Asymptomatic torsion of a gravid uterus

Abstract

Rotation of the uterus is common during pregnancy. In twothirds of cases, there is a physiologic dextrorotation of the uterus, probably due to its rightward shift during pregnancy [1]. The rotation is commonly less than 45 degrees. Uterus rotation of more than 45 degrees is classified as pathologic, but is scarcely seen in practice. We report an asymptomatic case of uterine torsion and review the cases that have been reported to date. In December 2011, a 38-year-old woman (gravida 4, para 2, and abortus 1) presented at the Prenatal Care Unit of Shahid Akbarabadi Hospital (Tehran, Iran). She was at the 34th week of gestation and had pregnancy-induced hypertension that had started 2 weeks previously (her systolic blood pressure was 170 mmHg). Her first pregnancy had led to a normal vaginal delivery 11 years earlier. However, her second and third pregnancies failed due to intrauterine death (at the 32nd week of gestation) and abortion (at the 8th week of gestation). Ultrasound showed a singleton fetus with normal status. On examination, the maternal vital signs were stable, but systolic/ diastolic blood pressure was 150/108 mmHg and her pulse rate was 86 beats per minute. On abdominal examination, the fetus was found in a longitudinal lie and cephalic presentation. Since there was no uterus contraction, vaginal examination was not performed. There was no vaginal blood or fluid loss. Using a Sonicaid, the fetal heart rate was determined as 140 beats per minute. The patient was admitted to the labor ward for her pregnancy-induced hypertension. According to the routine protocol of Shahid Akbarabadi Hospital, laboratory tests related to pre-eclampsia including blood urea nitrogen, creatinine, aspartate aminotransferase, alanine aminotransferase, uric acid, hemoglobin, hematocrit, prothrombin time, partial thromboplastin time, and blood sugar measurements were conducted (Table 1). Urine analysis and a 24-hour urine test were also ordered and a fetal non-stress