Torsion of gravid uterus: alternate management options.

Abstract

Dear Sir, I read the case report: Torsion of gravid uterus managed by obstetric hysterectomy with the fetus in situ authored by Gohil Alpana and Patel Meenaxi, published in vol. 64(No. 4) (page no. 279–281) of the Journal of Obstetrics and Gynecology of India. Indeed torsion of the gravid uterus is rare and carries high perinatal and maternal mortality. I would like to comment that cesarean delivery by posterior hysterotomy [1] could have been considered as an option specially since the woman was nulliparous and only 23 years. The reported case no doubt was in acute abdomen, but her BP was 100/60 and her coagulation profile was completely normal, and since the fetus was already dead and the uterus was not necrotic, the authors could have considered uterine artery ligation before proceeding with conventional cesarean section after untwisting the uterus to reduce blood loss as another option. I would also like to refer to the case reported by Sparic and colleagues [2], where there was fetal demise at 40 weeks with 180° torsion confirmed at laparotomy and cesarean section was safely completed. Bilateral plication of the round ligaments after cesarean section has been advocated as a procedure for preventing repeated torsion in the puerperium and subsequent pregnancies.