Case Report: Torsion of a Gravid Horn of a Didelphic Uterus

Achanna, Siva; Monga, Deepika; Hassan, Murnihayati

doi:10.1111/j.1447-0756.1996.tb00950.x

Cited by 8 publications

(7 citation statements)

References 3 publications

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“…Duplantier et al [5] reported only a case of torsion due to maternal trauma. Achanna et al [6] have reported a case of torsion in uterus didelphys due to abdominal massage during labor by traditional birth attendants. According to Jensen [2] this condition can occur in all age groups, all parity, and all stages of pregnancy.…”

Section: Discussionmentioning

confidence: 99%

A Case of Torsion of Gravid Uterus Caused by Leiomyoma

Gururaj

Kaul

Manjuladevi

2011

Case Reports in Obstetrics and Gynecology

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Uterine torsion during pregnancy is only sporadically reported in the literature. Here we present a case of leiomyoma causing uterine torsion in pregnancy and review the literature on etiology, diagnosis, and management. A 25-years-old primigravida with leiomyoma complicating pregnancy was admitted in our hospital with abdominal pain and uterine tenderness. She underwent emergency LSCS (lower segment cesarean section) for fetal bradycardia. Intraoperatively, the uterus was rotated 180 degrees left to right. Inadvertent incision on the posterior wall was avoided by proper delineation of anatomy. Torsion was corrected by exteriorization of leiomyoma and uterus, and lower segment cesarean was carried out safely. Prompt recognition and management of this condition is necessary for better maternal and fetal outcome.

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Section: Discussionmentioning

confidence: 99%

A Case of Torsion of Gravid Uterus Caused by Leiomyoma

Gururaj

Kaul

Manjuladevi

2011

Case Reports in Obstetrics and Gynecology

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“…The condition is usually associated with pregnancy in the third trimester, and may have been precipitated by the rapid increase in size of the uterus following the placental abruption. Although uterine torsion may give rise to similar symptoms as a concealed placental abruption 3 this case suggests that placental separation and fetal death were the antecedent events. In women who are known to have uterine anomalies who have acute severe abdominal pain in pregnancy, the possibility of uterine torsion should be considered.…”

Section: Discussionmentioning

confidence: 81%

“…Torsion is more common in the presence of uterine fibroids, presumably due to the asymmetrical weight distribution within the uterus. There is a consensus of opinion that the transmission of body movements plays an important part in activating torsion and has been implicated in previously reported cases 3 . Contractions of the abdominal muscles or the degree of filling of the bladder and distension of the intestines are thought to contribute to this mechanism.…”

Section: Discussionmentioning

confidence: 99%

Uterine torsion and ischaemia of one horn of a bicornute uterus: a rare cause of failed second trimester termination of pregnancy

Olàh¹

2002

BJOG

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A 30 year old woman with a known uterus didelphis bicollis (complete duplication with a midline vaginal septum) booked in her third pregnancy at 16 weeks of gestation. Her first pregnancy had resulted in an elective caesarean section for breech presentation at term, and the second had been a missed abortion at 12 weeks of gestation. The pregnancy had been in the right uterine horn on both occasions. An ultrasound scan had confirmed her dates to be correct, and that the right uterine horn was again the site of the pregnancy. The woman was booked for shared care and consultant review at 34 weeks of gestation.At 21 weeks of gestation she came to the accident and emergency department with a history of lower abdominal pain and absent fetal movements. She described the pain to be acute in onset, severe and sharp. On examination she had a small volume pulse at 64 beats/minute, with a blood pressure of 110/80 mmHg. Her uterus corresponded to the size of a 28-week pregnancy and felt tense and distended. Examination of the right sided vaginal entrance and cervix confirmed an uneffaced cervix. An urgent ultrasound scan showed an absent fetal heart, with a huge mass within the uterus measuring 14.5 cm Â 12 cm Â 9 cm, probably a retroplacental clot resulting from placental abruption. Coagulation studies and crossmatching were performed before termination of pregnancy with gemeprost was commenced. However, 24 hours later there was no change in the cervix and her haemoglobin concentration had decreased to 8.4 gm/dL. A repeat ultrasound scan was arranged to check for the site of pregnancy, which was confirmed to be in the right uterine horn. A second course of gemeprost pessaries was started, on completion of which her labour was still not established. Her condition had deteriorated. Vaginal examination showed the right cervix to be uneffaced and undilated, whereas the left cervix was 1 cm dilated.After review it was decided to start an extra-amniotic prostaglandin infusion. Under aseptic conditions a Foley catheter was introduced into the right cervix and the prostaglandin infusion started. Forty hours later there was no change in the cervix and although she complained of continuous pain, there were no discernible contractions.By the fifth day after admission all attempts at termination of her pregnancy had failed. On examination she had oedema of both legs, a generally distended abdomen and shortness of breath. There was no evidence of disseminated intravascular coagulopathy. A laparotomy was performed, when the right uterine horn was found to be distended to the size of a term pregnancy and was quite obviously ischaemic with a torsion (dextrorotation) at the level of the isthmus. The right ovary also appeared to be devoid of its blood supply. The left uterine horn looked normal, although the left adnexa was swollen with fibrinous adhesions. The right horn was opened with a cutting diathermy and the placenta, clot and fetus were evacuated. No bleeding occurred during the uterine incision. The contents of the uterus were fouls...

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“…In line with this, in the presented case, uterine torsion occurred in the 30th week of gestation and led to neonatal death. The precise etiology is not well known, but presence of uterine myomas, congenital anomalies, pelvic or adnexal masses or adhesions, abnormal fetal presentation, vigorous fetal movements, and abdominal trauma and high-ordered parities account for 70–84% of uterine torsions [ 24 – 27 ]. As mentioned before, relevant systemic signs and symptoms indicate that connective tissue disorders, most likely Ehlers–Danlos syndrome (EDS), are the only potential leading cause in our patient.…”

Section: Discussionmentioning

confidence: 99%

Uterine torsion as an elusive obstetrical emergency in pregnancy: is there an association between gravid uterus torsion and Ehlers–Danlos syndrome?: a case report

Ghalandarpoor-Attar

2022

J Med Case Reports

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Background Timely diagnosis of uterine torsion can lead to acceptable maternal and fetal outcomes. This article presents the case of a 42-year-old pregnant woman, diagnosed with a rare 270° uterine torsion, in whom proper management led to good maternal outcomes but, unfortunately, severe prematurity and metabolic acidosis led to neonatal death. Moreover, the mother was clinically suspected for Ehlers–Danlos syndrome. Case presentation In December 2020, a 42-year-old pregnant Iranian woman, Gravid 3 para2 live2, at 30 weeks of gestation presented to the obstetric emergency department of Vali-Asr Hospital (Birjand, Iran) suffering from acute severe generalized abdominal pain, nausea, vomiting, and dizziness while she was hemodynamically unstable. After resuscitation, owing to persistent fetal bradycardia on fetal heart rate monitoring, she underwent an emergency cesarean section. Infra-umbilical midline skin incision was made, and when the abdominal cavity was opened, owing to abnormal appearance of the uterus, we further investigated the abdominopelvic cavity. Surprisingly, the uterus was dextrorotated by 270°. After uterine detorsion through a Kerr incision, a nonvigorous male baby was born with severe metabolic acidosis that led to his death soon after birth. Interestingly, we could find no predisposing factors such as pelvic abnormalities during surgery. Nevertheless, as her postoperative detailed physical examination revealed skin hyperextensibility, joint laxity, pelvic organ prolapse, and trivial exophthalmos, connective tissue disorders, mainly Ehlers–Danlos syndrome, were suspected. Unfortunately, for significant financial, cultural, and religious reasons, the patient refused to undergo further investigations. Additionally, despite severe congested uterus and subsequent uterine atony, timely diagnosis and anatomical correction of the gravid uterus before uterine incision prevented iatrogenic complications. The mother was discharged 2 days later without any postpartum complications. Conclusion Although uterine torsion is an extremely rare condition during pregnancy, based on severe associated maternal and perinatal complications, it is important to take this diagnosis into consideration as an differential diagnosis. Moreover, connective tissue disorders seem to be a potential risk factor for uterine torsion, although further studies on this subject are required.

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Case Report: Torsion of a Gravid Horn of a Didelphic Uterus

Cited by 8 publications

References 3 publications

A Case of Torsion of Gravid Uterus Caused by Leiomyoma

A Case of Torsion of Gravid Uterus Caused by Leiomyoma

Uterine torsion and ischaemia of one horn of a bicornute uterus: a rare cause of failed second trimester termination of pregnancy

Uterine torsion as an elusive obstetrical emergency in pregnancy: is there an association between gravid uterus torsion and Ehlers–Danlos syndrome?: a case report

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