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.
| Published in | Journal of Gynecology and Obstetrics (Volume 8, Issue 6) |
| DOI | 10.11648/j.jgo.20200806.19 |
| Page(s) | 211-213 |
| Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
| Copyright |
Copyright © The Author(s), 2020. Published by Science Publishing Group |
Uterine Torsion, Cesarean Section, Pregnancy, Plication of Round Ligaments
| [1] | Jensen JG. Uterine torsion in pregnancy. Acta Obstet Gynecol Scand. 1992 May; 71 (4): 260-5. |
| [2] | Kilicci C, Sanverdi I, Bostanci E, et al. Uterine torsion of 720 degrees in the third trimester of pregnancy and accompanying bladder torsion: a case report. Pan Afr Med J 2018; 29: 175. |
| [3] | Steigrad SJ. Torsion of the gravid uterus. Aust NZ J Obstet Gynecol 1987; 27: 66-8. |
| [4] | Karavani G, Picard R, Elami-Suzin M, et al. Complete uterine torsion diagnosed during an elective caesarean section following failed external cephalic version: a case report. J Obstet Gynaecol 2017; 37: 673–674. |
| [5] | Liu YG and Sun WY. Uterine torsion caused by full-term pregnancy scar uterus and pregnancy with uterine fibroids: a case report and clinical analysis. The Journal of Medical Theory and Practice 2014; 27: 2325–2326. |
| [6] | Feng-Ling Yin, Hong-Xiang Huang, Meng Zhang et al. Clinical analysis of uterine torsion and fibroids in full-term pregnancy: A case report and review of the literature. Journal of International Medical Research 2020; 48 (5) 1–7. |
| [7] | Huang MM, Zhang J and Yao L. Uterine torsion with placental abruption in late pregnancy: a case report and literature review. Chinese Journal of Practical Gynecology and Obstetrics 2017; 33: 991–992. |
| [8] | Carrier M, Korb D, Morin C, et al. Asymptomatic uterine torsion diagnosed after two uneventful pregnancies. J Gynecol Obstet Hum Reprod 2018; 47: 583–585. |
| [9] | Li L, Lian Y and Wang XT. Placental ischemia and placental abruption. Chinese Journal of Practical Gynecology and Obstetrics 2016; 32: 312–315. |
| [10] | Wang CM. Uterine torsion at 27 weeks of gestation: a case report. Heilongjiang Medical Journal 2002; 26: 478. |
| [11] | Tian N and Fan L. Diagnosis and treatment of placental abruption. Chinese Journal of Practical Gynecology and Obstetrics 2016; 32: 1167–1171. |
| [12] | Ulu I, Gunes¸ MS, Kiran G, et al. A rare cause of placental abruption: uterine torsion. J Clin Diagn Res 2016; 10: 265–274. |
| [13] | Liu LX. Two cases of uterine torsion during pregnancy. China Practical Medicine 2010; 5: 181–182. |
| [14] | Wilson D, Mahalingham A, Ross S. Third trimester uterine torsion: case report. J Obstet Gynaecol Can. 2006 Jun; 28 (6): 531-535. |
| [15] | Gohil A and Patel M. Torsion of gravid uterus by obstetric hysterectomy with the fetus in situ. J Obstet Gynaecol India 2013; 63: 279–281. |
| [16] | Chibber G. Surgical correction of congenital and acquired defects of the birth canal. Operative Perinatology. New York: Macmillan Publishing Company; 1987. p. 460-8. |
| [17] | Pelosi MA, Pelosi MA. Managing extreme uterine torsion at term. A case report. J Reprod Med. 1998 Feb; 43 (2): 153-7. |
| [18] | Mustafa MS, Shakeel F. Sporrong B. Extreme torsion of the pregnant uterus Aust NZ J Obstet Gynecol 1999; 39: 360-3. |
APA Style
Ninni Filippo, Guiggi Ilaria, Landucci Edi, Masoni Stefano, Tosi Veronica, et al. (2020). Uterine Torsion Diagnosed at the Time of Laparotomy for a Planned Cesarean Section at Term. Journal of Gynecology and Obstetrics, 8(6), 211-213. https://doi.org/10.11648/j.jgo.20200806.19
ACS Style
Ninni Filippo; Guiggi Ilaria; Landucci Edi; Masoni Stefano; Tosi Veronica, et al. Uterine Torsion Diagnosed at the Time of Laparotomy for a Planned Cesarean Section at Term. J. Gynecol. Obstet. 2020, 8(6), 211-213. doi: 10.11648/j.jgo.20200806.19
AMA Style
Ninni Filippo, Guiggi Ilaria, Landucci Edi, Masoni Stefano, Tosi Veronica, et al. Uterine Torsion Diagnosed at the Time of Laparotomy for a Planned Cesarean Section at Term. J Gynecol Obstet. 2020;8(6):211-213. doi: 10.11648/j.jgo.20200806.19
Share This Article
Twitter
Linked In
Facebook
Copy
Download@article{10.11648/j.jgo.20200806.19,
author = {Ninni Filippo and Guiggi Ilaria and Landucci Edi and Masoni Stefano and Tosi Veronica and Abate Sergio},
title = {Uterine Torsion Diagnosed at the Time of Laparotomy for a Planned Cesarean Section at Term},
journal = {Journal of Gynecology and Obstetrics},
volume = {8},
number = {6},
pages = {211-213},
doi = {10.11648/j.jgo.20200806.19},
url = {https://doi.org/10.11648/j.jgo.20200806.19},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.jgo.20200806.19},
abstract = {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.},
year = {2020}
}
TY - JOUR T1 - Uterine Torsion Diagnosed at the Time of Laparotomy for a Planned Cesarean Section at Term AU - Ninni Filippo AU - Guiggi Ilaria AU - Landucci Edi AU - Masoni Stefano AU - Tosi Veronica AU - Abate Sergio Y1 - 2020/12/31 PY - 2020 N1 - https://doi.org/10.11648/j.jgo.20200806.19 DO - 10.11648/j.jgo.20200806.19 T2 - Journal of Gynecology and Obstetrics JF - Journal of Gynecology and Obstetrics JO - Journal of Gynecology and Obstetrics SP - 211 EP - 213 PB - Science Publishing Group SN - 2376-7820 UR - https://doi.org/10.11648/j.jgo.20200806.19 AB - 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. VL - 8 IS - 6 ER -
Information
Email: