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.
Case 2: A 27-year-old pregnant Chinese nulligravida presented to the Obstetrics Department with intermittent urinary retention at 17 wk of gestation on December 26, 2018.