated retroverted gravid uterus with a large anterior leiomyoma: a case report.
BACKGROUND
Incarceration of the gravid uterus is a rare but serious complication of pregnancy. The often required cesarean section is technically complicated, and preoperative planning is critical. An important initial surgical step is to lift the fundus out of the pelvis prior to creating the hysterotomy in order to facilitate adequate visualization of the pelvic anatomy.


METHODS
A 38-year-old primigravida with uterine incarceration from a large anterior leiomyoma underwent cesarean delivery at 29 weeks' gestation. In this case, a failure of the fundal height to increase was not appreciated as the anterior leiomyoma was palpated to represent the fundus. Intraoperatively the uterus was unable to be repositioned because of the leiomyoma. However, the surgery did proceed smoothly primarily due to the highly detailed images obtained on pelvic magnetic resonance imaging.


CONCLUSIONS
Although uterine incarceration is rare, knowledge of this condition is important. Magnetic resonance imaging is a useful tool in that it enables the detailed evaluation of the pelvic anatomy in cases with suspected uterine incarceration.
Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Nobutaka
N
Hachisuga
Nobuhiro
N
Hidaka
Yasuyuki
Y
Fujita
Kotaro
K
Fukushima
Norio
N
Wake
D000328:Adult; D002585:Cesarean Section; D005260:Female; D006801:Humans; D007889:Leiomyoma / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000000981:diagnostic imaging* / Q000601:surgery; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D011296:Prenatal Diagnosis / Q000379:methods*; D011300:Preoperative Care; D014463:Ultrasonography; D014594:Uterine Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D060725:Uterine Retroversion / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery