Clinical analysis of uterine torsion and fibroids in full-term pregnancy: A case report and review of the literature

Abstract

This study was performed to describe the clinical features, risk factors, and treatment methods of uterine torsion in pregnancy. The most common symptoms are abdominal pain, fetal heart rate changes, and failure of cervical dilatation and are often accompanied by complete or partial placental abruption. Preoperative diagnosis is challenging even with the use of ultrasound. Uterine torsion in the third trimester is correlated with the presence of multiple uterine fibroids. The causes of gravid uterine torsion vary and the clinical manifestations are nonspecific. Early diagnosis and improved detection approaches are the keys to treatment of patients with uterine torsion. However, the preoperative diagnosis remains difficult and the diagnosis is often made during cesarean section.

Uterine torsion in a full-term pregnancy presenting as prolonged latent phase and fetal intolerance of labor: A case report

“…In this case the presentation was gradual compared with the more acute presentations that have been reported in the literature [ 2 , 4 , 10 , 11 ]. Non-reassuring fetal heart tracings and slow cervical progression despite labor induction and augmentation, as seen in this case, may mislead clinicians toward more common differential diagnoses, such as first- or second-stage arrest, failed induction of labor, or fetal intolerance of labor.…”

“…Due to the rarity of uterine torsion, it is difficult to study the actual epidemiology of this obstetric emergency [ 5 ]. While the definitive etiology remains elusive, risk factors have been identified, including abnormal fetal position, uterine ligament relaxation, uterine malformations, uterine fibroids, polyhydramnios, ovarian cysts, and pelvic adhesions [ 4 , 6 , 7 ]. However, this case falls under the 30% of cases that occur without discoverable cause [ 8 ].…”

“…Maternal complications include complete or partial placental abruption and maternal hemodynamic shock [ 1 , 2 ]. There have been no maternal deaths reported before 20 weeks, mortality rates of 17% reported between 20 and 28 weeks, 10% at 29 to 34 weeks, and 9% at term gestation [ 4 ]. Fetal complications associated with uterine torsion are fetal hypoxia, fetal antepartum hemorrhage, and death [ 3 ].…”

“…The uterine vessels appeared engorged but improved after delivery of the fetus. If the uterus had been necrotic, a cesarean hysterectomy would have been indicated [ 4 ].…”

“…Severe acute uterine torsion can lead to placental abruption [ 1 , 2 ], maternal death, and intrauterine fetal death [ 3 ]. The most common symptoms of uterine torsion in pregnancy are abdominal pain, fetal heart rate changes, and failure of cervical dilatation [ 4 ]. This report describes the clinical features, risk factors and treatment used for uterine torsion in term pregnancy.…”