Asymptomatic uterine torsion diagnosed after two uneventful pregnancies

Uterine torsion in twin pregnancy with complete bicorporeal uterus, double cervix, longitudinal non-obstructing vaginal septum - a case report

Even though uterine torsion is a rare obstetric complication in humans, it has been linked to severe complications like placental abruption, uterine rupture, foetal bradycardia, or even death. Here, we present a rare case of maternal shortening and prolonged foetal bradycardia. The patient suffered from congenital malformations of the female genital tract, which were classified as a complete bicorporeal uterus, a double "normal" cervix, and a longitudinal non-obstructing vaginal septum (U3b/C2/V1). The patient had an emergency caesarean section due to suspected placental abruption. Uterine torsion was found during the surgery, and the postoperative recovery was good. Obstetricians should be aware of the possibility of uterine torsion as a complication of pregnancy to avoid a delayed diagnosis of uterine torsion, especially in patients with genital malformations. During the surgery, there could be serious damage to blood vessels and tissues around the uterus due to an unclear surgical field, and difficulties in exposing the uterine body should be considered.

Successful management of a recurrent 180° uterine torsion: a rare case report

Uterine torsion (UT) is one of the most uncommon obstetric complications. It usually occurs in the third trimester. The confirmed diagnosis relies on > 45° rotation at the utero-cervical junction around its longitudinal axis. The etiology is unknown in 20% of cases. It might be asymptomatic in some rare cases; however, symptoms usually manifest with acute abdominal pain, fetal bradycardia, vaginal bleeding or failure of labor progress. Laparotomy is used to establish the diagnosis and the management of UT. We report a 180° uterine dextrotorsion case of an obese 24-year-old pregnant female who presented with severe abdominal pain at the 35th gestational week, which was diagnosed and managed by an emergency laparotomy. UT is a rare though serious condition and must be doubted before a suspicious clinical image. Therefore, it is suggested to avoid consecutive pregnancies and the resultant uterine rupture.

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

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.

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

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.

Torsion in the Gravid and Nongravid Uterus: A Review of the Literature of an Uncommon Diagnosis

Importance

Uterine torsion is an uncommon but life-threatening clinical situation that requires a high index of suspicion for diagnosis.

Objective

The aim of this study was to review literature and determine the etiology, presentation, diagnosis, and management of uterine torsion in the gravid and nongravid patients.

Evidence Acquisition

A literature search was undertaken by our research librarian using the search engines PubMed and CINAHL. The search terms used were "uterine torsion" OR (uterus and torsion). The search was limited to the English language, but the years searched were unlimited.

Results

The search identified 177 articles, 91 of which are the basis for this review. There have been 41 cases or gravid uterine torsion, their characteristics, and symptoms published since 2006. Torsion is rare in nongravid patients, but can still occur.

Conclusion and Relevance

Uterine torsion is rare, can affect all ages, and can have significant implications for women. Prompt recognition allows for timely intervention and can mitigate harm.