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Pregnancy is accompanied by a reduction in uterine noradrenaline, and the study was undertaken to investigate associated structural and functional integrity of the sympathetic nerves in the organ. The formaldehyde-induced fluorescence of adrenergic nerves was studied in different uterine regions before and after in vitro incubation or injection with alpha-methyl-noradrenaline in pregnant and puerperal guinea-pig uterus at 6 time periods, from early pregnancy (about 20 days post coitum) to 3 months post partum. The changes were related to the position of the fetuses, which were often present in only one of the two uterine horns. There was a drastic loss of fluorescent adrenergic nerves in myometrial tissue from horns distended by fetuses. Attempts to restore this fluorescence by incubation or injection with alpha-methyl-noradrenaline were essentially ineffective. Tissues from uterine regions outside (and not distended by) fetuses (in the case of early pregnancy), from horns devoid of fetuses (in the case of unilateral pregnancy), and from the cervix also lost their noradrenaline-fluorescent nerves, but this occurred at a much later stage of pregnancy. After treatment with alpha-methyl-noradrenaline, a fluorescent plexus of sympathetic nerves could be restored to a considerable extent in these latter tissues. In puerperal animals the horn that had been devoid of fetuses regained its endogenous fluorescence much faster, and the uptake of alpha-methyl-noradrenaline was more efficient, than in the horn which had contained fetuses. In this latter horn clear signs of restoration of endogenous adrenergic fluorescence and a clear uptake capacity was not found until 3 months after delivery. In the tubal end of the uterus, the reduction in the number of fluorescent nerves was only insignificant, and the region thus clearly differed from the rest of the uterus. It is concluded that (1) there are clear regional differences with regard to the disappearance of the noradrenaline transmitter in the uterus, (2) this disappearance in early pregnancy is related to the position of the conceptus, and (3) the changes involve de- and regenerative phenomena as well as alterations in transmitter levels of intact neurons.

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Extreme uterine torsion of 180 degrees at term is a rare obstetric event and raises several critical management considerations. We report such a case detected at laparotomy for a repeat Caesarean section. The existing literature on uterine torsion is reviewed and a plan of management is suggested, based on previous reports and our own experience.