Acute gravid uterus torsion: A rare and dangerous obstetric emergency

Uterine torsion in pregnancy: A case report

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.

Torsion in Uterus: An Obstetrical and Gynaecological Emergency

Uterine torsion is defined as torsion of the uterus along its longitudinal axis greater than 45 degrees. It is observed in all age groups of the reproductive period, in all parity groups, and at all stages of pregnancy. Torsion from 60 degrees to 720 degrees has been described. It is not possible to clarify why it occurs, but numerous abnormalities have appeared with uterine torsion. It is a rare complication that can result in placental abruption and intrauterine foetal death. Pregnancy, giant fibroids, and ovarian cysts are among the most common causes. Vague clinical attributes make diagnosis challenging pre-operatively and can be missed on routine ultrasound. Being a rare life-threatening condition, it necessitates a high level of concern for diagnosis and prompt intervention to optimise results. This review will help the healthcare worker to understand the various presentation of uterine torsion and their management by appropriately and timely diagnosing it.

A case of uterine incarceration with unrecognized uterine torsion

Fetal imagers are tasked with diagnosing complex fetal anomalies, but maternal abnormalities that may impact the pregnancy are also of utmost importance to recognize and report. Two rare obstetrical complications are uterine incarceration and torsion which can lead to increased maternal/perinatal mortality. Uterine incarceration occurs secondary to a retroverted uterus that becomes retroflexed and entrapped within the pelvis during the first trimester of pregnancy. Uterine torsion is rotation of more than 45° around its long axis. We report a rare case of an incarcerated uterus with presumed spontaneous resolution on follow-up MRI that was ultimately recognized to be uterine torsion at the time of delivery. Knowledge of these entities may help aid in timely detection and diagnosis of complex imaging presentations and avoid downstream complications.