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

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. Target Audience Obstetricians and gynecologists, family physicians. Learning Objectives After completing this activity, the learner should be better able to diagnose uterine torsion in the gravid and nongravid uteri and identify causative factors if present; ascertain differences in uterine torsion presentation in gravid and nongravid patients; identify severity of symptoms from asymptomatic to acute; and implement a treatment plan based on the reduction of morbidity and mortality while considering fertility preservation.

Rare cause of abdominal pain in the third trimester: uterine torsion

“…It is an obstetric emergency as fetal morbidity and mortality rates are high if diagnosis and delivery are delayed. Unfortunately, diagnosing uterine torsion in pregnancy can be difficult as most women present with non-specific symptoms such as abdominal pain, vaginal bleeding, decreased fetal movements, syncopal episodes, and nausea and vomiting 3. One-third of them can be asymptomatic 1.…”

“…It is rare and may occur at any stage of life but more commonly during pregnancy as the physiological rotation of the uterus is more distinct in pregnancy. The aetiology of uterine torsion remains unclear and diagnosing uterine torsion in pregnancy can be difficult due to the non-specific clinical presentation 3. Recognition and prompt management of uterine torsion in pregnancy are however vital as maternal and fetal well-being can be compromised if management is delayed 4.…”

Uterine torsion as an elusive obstetrical emergency in pregnancy: is there an association between gravid uterus torsion and Ehlers–Danlos syndrome?: a case report

“…Mild-to-severe abdominal pain accompanied by neurologic or hypovolemic shock is the most common feature, as seen here. Vaginal bleeding, nausea and vomiting, hemodynamic instability, uterine hypertonicity, increased fundal height, decreased fetal movements, fetal distress, intrauterine fetal death, obstructed labor, and dystocia are other possible manifestations [ 31 , 32 ]. Surprisingly, our patient had fulfilled almost all these symptoms (hemodynamic instability, nausea and vomiting, severe acute abdominal pain, uterine hypertonicity, increased fundal height, and fetal distress).…”

“…The diagnosis is difficult and almost always occurs during laparotomy [ 8 , 33 ], as this patient was transferred to operating room with presumed diagnose of severe occult placental abruption. However, imaging modalities such as ultrasound, computed tomography, or magnetic resonance imaging can facilitate diagnosis before surgery [ 31 , 34 , 35 ]. Nevertheless, because uterine torsion presents as an obstetrical emergency, definite diagnosis is almost always delayed until surgery time and there is not enough time to perform any imaging modalities.…”

Abnormal uterine position during pregnancy secondary to abdominal surgery: Two case reports

“…The etiology is not clear and various risk factors were reported such as fibroids, pelvic adhesions, ovarian cysts, anatomical alteration. [2][3][4] As the pregnancy progresses, physiological changes in the uterus are affected by many other factors, which can result in abnormal positions of the uterus.…”