Torsion of preterm gravid uterus: A case report

Abstract

Introduction: Rotation of the gravid uterus is a normal occurrence in the third trimester of pregnancy. However, a pathologic rotation of the uterus beyond 45 degrees i.e, torsion of the entire uterus­is rarely encountered. We report here a case of uterine torsion from our obstetrical practice. Case Report: A young 25­ year­old second gravida, para one presented with features of antepartum hemorrhage (Abruptio placentae) with intrauterine fetal demise at 25 weeks of pregnancy. During laparotomy uterine torsion of 180 degrees was diagnosed. As all attempts at detorsion failed, a deliberate posterior lower segment incision was made to deliver the baby. Subtotal hysterectomy had to be done as conservative procedures (utertonics, uterine artery ligation, B­Lynch suture) to control postpartum hemorrhage failed. The patient was recovering in the postoperative period, when she died unfortunately of a suspected pulmonary embolism. Conclusion: Uterine torsion is an infrequently reported and potentially dangerous complication of pregnancy that occurs mainly in the third trimester with adverse maternal and neonatal consequences. Aetiopathogenesis of this condition is still unclear. The diagnosis is usually made at laparotomy. Often posterior lower segment incision is used for delivering the baby. It merits consideration as a differential diagnosis of acute abdomen in pregnancy.