Asymptomatic uterine torsion diagnosed after two uneventful pregnancies

Carrier, Marine; Korb, Diane; Morin, Cécile; Sibony, Olivier

doi:10.1016/j.jogoh.2018.09.004

Cited by 8 publications

(9 citation statements)

References 8 publications

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“…Sometimes gynecologic digital examination can reveal a high cervix difficult to reach with a spiral vaginal mucosa [8], although presentation of uterine torsion during pregnancy may be variable and nonspecific. It can be asymptomatic or it can result in a severe acute abdomen that can be easily confused with others clinical situations [9].…”

Section: Discussionmentioning

confidence: 99%

Uterine Torsion Diagnosed at the Time of Laparotomy for a Planned Cesarean Section at Term

Ninni¹,

Guiggi²,

Edi³

et al. 2020

JGO

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Background: Uterine torsion is defined as the rotation of the uterus more than 45 degrees around its long axis. The angle of rotation is usually 180 degrees, although, in the literature, there are reported cases of uterine torsion up to 720 degrees. This is a rare complication of pregnancy but associated with significant mortality and morbidity. Etiology still remains unclear and clinical diagnosis may be challenging. Symptoms can be absent or few and nonspecific as in chronic conditions or catastrophic such in case of acute presentation associated with acute abdomen. Final diagnosis is usually made at the time of laparotomy or even after delivery. In the literature, bilateral plication of round ligaments is proposed to prevent recurrences. However, there are no validated guidelines for the management of uterine torsion in pregnancy. Case: We present a 33-year-old, gravida 2 para 1. She had a previous vaginal delivery and no medical known conditions. She was admitted for a planned caesarian section at 39 weeks of gestation for breech presentation. After a difficult delivery of a healthy female neonate with normal Apgar scores and cord pH levels, a spontaneous derotation of the uterus of 180 degrees was observed. Giving the absence of pelvic anomalies, we chose to not perform any additional preventive surgical procedure. The patient was discharged on 3rd postoperative day. Finally, no complications were observed at the two-months postpartum visit. Conclusion: Uterine torsion in pregnancy is an uncommon pathology but potentially life threatening that obstetrician should be aware of. Occasionally, imaging can be helpful, but diagnosis is mostly made during surgery. In case of irreducible torsion, delivery can be made with a transverse incision in the lower posterior uterine segment. Bilateral plication of round ligaments, as previously described by other authors, may be evaluated as a taylored treatment in case of extreme uterine torsion and other pelvic anomalies, in order to prevent the recurrence of the torsion.

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Section: Discussionmentioning

confidence: 99%

Uterine Torsion Diagnosed at the Time of Laparotomy for a Planned Cesarean Section at Term

Ninni¹,

Guiggi²,

Edi³

et al. 2020

JGO

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“…2 Therefore, it typically is not identified until intra-operative evaluation in the setting of an emergent cesarean section. 1 Other symptoms may include failure to progress in labor, uterine atony, hemorrhagic shock, urinary and intestinal symptoms, placental abruption, fetal distress, or intrauterine fetal demise. [1][2][3] Uterine torsion carries a significant fetal mortality rate estimated at 12% to 18%.…”

Section: Mostmentioning

confidence: 99%

“…1 Other symptoms may include failure to progress in labor, uterine atony, hemorrhagic shock, urinary and intestinal symptoms, placental abruption, fetal distress, or intrauterine fetal demise. [1][2][3] Uterine torsion carries a significant fetal mortality rate estimated at 12% to 18%. 2,4 The associated maternal mortality rate is dependent on the stage of pregnancy, with higher rates reported in the late second trimester and decreasing thereafter.…”

Section: Mostmentioning

confidence: 99%

“…Dextrorotation of the uterus up to 45 degrees around the long axis or the junction between the cervix and the corpus is a normal finding during pregnancy with respect to the relationship between the gravid uterus and sigmoid colon. 1 However, if this is greater than 45 degrees, it is defined as uterine torsion and has been reported in the literature to twist as much as 720 degrees. Most reported cases of uterine torsion range between 90 degrees and 180 degrees dextrorotation.…”

Section: Introductionmentioning

confidence: 99%

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Diagnosis of uterine torsion during cesarean section

Gross

Gnade

Coyne

2020

Proc Obstet Gynecol

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“…A change in position of ovarian vessels and placental site detected using Doppler and Ultrasonography, respectively, as well as the presence of an abnormal X-shaped upper vagina on Magnetic Resonance Imaging may be signs that establish an early preoperative diagnosis [ 9 , 11 ]. The potential consequences of UT may include placental abruption, irregular fetal heart rate, fetal distress and fetal death, whereas chronic torsion in the early stages of pregnancy can be a cause of Intrauterine Growth Restriction [ 11 , 12 ]. In all cases, prompt laparotomy with manual detorsion (MD) is considered to be an imperative treatment [ 1–3 ].…”

Section: Introductionmentioning

confidence: 99%

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

Mansour¹,

Alchihan

AlKhrait

et al. 2022

Journal of Surgical Case Reports

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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.

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Asymptomatic uterine torsion diagnosed after two uneventful pregnancies

Cited by 8 publications

References 8 publications

Uterine Torsion Diagnosed at the Time of Laparotomy for a Planned Cesarean Section at Term

Uterine Torsion Diagnosed at the Time of Laparotomy for a Planned Cesarean Section at Term

Diagnosis of uterine torsion during cesarean section

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

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