Background: Cases of incarcerated gravid uterus (IGU) are quite rare at about 1 in 3000 pregnancies. IGU is defined as the entrapment of the gravid uterus between the pubic symphysis and the sacral promontory. Due to compression of adjacent structures, symptoms of IGU present non-specifically as urinary retention, dysuria, abdominal pain, and constipation, often causing this condition to be misdiagnosed. Reduction of an IGU proves to be crucial as serious complications such as urinary tract obstructions, urinary tract infections, renal failure, fetal growth restriction, fetal demise, and uterine wall rupture may occur.

Case Presentation: A 34-year-old G2P1 woman at 12 3/7 weeks presented with difficulty urinating, difficulty stooling, and a feeling of incomplete emptying. At the patient’s first visit a week prior, it was thought that she had a urinary tract infection as it proved to be the most likely cause of her symptoms; however, cultures were negative and completion of the antibiotic treatment provided no relief. The patient was reevaluated the following week when an anterior displacement of the cervix on speculum exam was noted. This led to the diagnosis of an IGU, pivoting the management to passive and active reduction techniques. A catheter was placed to relieve the patient’s bladder. 2200 cc of urine were drained after which the patient reported significant relief of pelvic pressure. The patient was placed in the knee/chest position for two hours before a manual replacement was attempted. The uterus was lifted from the cul-de-sac, and the patient was sent home with the foley in case the incarceration recurred. She returned to the clinic 10 days later for a voiding trial after removal of the foley which proved to be successful. The patient is continuing with her pregnancy without any issues.

Discussion: IGU often presents with urinary symptoms and can be conservatively managed by draining of the bladder, non-invasive methods such as knee-chest, and manual reduction if none of these efforts are successful. Early identification and management of an IGU is crucial for a safe pregnancy. Due to its rarity, it is often not considered when patients present with non-specific or primarily urinary symptoms. Cases are often misdiagnosed, leading to a delay in treatment and resolution of symptoms for patients. In this case, we note that the presentation of an IGU can easily be attributed to other causes and that if identified properly, can be reduced earlier in the pregnancy to avoid serious complications.