What are the treatment options for a patient with symptoms of an impacted uterus at 11 weeks pregnancy, specifically how is the knee-to-chest position performed?

Treatment Options for Impacted Uterus at 11 Weeks Pregnancy

The primary treatment for impacted uterus during pregnancy is manual replacement of the uterus into an anterior position, which can be facilitated by the knee-chest position. 1 This approach effectively relieves symptoms and prevents complications related to uterine impaction.

Understanding Impacted Uterus in Pregnancy

An impacted uterus during pregnancy typically occurs when a retroverted uterus becomes trapped in the pelvis as it enlarges. This can lead to:

• Urinary retention
• Pelvic pain
• Pressure symptoms
• Risk of pregnancy complications if left untreated

Treatment Algorithm

1. Initial Assessment

   • Confirm diagnosis of impacted uterus
   • Assess for urinary retention (common complication)
   • Evaluate for signs of uterine compression

2. First-Line Treatment

   • Bladder catheterization if urinary retention is present 1
   • Manual replacement of the uterus into an anterior position 1
   • Knee-chest position to facilitate spontaneous reduction

3. If Initial Treatment Fails

   • Chronic bladder drainage until the uterus spontaneously ascends out of the pelvis 1
   • Left lateral positioning to relieve pressure
   • Close monitoring for complications

Proper Knee-Chest Position Technique

The knee-chest position is performed as follows:

1. Have the patient kneel on a firm surface with knees apart
2. Lower the chest to the surface, keeping the buttocks elevated
3. The head should be turned to one side for comfort
4. Arms can be extended forward or folded under the head
5. Maintain this position for 10-15 minutes, 3-4 times daily
6. The position uses gravity to help move the uterus out of the pelvis

Additional Management Considerations

• Patient positioning: After 20 weeks of gestation, patients should not lie supine during procedures to prevent aortocaval compression 2
• Left lateral tilt: For patients beyond mid-pregnancy, use left lateral tilt or manual uterine displacement to increase venous return and cardiac output 3
• Monitoring: Regular follow-up to ensure the uterus remains properly positioned

Prevention of Recurrence

• Regular prenatal visits to monitor uterine position
• Pelvic rest as needed
• Patient education about symptoms requiring immediate attention
• Avoiding prolonged periods in positions that might exacerbate impaction

Potential Complications if Untreated

• Urinary tract infections
• Renal dysfunction
• Uterine ischemia
• Pregnancy loss
• Preterm labor

Early intervention with proper positioning techniques and manual replacement is essential for maternal and fetal well-being in cases of impacted uterus during pregnancy.