A 35-year-old gravida 7, para 1, and abortus 5 female with hypogastric pain and inability to void urine after 14 + 3 weeks of amenorrhea was examined in the emergency department. One year before, a uterine prolapse had been diagnosed in another hospital.\nExamination showed an anteverted uterus and uterine prolapse grade 2 with palpable bladder. The patient was unable to void urine. Ultrasound revealed a cervical length of 30 mm and a singleton, cephalic fetus. A manual reduction of the uterine prolapse was made, and the patient underwent an emergency catheterization for bladder drainage (500 mL urine). No urinary tract infection was found. Then, it a Hodge pessary (size 70), and was placed after a spontaneous micturition, the woman was discharged for further ambulatory followup. The following day, the patient was admitted in to the emergency department because of a new AUR. Hodge pessary was replaced by another one of size 75, and due to the persistence of the symptoms, finally an Arabin cerclage pessary was placed (). The patient was discharged after a rapid resolution of symptoms.\nObstetric controls, which included vaginal cultures, were made every two weeks during the whole pregnancy. With negative vaginal cultures, the pregnancy progressed without incidences. The woman was admitted into the hospital at 36 + 5 weeks of gestation, due to a premature rupture of membranes. No evidence of vaginal infection was found. Then, Arabin cerclage pessary was removed, and the patient underwent a vaginal delivery, giving birth to a boy weighing 2,650 g.
A 31-year-old primigravida had been admitted to another hospital for 3 days because of acute urinary retention, which was conservatively managed; the management strategy included pain control. She was referred to us at 6 weeks of gestation, with a 12.6 cm × 9.4 cm-sized myoma in the posterior uterine wall. She also complained of urinary retention and dysuria, along with severe back pain. Pelvic examination revealed fullness in the posterior fornix and anterior displacement of the cervix. On bimanual examination, the retroverted uterine fundus was palpable as a large mass in the cul-de-sac. Ultrasound findings showed the uterus entrapped in the pelvis in the hollow of the sacrum along with a posterior myoma (). An indwelling urinary catheter was inserted and 750 mL of urine was drained, with the catheter kept in place.\nManual reduction was attempted by applying steady pressure with two fingers in the posterior vaginal fornix and by pushing the uterus in a cephalad direction without anesthesia while the patient was in the dorsal lithotomy and knee-chest position; however, it failed. Subsequently, gentle bimanual reduction through the rectum and vagina was attempted by applying continuous pressure under ultrasonographic guidance. Subsequently, slight pain reduction was achieved. In order to prevent re-incarceration of the uterus, pessary insertion was attempted; however, it failed owing to the narrow space. Instead, a large gauze was packed in the vagina, the Foley catheter was left in place, and the patient was kept on bed rest for 1 day. Final ultrasound showed a uterine myoma that was positioned slightly upward after reduction (). On the next day, the gauze and Foley catheter were removed. The patient still complained of intermittent back pain but was able to void the bladder, and was discharged. Although the uterine incarceration improved slightly, the patient subsequently had a spontaneous abortion after 1 week, and a myomectomy was conducted for her subsequent pregnancy.