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 ().
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.