A 34-year-old multiparous woman was admitted at 7.2 weeks of gestation with acute urinary retention and a mass in the upper vaginal wall. She had adenomyosis (uterus size, 10.4 cm × 11.6 cm), and a 2-week history of increased urinary frequency and a sensation of incomplete bladder emptying. In the emergency room, 850 mL of urine was drained by urinary catheterization. Transvaginal (TV) ultrasound and MRI showed no specific findings except a retroverted gravid uterus with adenomyosis, and an elongated and anteriorly displaced cervix behind the pubic symphysis (; TV ultrasound, ; MRI). Nonetheless, uterine incarceration was clinically suspected. The change in uterine polarity was noted after manual reduction (), and a pessary was inserted to prevent recurrence (74 mm; Smiths Medical, Minneapolis, MN, USA). The pessary was removed at 15 weeks, and the patient delivered a healthy male baby weighing 3,100 g at 38 weeks. Ultrasound examination performed at 6 weeks after delivery showed a retroverted uterus with a slightly thickened wall, although it was thinner than expected ().
Case 3: A 31-year-old pregnant woman (gravida 3 para 1, abortion 1) at 14 + 5 wk of gestation presented with constipation and no bowel movements for 10 d and was admitted to the Obstetrics Department on February 8, 2011.