A rare obstetric emergency: acute uterine torsion in a 32-week pregnancy

Abstract

Uterine torsion is rare in pregnancy and the cause in most cases is unknown. It is associated with fetal compromise, with perinatal mortality reported to be around 12%. Our case describes an acute torsion, presenting in pregnancy with severe abdominal pain and vomiting with a viable 32-week gestation. Emergency caesarean section was performed and the 180° uterine torsion was diagnosed intraoperatively. Posterior hysterotomy was required for delivery prior to detorsion of the uterus. This report describes that prompt recognition and intraoperative vigilance can achieve a successful maternal and fetal outcome in this rare and difficult obstetric scenario.

Acute gravid uterus torsion: A rare and dangerous obstetric emergency

“…Gravid uterus torsion is an urgent condition that is often associated with uterus malformations, pelvic adhesions, and abnormal fetal presentations, as seen in the present case study. The most common clinical presentation is persistent and non‐specific abdominal pain.…”

Uterine torsion of 90 degrees: case report

“…In this series, over 30% cases had no cause identified. 5 Transverse fetal lie (or malpresentation) is commonly reported in association with uterine torsion, which is the case in the patient. [6][7][8][9] More recent studies with no identified causative pelvic factors have suggested previous caesarean section as a common feature, and MRI of patients after caesarean section has suggested that poor isthmic healing, resulting in an elongated cervix with structural weakness and angulation may predispose to torsion of the uterus.…”

Asymptomatic levo uterine torsion of 90 degrees during caesarean section

“…Perinatal mortality has been reported to be around 12 % and occasional maternal mortality reported. 2 Only in about 16% cases cause has not been associated, the other causes associated with torsion were uterine asymmetry, uterine anomalies, and severe adhesions from pelvic surgeries.…”

“…In this series, over 30% cases had no cause identified. 2 More recent studies with no identified causative pelvic factors have suggested previous caesarean section as a common feature, and MRI of patients after caesarean section has suggested that poor isthmic healing, resulting in an elongated cervix with structural weakness and angulation may predispose to torsion of the uterus. Presentation of uterine torsion has been studied to be independent of maternal age, parity and gestation.…”

“…Maternal mortality is studied to be as 1% and is directly proportional to degree of torsion and gestational age. 2 The cause of uterine torsion in most cases is unknown. A case series by Piot ET AL described a number of possible associative and causative factors: 32% cases had a fibroid uterus, 15% had other uterine anomalies such as a bicornuate uterus, 8% had pelvic adhesions, 7% had ovarian cysts or other adnexal masses, 5% had abnormal fetal presentation and fetal abnormalities were identified in 3% cases.…”