Казуистика в акушерстве: перекрут матки во время беременности

Abstract

Uterine torsion is defined as the rotation of the uterus more than 45° around its long axis. This complication of pregnancy is very uncommon, with no more than 300 cases reported in medical literature in the past 150 years. Uterine torsion is a potentially dangerous obstetric condition that can lead to maternal and perinatal morbidity and mortality. This article discusses the incidence of uterine torsion, maternal and perinatal mortality rates. Risk factors include uterine fibroids, uterine malformations, abnormal fetal positions, polyhydramnios, multiple pregnancy, and cesarean section in medical history. Clinical manifestations are non-specific and diverse, sometimes asymptomatic course is noted. However, uterine torsion is often accompanied by acute abdominal pain, which requires differential diagnosis with placental abruption, uterine rupture, abdominal pregnancy, torsion of the uterine appendages, and acute appendicitis. In all cases of acute abdominal pain in pregnancy, especially when risk factors are present, uterine torsion should be excluded. Most cases of uterine torsion are diagnosed during laparotomy. Mandatory evaluation of anatomy in cesarean section is necessary to avoid incisions through the posterior uterine wall. It is emphasized that the effect of posterior hysterotomy on the course of future pregnancies is currently unknown. The analysis of 37 cases published in the English-language literature over the past 10 years is presented. Key words: fetal distress, posterior hysterotomy, cesarean section, uterine torsion, placental abruption