Complete axial torsion of pregnant uterus with leiomyoma

Sachan, Rekha; Patel, Munna Lal; Sachan, Pushpalata; Arora, Arushi

doi:10.1136/bcr-2014-205558

Cited by 16 publications

(15 citation statements)

References 10 publications

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“…On US, painful myoma >200 cm 3 presenting a change in the echogenicity with the appearance of internal cystic areas can suggest red degeneration and infarction . Low indices on 3‐D Doppler are associated with the ischemic processes within the tumor . MRI should be considered in such situations to confirm the diagnosis and facilitate fibroid mapping before surgery.…”

Section: Obstetric Complications Of Myomas During Pregnancymentioning

confidence: 99%

Myoma and myomectomy: Poor evidence concern in pregnancy

Milazzo¹,

Catalano²,

Badia³

et al. 2017

J of Obstet and Gynaecol

110

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Aim: Summarize the results of the many, but often underpowered, studies on pregnancy complicated by myoma or myomectomy. Methods: Survey of the electronic PubMed database for the last two decades was conducted. We selected reviews, meta-analyses, case series, case reports, clinical studies only with statistical analysis, and guidelines from scientific societies. Results: Delaying childbearing leads to an increased incidence of pregnancy complicated by fibroids or previous myomectomy. Approximately 10-30% of pregnant women with myomas develop complications during gestation, at delivery and in puerperium. Submucosal, retroplacental, large and multiple myomas have a greater risk of complications. Cervical myomas, although rare, need careful management. The location and size of the fibroids should be assessed from the first trimester. Despite the increased risk of cesarean section, fibroids are not a contraindication to labor, unless they obstruct the birth canal or other obstetric conditions coexist. Myomectomy during pregnancy, in selected cases, is feasible and safe. Myomectomy cannot be considered a prophylactic measure prior to conception, but has to be individualized. Uterine rupture after myomectomy generally occurs in the third trimester or during labor and some associated risk factors have been identified. There is no consensus on the optimal interval between myomectomy and conception. Conclusions: Pregnancy in patients with fibroids or previous myomectomy should be considered as high risk, requiring a maternal-fetal medicine specialist. To date available literature is inconsistent on evidence-based management. Further research is needed for definitive recommendations.

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Section: Obstetric Complications Of Myomas During Pregnancymentioning

confidence: 99%

Myoma and myomectomy: Poor evidence concern in pregnancy

Milazzo¹,

Catalano²,

Badia³

et al. 2017

J of Obstet and Gynaecol

110

View full text Add to dashboard Cite

show abstract

“…Finally, 38 articles were included in the analysis. In our literature review, none UTs were reported in the first trimester of pregnancy, five (13%) cases [38][39][40][41][42] in the second trimester, and 33 (87%) cases occurred in the third trimester. Most of the cases concerned a singleton pregnancies and only four cases 6,9,30,37 (10.5%) a twin pregnancy.…”

Section: Literature Reviewmentioning

confidence: 75%

“…45 Some authors report possible morbidity with a posterior incision with increased risk of surgical bleeding and uterine rupture in following pregnancies. 13,24 In few cases, UT was suspected to reduce adnexal blood supply 38,40 simulating hence an adnexal torsion 46 and requiring salpingo-oophorectomy. 38 Bilateral salpingectomy could be also safely performed for sterilization without increasing complication rate.…”

Section: Discussionmentioning

confidence: 99%

Uterine torsion and intrauterine growth restriction: Case report and systematic literature review

Ferrari

Negri

et al. 2021

J of Obstet and Gynaecol

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Purpose: Uterine torsion (UT) in pregnancy is a rare condition in obstetric practice. It is defined as a rotation of the uterus of more than 45 around its long axis. Presentations are varied and, most of the time, this condition is recognized at laparotomy or cesarean section (CS). The aim of this study is to summarize the latest evidence about UT in pregnancy. Methods: A systematic research of the literature was conducted fetching all papers published from March 2006 to June 2020. We collected data regarding clinical features, treatment, and feto-maternal outcomes. Finally, we reported data of a case of UT associated with intrauterine growth restriction (IUGR) diagnosed and treated at our institution. Results: According to our search strategy, 38 articles were included. In 66% of the cases, acute symptomatology was present at the onset, most frequently abdominal pain was reported. In one-third of the cases, UT was diagnosed during CS without clinical suspicion. Only in two cases, including our case, IUGR was reported. Most (66%) of the cases presented a 180 torsion. In the majority of the cases, a CS was performed also with a deliberate or accidental posterior hysterotomy. One and six cases of maternal and fetal death were, respectively, reported. Conclusion: UT is an infrequent obstetric condition but should be considered in case of abdominal pain, vomiting, or shock presentation during pregnancy. It could lead to a reduction in uterine blood flow contributing to poor placental perfusion, even though more evidence is needed to clarify this link.

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“…The authors present a case of asymptomatic torsion with 180-degree levorotation of the uterus at the time of caesarean section. Diagnosis was made following delivery of the fetus and de torsion of the uterus to facilitate hemostasis of a bleeding vein in the IP vascular bundle [21,22]. This case report and review has been undertaken to reaffirm the awareness of uterine torsion among practitioners and provide an update of this rare obstetric condition.…”

Section: Discussionmentioning

confidence: 97%

Uterine Torsion–A Case Report and Literature Review

Jayaratnam

2018

GJORM

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A 38-year-old woman Gravida 4 Para 2 was admitted to the Cairns Hospital for an elective repeat caesarean section at 39 weeks gestation. She had one emergency Caesarean Section in 2008 for transverse lie and one elective repeat Caesarean Section for breech presentation at term in 2010. Both procedures were uncomplicated with some omental adhesions noted on repeat caesarean section. Other than her BMI of 48 and a diagnosis of genital herpes in 2010, she had a low risk pregnancy. Antenatal investigations revealed a normal glucose tolerance test at 18 and 28 weeks gestation, a negative serology for hepatitis B, hepatitis C, HIV, Syphilis and a Haemoglobin of 117. Her combined first trimester screen revealed low risk of aneuploidy and an ultrasound scan at 20 weeks revealed a single fetus with normal morphology and a placenta posteriorly located and clear of the cervical os. She had an ultrasound to assess fetal growth at 34 weeks which showed a normally grown fetus on the 75th centile with an AFI of 10.2cm and normal umbilical artery dopplers.

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Complete axial torsion of pregnant uterus with leiomyoma

Cited by 16 publications

References 10 publications

Myoma and myomectomy: Poor evidence concern in pregnancy

Myoma and myomectomy: Poor evidence concern in pregnancy

Uterine torsion and intrauterine growth restriction: Case report and systematic literature review

Uterine Torsion–A Case Report and Literature Review

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