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

Abstract

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.

Effects of Low-Dose Aspirin Combined with Vitamin E on the Incidence of Intrauterine Growth Restriction and Hemorheological Indexes of Pregnant Women in Patients with Gestational Hypertension

“…However, with the development of life, multiple factors impact individuals, which may weaken or increase the differences observed in intrauterine and early intrauterine growth restriction [ 21 , 22 ]. Following up children with intrauterine growth restriction, most infants and young children will have excessive weight gain, also known as compensatory growth [ 23 ]. Therefore, intrauterine growth restriction is a risk factor for late obesity [ 24 ].…”

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

“…This leads to increased pressure rise in the placenta cotyledons causing decreased placenta perfusion and ischaemic injury of the placenta. This can then precipitate separation of placenta and preterm labour 1 5. It is an obstetric emergency as fetal morbidity and mortality rates are high if diagnosis and delivery are delayed.…”

“…Due to the anatomical position of the sigmoid ring in relation to the uterus, physiological clockwise rotation of the uterus in pregnancy not exceeding 45 degrees is considered normal.Uterine torsion is defined as a rotation of the uterus of more than 45 degrees along the longitudinal axis 1 2. 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.…”

Umbilical Cord Hematoma and Uterine Torsion: Rare Pregnancy Complications at Tu Du Hospital and Review of Literature

“…Some reports revealed that huge fibroma could attribute to uterine torsion because of asymmetric weight distribution, commonly, in non-gravid uterus and in postmenopausal periods due to atrophy of uterus. Diagnosis by imaging technology as magnetic resonance imaging (MRI) can be helpful in this complication ( 21 ), ( 25 ), ( 26 ). Until now, we have not found any case report related to uterine torsion in combination with cervical pessary.…”