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Bui TTK, Le TV, Nguyen OTK, Tran HTB, Nguyen TDP. Uterine torsion in pregnancy: A case report. Int J Surg Case Rep 2024; 116:109441. [PMID: 38430898 PMCID: PMC10944129 DOI: 10.1016/j.ijscr.2024.109441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/19/2024] [Accepted: 02/21/2024] [Indexed: 03/05/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Uterine torsion are extremely rare in pregnancy as few cases have been reported. Torsion of the pregnant uterus is defined as the rotation more than 45 degrees around the long axis of the uterus. It has been referred as, once-in-a-lifetime diagnosis by obstetricians and gynecologists. This paper reports a case of uterine torsion and velamentous cord insertion from our obstetrical practice, along with a review of reported cases. CASE PRESENTATION The 30-year-old patient (G2P1) at 38 weeks' gestation with a singleton pregnancy, was admitted to the Obstetrical Unit with uterine cramping and decreased fetal movement. Her prior obstetrical history included one uncomplicated term Cesarean section (2016), the current pregnancy had been velamentous cord insertion at 20 weeks' gestation and intra-uterine growth restriction at the 33rd -week gestation until the presentation date. Emergency Cesarean section was performed the 90 degrees uterine torsion and was diagnosed intra-operatively. This patient and her baby recovered and were discharged home on the fifth post-operative day. CLINICAL DISCUSSION Uterine torsion, a rare pregnancy complication, should be considered when evaluating acute abdominal pain or performing a Cesarean delivery, especially in cases of abnormal fetal presentation, pelvic adhesions, uterine fibroids, malformations, or ovarian tumors. Early diagnosis and proper treatment are crucial due to the negative prognosis for both mother and baby. CONCLUSION Uterine torsion along with velamentous cord insertion is difficult to diagnosis due to its rarity. It is essential to focus on uterine malformations during ultrasound examinations in the first, second, and third trimesters.
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Affiliation(s)
- Thao Thi Kim Bui
- University Medical Center Ho Chi Minh City, Ho Chi Minh City, Vietnam.
| | - Tung Viet Le
- University Medical Center Ho Chi Minh City, Ho Chi Minh City, Vietnam; University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
| | - Oanh Thi Kieu Nguyen
- University Medical Center Ho Chi Minh City, Ho Chi Minh City, Vietnam; University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
| | - Huyen Thi Bich Tran
- University Medical Center Ho Chi Minh City, Ho Chi Minh City, Vietnam; University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
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Liu S, Zhou L, Song B, Liu D, Zheng C, Wu X, Wei Z, Chen X. Uterine torsion complicated by severe placental abruption in the second trimester: a case report and literature review. BMC Pregnancy Childbirth 2023; 23:51. [PMID: 36681791 PMCID: PMC9863092 DOI: 10.1186/s12884-023-05377-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/12/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Uterine torsion is a rare obstetric event that can occur during pregnancy and is difficult to diagnose. Its occurrence may lead to serious adverse pregnancy outcomes. CASE INTRODUCTION The patient was a 33-year-old woman at 30+ 5 weeks' gestation with a singleton pregnancy. The pregnancy course, including fetal growth, and prenatal examinations were regular. Except for a small amount of vaginal bleeding in early pregnancy and treatment with progesterone, there were no prenatal abnormalities, and the patient denied any trauma or sexual history. The patient was admitted to the emergency department with persistent severe pain in the lower abdomen and slight vaginal bleeding during night sleep. Abdominal pain started two hours prior to admission and was accompanied by nausea, vomiting, and dizziness. Examination revealed positive abdominal tenderness, high uterine tone, and no significant intermittent period of uterine contractions, and measurement of the fetal heart rate by means of the nonstress test revealed a rate of 60 beats per minute. Therefore, placental abruption was highly suspected. Subsequently, an emergency cesarean section was performed under general anesthesia. The newborn boy, with Apgar scores of 0-3-4 after birth and weighing 1880 g, was transferred to the neonatal intensive care unit (NICU) and died two days later due to ineffective rescue. After the uterine incision was sutured, the examination revealed that the uterine incision was located on the posterior wall of the uterus, and the uterus was twisted 180° to the right. The diagnosis after cesarean section was 180° uterine torsion to the right, severe placental abruption, and severe neonatal asphyxia. On the fifth day after surgery, the patient recovered and was discharged from the hospital. CONCLUSIONS Posterior uterine incision cesarean section may be performed in unexpected circumstances and is also feasible as a safe option for resetting if torsion is not complete. Abdominal pain during pregnancy is less likely to be diagnosed as uterine torsion, which often leads to premature birth, fetal asphyxia, placental abruption, and even perinatal death. Therefore, for abdominal pain during pregnancy, obstetricians should consider the possibility of uterine torsion.
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Affiliation(s)
- Shuhua Liu
- Department of Obstetrics and Gynecology, Anhui Province Maternity and Child Health Hospital, Hefei, China ,grid.412679.f0000 0004 1771 3402Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Linlin Zhou
- grid.186775.a0000 0000 9490 772XFirst Clinical College, Anhui Medical University, Hefei, China
| | - Bing Song
- grid.412679.f0000 0004 1771 3402Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Dehong Liu
- Department of Obstetrics and Gynecology, Anhui Province Maternity and Child Health Hospital, Hefei, China
| | - Chenmin Zheng
- Department of Obstetrics and Gynecology, Anhui Province Maternity and Child Health Hospital, Hefei, China
| | - Xiumei Wu
- Department of Obstetrics and Gynecology, Anhui Province Maternity and Child Health Hospital, Hefei, China
| | - Zhaolian Wei
- grid.412679.f0000 0004 1771 3402Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xianxia Chen
- Department of Obstetrics and Gynecology, Anhui Province Maternity and Child Health Hospital, Hefei, China
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Ghalandarpoor-Attar SN, Ghalandarpoor-Attar SM. Uterine torsion as an elusive obstetrical emergency in pregnancy: is there an association between gravid uterus torsion and Ehlers-Danlos syndrome?: a case report. J Med Case Rep 2022; 16:210. [PMID: 35578307 PMCID: PMC9112583 DOI: 10.1186/s13256-022-03409-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 04/12/2022] [Indexed: 11/10/2022] Open
Abstract
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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Luthra A, Chowdhury S, Marquez A, Juusela AL. Cesarean Delivery via Posterior Classical Hysterotomy for Anterior Fibroids: A Case Report and Review of the Literature. J Gynecol Surg 2021. [DOI: 10.1089/gyn.2020.0177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ankita Luthra
- Newark Beth Israel Medical Center, Newark, New Jersey, USA
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Liang R, Gandhi J, Rahmani B, Khan SA. Uterine torsion: A review with critical considerations for the obstetrician and gynecologist. TRANSLATIONAL RESEARCH IN ANATOMY 2020. [DOI: 10.1016/j.tria.2020.100084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Pace M, Jastrow N, Pellegrinelli JM. Uterine torsion in pregnancy: a rare but life-threatening condition. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2020. [DOI: 10.23736/s0393-3660.19.04051-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Torsion in the Gravid and Nongravid Uterus: A Review of the Literature of an Uncommon Diagnosis. Obstet Gynecol Surv 2020; 75:243-252. [PMID: 32324250 DOI: 10.1097/ogx.0000000000000767] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
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.
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Fatih FF, Gowri V, Rao K. Uterine torsion in second trimester of pregnancy followed by a successful-term pregnancy. BMJ Case Rep 2012; 2012:bcr-2012-006359. [PMID: 22914233 DOI: 10.1136/bcr-2012-006359] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Uterine torsion is defined as rotation of the uterus of more than 45° on its long axis. It is an unusual complication of pregnancy and for most obstetricians it probably represents a 'once-in-a-lifetime' diagnosis. Fetal mortality up to 12% and occasional maternal mortality are reported. A 22-year-old second gravida presented at 22+ weeks gestation with severe abdominal pain and shock. Laparotomy was done for suspected abruptio placenta, when torsion of the uterus to 180° was diagnosed. Posterior hysterotomy was performed. She conceived the next year and was delivered at term by caesarean section. Uterine torsion is a rare complication of pregnancy and obstetricians should have this complication in mind when performing a caesarean section for undiagnosed severe abdominal pain in pregnancy. Anatomical landmarks should be defined if possible, prior to uterine incision during a caesarean section, to avoid posterior hysterotomy.
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Affiliation(s)
- Farah Farouq Fatih
- Department of Obstetrics and Gynecology, Sultan Qaboos University, Muscat, Oman
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Erdogdu E, Arısoy R, Tugrul S, Pekin O. Third trimester uterine torsion. Arch Gynecol Obstet 2012; 286:1333-4. [PMID: 22729135 DOI: 10.1007/s00404-012-2427-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 06/07/2012] [Indexed: 10/28/2022]
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Chaney KP, Holcombe SJ, LeBlanc MM, Hauptman JG, Embertson RM, Mueller POE, Beard WL. The effect of uterine torsion on mare and foal survival: a retrospective study, 1985-2005. Equine Vet J 2010; 39:33-6. [PMID: 17228592 DOI: 10.2746/042516407x159862] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
REASONS FOR PERFORMING STUDY Anecdotal speculation suggests that prognosis for survival of mares and foals following correction of uterine torsion has improved over the past 30 years. OBJECTIVES To determine statistically the outcome of uterine torsion according to duration of clinical signs, stage of gestation, parity, physical examination findings, method of correction, prognosis for survival and reproductive health of the mare, and prospects for the foal within the neonatal period. METHODS This retrospective study combined cases from 4 equine referral hospitals. RESULTS The stage of gestation at which uterine torsion occurred was a risk factor for survival of mare and foal. Overall mare survival was 53/63 (84%); when uterine torsion occurred at < 320 days gestation, 36/37 (97%) of mares survived compared to 17/26 (65%) survival rate when uterine torsion occurred at > or = 320 days gestation. Overall foal survival was 54% (29/54). When uterine torsion occurred at < 320 days gestation, 21/29 (72%) foals survived compared to 8/25 (32%) when uterine torsion occurred at > or = 320 days gestation. Thirty mares were discharged from the hospital carrying a viable fetus following uterine torsion correction and 25/30 (83%) of these mares delivered live foals that survived beyond the neonatal period. CONCLUSIONS Prognosis for survival for mares and foals following uterine torsion is good and improves if torsion occurs < 320 days compared to > or = 320 days gestation. CLINICAL RELEVANCE Gestational timing of uterine torsion should be considered when advising clients about the prognosis for survival of the mare and foal. The prognosis for a mare delivering a live foal is good if the mare is discharged from the hospital following uterine torsion correction with a viable fetus.
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Affiliation(s)
- K P Chaney
- Department of Large Animal Clinical Sciences, Michigan State University, East Lansing, Michigan 48824, USA
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Affiliation(s)
- B Dandawate
- Department of Obstetrics and Gynaecology, Poole General Hospital, Dorset, UK.
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Wilson D, Mahalingham A, Ross S. Third Trimester Uterine Torsion: Case Report. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2006; 28:531-535. [PMID: 16857121 DOI: 10.1016/s1701-2163(16)32180-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Rotation of the gravid uterus is a normal finding in the third trimester of pregnancy. However, a pathologic rotation of the uterus beyond 45 degrees-torsion of the entire uterus-is rarely seen in obstetrical practice. We report here a case of uterine torsion from our obstetrical practice and a review of reported cases. CASE The patient, a 36-year-old gravida 3 para 2 at 36 weeks' gestation with a singleton pregnancy, was admitted to the obstetrical unit with uterine cramping and decreased fetal movement. Her prior obstetrical history included two uncomplicated term vaginal deliveries, and the current pregnancy had been uncomplicated until the date of presentation. After 3 hours' observation, uterine cramping and tenderness increased, and fetal tachycardia developed. The presumptive diagnosis was a concealed placental abruption. The patient was not in labour, so an emergency Caesarean section (CS) was carried out. At the time of CS, the diagnosis of uterine torsion was made. The patient recovered and was discharged home with her baby on the third postoperative day. CONCLUSION Uterine torsion is an infrequently reported and potentially dangerous complication of pregnancy that occurs mainly in the third trimester with adverse maternal and neonatal consequences.
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Affiliation(s)
- Don Wilson
- Department of Obstetrics and Gynaecology, University of Calgary, Calgary AB
| | | | - Sue Ross
- Department of Obstetrics and Gynaecology, University of Calgary, Calgary AB; Departments of Family Medicine and Community Health Sciences, University of Calgary, Calgary AB
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Affiliation(s)
- K I Munro
- Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH1S 5SA, UK
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