Breech Presentation Research Articles

Impact of Pavlik Harness treatment on motor skills acquisition: A case-control study.

Our purpose was to analyze the impact of Pavlik Harness treatment on children motor skills development, comparing to a control group. A total of 121 children were included: 55 cases (children with Developmental Dysplasia of the Hip) and 66 healthy controls. Cases were recruited from 2017 to 2021 and followed up to 2022. Controls (healthy children without orthopedic pathology) were recruited from 2020 to 2022. The primary endpoint was the time of achievement of three gross motor milestones (sitting without support, hands-and-knees crawling, and walking independently). The groups had no differences regarding sex distribution, gestational age, birth weight, and rate of twin pregnancy. The prevalence of positive family history of Development Dysplasia of the Hip (20.0% vs 3.0%, p < 0.003), breech presentation (38.2% vs 1.5%, p < 0.001), and C-section delivery (60.0% vs 19.7%, p < 0.001) was significantly higher in Development Dysplasia of the Hip group. Children with Development Dysplasia of the Hip achieved the three gross milestones evaluated 1 month later than healthy controls, although this was not statistically significant (p = 0.133 for sitting, p = 0.670 for crawling, and p = 0.499 for walking). Children with Development Dysplasia of the Hip, treated by Pavlik harness, do not have significant delays in motor skills acquisition.

Successful Twin Delivery Through In Vitro Fertilization in a High-Gestation Age Kidney Transplant Recipient: A Case Report

BackgroundNumerous successful pregnancy outcomes have been reported after kidney transplantation, but until now, there have been no reports of healthy twin deliveries through in vitro fertilization treatment in high-gestation aged women with a long post-transplant duration. In our report, we present a case of a high-gestation aged kidney transplant recipient who successfully delivered healthy twins with the aid of in vitro fertilization. Case presentationAt the age of 29, a woman with end-stage kidney disease caused by immunoglobin A nephropathy underwent kidney transplantation. She had a history of premature ovarian failure and had been on continuous ambulatory peritoneal dialysis since the age of 18. Eleven years after starting dialysis, she received a cadaveric kidney transplant. Despite being infertile for 7 years after transplantation, she wished to have children. In vitro fertilization embryo transfer was conducted after failure of ovarian stimulation, considering her age and premature ovarian failure. The patient successfully delivered twins at 29 weeks gestation via cesarean section, as the first fetus presented in breech position. The first newborn weighed 945 g and the second weighed 855 g, with no other congenital abnormalities found. One year after childbirth, neither the recipient nor her babies experienced any fatal complications. ConclusionsA woman who underwent kidney transplantation and has stage 3 CKD may successfully deliver healthy twins through in vitro fertilization embryo transfer, even if she is of advanced maternal age and has a long post-transplant period. However, there is a risk of preterm premature rupture of membrane in such cases.

External cephalic version complicated by bradycardia and placental abruption– a case report

Introduction: Pregnancies with the fetus in breech position at term are routinely managed by offering external cephalic version to increase the likelihood of vaginal birth in the cephalic position and reducing the risk of cesarean delivery. Although complications from external cephalic version are infrequent, placental abruption is a rare but serious risk, occurring in 0.08% of attempts. Methods: This case report details the experience of a woman with an uncomplicated singleton pregnancy with fetal breech presentation at gestational age 37 weeks and 2 days, coming for an outpatient external cephalic version. Preceding the external cephalic version, a fetal ultrasound and cardiotocography were both normal. Intravenous salbutamol was administered shortly before the procedure. Results: The external cephalic version was complicated by a three minute episode of fetal bradycardia, which resolved spontaneously without any maternal symptoms of abdominal pain or vaginal bleeding. Within 35 minutes post-procedure, an ultrasound revealed a de novo placental lake with a jet, potentially coming from a placental artery. The patient also started reporting increasing pain and upon palpation of the abdomen, increased uterine tone was noted. Emergency cesarean was performed resulting in the birth of a healthy girl with normal Apgar scores. Fetal hemoglobin was low at 8.3 mmol/L (reference 9.4 -14.4 mmol/L). Conclusion: This case accentuates the importance of caution in women with symptoms of placental abruption such as uterine contractions, increased tone, or vaginal bleeding, especially following a bradycardic event after external cephalic version. While such complications are rare, clinicians should consider a post-procedure fetal ultrasound before discharge in cases where bradycardia is observed. Funding None Trial registration Not relevant.

Does overweight and obesity have an impact on delivery mode and peripartum outcome in breech presentation? A FRABAT cohort study

PurposeObesity is a worldwide and growing issue affecting women in childbearing age, complicating surgical procedures as well as pregnancy. Through a reduction of not necessarily required cesarean deliveries—for instance in pregnancies with breech presentation—obesity mediated and surgery-associated morbidity might be contained. Date on the impact of maternal BMI in vaginally attempted breech delivery is not existing. To give insight into whether an elevated BMI leads to an increased perinatal morbidity in vaginally intended deliveries out of breech presentation, we analyzed delivery outcome of laboring women with a singleton baby in breech presentation with overweight and obesity (BMI ≥ 25 kg/m2) in comparison to women with a BMI of below 25 kg/m2.MethodsBased on data from January 2004 to December 2020, a cohort study was performed on 1641 women presenting with breech presentation at term (> 37 weeks). The influence of maternal BMI on perinatal outcome was analyzed with Chi2 testing for group differences and logistic regression analysis. Patients with a hyperglycemic metabolism were excluded from the study.ResultsFetal morbidity was not different when patients with a BMI of ≥ 25 kg/m2 (PREMODA morbidity score 2.16%) were compared to patients with a BMI of below 25 kg/m2 (1.97%, p = 0.821). Cesarean delivery rates were significantly higher in overweight and obese women with 43.9% compared to 29.3% (p < 0.0001). BMI and cesarean delivery were significantly associated in a logistic regression analysis (Chi2 coefficient 18.05, p < 0.0001). In successful vaginal deliveries out of breech presentation, maternal perineal injury rates (vaginal birth in normal-BMI women 48.4%; vaginal birth in overweight and obese women: 44.2%; p = 0.273) and rates of manually assisted delivery (vaginal birth in normal-BMI women: 44.4%; vaginal birth in obese and overweight women: 44.2%; p = 0.958) were not different between BMI groups.ConclusionsObesity and overweight are not associated with peripartum maternal or newborn morbidity in vaginally attempted breech delivery, if the patient cohort is thoroughly selected and vaginal breech delivery is in an upright maternal position. Reduction of cesarean delivery rates, especially in overweight and obese women might, have an important positive impact on maternal and newborn morbidity.

Multidisciplinary Obstetric Simulation Training: Experience at KK Women's and Children's Hospital (KKH), Singapore, a Tertiary Referral Centre.

Background Multidisciplinary simulation training in the management of acute obstetric emergencies has the potential to reduce both maternal and perinatal morbidity. It is a valuable tool that can be adapted for targeted audiences of different specialities at all experience levels from medical students to senior consultants. Methods In this study, pre- and post-course questionnaires of learners with varying levels of clinical experience from Obstetrics and Gynaecology (O&G), Anaesthesia, Neonatology, Emergency Medicine, midwifery, and nursing who undertook two simulation courses (namely the Combined Obstetrics Resuscitation Training course, CORE, and the CORE Lite), which comprised lectures and simulation drills with manikins and standardized patients, between 2015 and 2023 were compared. This also included a period when training was affected by the coronavirus disease 2019 (COVID-19) pandemic. Results The results showed that both simulation courses increased confidence levels amongall learners in the management of obstetric emergencies. Pre-course, participants were most confident in the management of neonatal resuscitationand severe pre-eclampsia, followed by postpartum haemorrhage.They were least confident in the management of vaginal breech delivery, uterine inversion, and twin delivery. Post-course, participants were most confident in the management of neonatal resuscitation and shoulder dystocia, followed by postpartum haemorrhage. They were least confident in the management of uterine inversion and maternal sepsis, followed by vaginal breech delivery and twin delivery. Whilst we saw a huge improvement in confidence levels for all obstetric emergencies, the greatest improvement in confidence levels was noted in vaginal breech delivery,twin delivery,and uterine inversion. Conclusion The simulation courses were effective in improving the confidence in the management of obstetric emergencies. While it may be difficult to measure the improvement in clinical outcomes as a result of simulation courses alone, the increase in confidence levels of clinicians can be used as a surrogate in measuring their preparedness in facing these emergency scenarios.

Результаты ультразвукового скрининга дисплазии тазобедренных суставов у детей грудного возраста

Hip dysplasia (HD) represents the congenital underdevelopment of the hip joint (HJ) being the most common orthopedic problem of newborns having the prevalence of 5–20%. Late HD detection is the main cause of coxarthrosis in young adulthood. The study was aimed to assess the results of ultrasound screening for HD in infants. The study involved 860 full-term infants aged 1–3 months (446 boys (51.9%) and 414 girls (48.1%)). All newborns underwent ultrasound imaging of the hip joint at the age of 1 month and the follow-up examination at the age of 3 months (Graf method). The χ2 test and p &lt; 0.05 were used to compare the data. In their first year of life, 685 newborns (79.7%) had joints of normal or transitory shape, 161 (18.7%) showed physiological immaturity and 14 (1.6%) showed the HJ abnormality; the HJ immaturity and abnormality were more prevalent in girls (113 cases (26.3%)) than in boys (62 cases (13.9%)). The relationship between the breech presentation and the likelihood of developing HD was revealed (p &lt; 0.001). Spontaneous improvement by the age of 3 months took place in the majority of infants having the ultrasound signs of HD, the rate of normal HJ increased from 79.8 to 94.5%. Ultrasound screening is an effective method allowing one to detect HD starting from the first days of the child’s life. The risk factors of HD are still female sex and breech presentation, regardless of the number of births. Spontaneous improvement following prescription of relaxing massage occurs in the majority of children.

Full-Term Baby with Cerebellar Hemorrhage Referred for Severe Jaundice Occurring within the First 3 Days of Life

Cerebellar hemorrhage in full-term infants is a rare condition recently recognized in high-risk newborns requiring intensive care with the availability of advanced neuroimaging techniques. Several aspects such as the incidence, pathophysiology, clinical features, and prognosis of cerebellar hemorrhage in full-term infants remain unknown. We present a case of cerebellar hemorrhage with subdural hemorrhage in a patient hospitalized for jaundice after birth without a history of traumatic delivery, such as breech presentation, prolonged labor or forceps delivery. A full-term female infant weighing 3,100 g at birth, with no complications during delivery, developed jaundice within 48 hours of birth and was admitted for intensive phototherapy in the first 3 days of life with a transcutaneous total bilirubin level of 18.1 mg/dL. Magnetic resonance imaging revealed cerebellar brain lesions with a subdural hemorrhage. At the age of 3 months, the infant exhibited leg rigidity and was referred for rehabilitation. The patient showed signs of improvement during treatment and was generally catching up well with her peers at the age of 9 months. Long-term follow-ups are required to evaluate the consequences on cognitive development, behavior, and motor performance subsequently in life.

Dystocia due to Breech presentation with cranio -skeletal malformations in a crossbred cow

A third calving full term pregnant Jersey cross bred cattle was presented to Veterinary Poly Clinic with the history of calving difficulty. All the vital sign parameters of the Dam were within the normal limits. The animal is on sternal recumbency. Upon vaginal examination, it was found that the cervix was fully dilated. Additionally, a breech presentation was observed. Detailed vaginal examination and manipulations the calf was brought to extended position of hind legs. Then by careful assistance hind limb was dragged outside then the calf's hip and thigh region were locked at the pelvic brim of the dam, making delivery difficult. Despite ample lubrication, a bulldog calf with cranio-skeletal malformations was delivered. These malformations are attributed to hereditary causes, primarily driven by recessive autosomal genes. The communication highlights the importance of understanding genetic predispositions and conducting thorough examinations during pregnancy to detect such anomalies early. It also emphasizes the need for careful breeding practices to minimize the risk of inherited disorders in livestock populations.

Systematic Review of the Effectiveness of Remifentanil in Term Breech Pregnancies Undergoing External Cephalic Version

(Int J Obstet Anesth. 2023:54:103649) Approximately 3% to 4% of pregnancies involve a fetus in the breech position. External cephalic version (ECV) is supported and recommended to reduce the cesarean delivery rate. Neuraxial analgesia for ECV can improve the success rate; however, there are associated risks with the use of neuraxial analgesia in these cases. Remifentanil has recently been proposed as an alternative to neuraxial analgesia for ECV. This study aimed to assess and analyze the use of remifentanil in cases where ECV is necessary, as well as compare it to outcomes in ECV with other forms of analgesia.

Confronting the Fear: Our Experience with Breech Vaginal Delivery-A Retrospective Analysis

Introduction: Mode of delivery for term singleton breech presentation has been a raging topic of discussion for decades and continues to be so. The ‘Term Breech Trial’ was a big blow to vaginal breech delivery leading to a torrential increase in the rate of caesarean sections the world over. We intend to compare and evaluate the maternal and perinatal outcomes of vaginal versus caesarean section breech delivery so as to analyse the safety of vaginal delivery for breech presentation. Objectives: Analyse and compare perinatal and maternal outcomes between vaginal versus caesarean deliveries of term or near-term singleton breech presentation. Materials and Methods: Retrospective comparison between 30 vaginal breech deliveries (Group 1) and 252 caesarean deliveries (Group 2) done for singleton breech presentation between 36 weeks to 42 weeks, either in early or advanced labour conducted between January 2015-January 2022 at various Military Hospitals. Statistical Analysis: The association between maternal and perinatal outcomes was estimated using the Chi-square test and Fisher exact test with P &lt; 0.05 considered statistically significant. Results: No maternal complications were noted in Group 1 while in Group 2 surgical site infection and post-partum haemorrhage of varying degree, was noted in 14% cases and 7% cases respectively which was statistically significant. There was no significant difference noted between the groups with regard to neonatal outcomes or NICU admission. Conclusion: Vaginal delivery for termsingleton breech is a reasonable option in well-selected patients at optimally equipped centres, in the hands of an experienced Obstetrician.

Point-of-care ultrasound, today, tomorrow, and the future – the place for task sharing

Background: Maternal and neonatal morbidity and mortality remain public health concerns. A study onmortality in Kenyan hospitals found that neonates comprise two-thirds of deaths in the pediatric agegroup (0–13 years). These deaths are caused by preventable conditions or those, which can bemanaged better if diagnosed early, such as placenta insufficiency, placenta previa, severe fetal growthrestriction, congenital abnormalities, multiple pregnancies, and breech presentation; these can all beidentified using point-of-care ultrasound (POCUS). Obstetrical ultrasound availability is limited to level 4and higher facilities, yet most women access lower levels of health care. Implementation of POCUS iscurrently limited because of a lack of appropriate training, limited scope of practice for frontline workers,and legal framework.Objective: The POCUS project is being undertaken to develop national guidelines to facilitate the roll outand scale-up of obstetrical POCUS.Methods: A collaborative participatory approach is planned for the development of the national POCUSguidelines. The key in this process is the identification of suitable frontline workers who, with adjustmentto their scope of practice, appropriate training, implementation of a supervision/referral system, canundertake obstetrical POCUS and gain buy-in from regulatory bodies, the inclusion of voices of relevantstakeholders, and leadership from government. A landscape and stakeholders analysis will also beundertaken as part of the process of the guideline development.Results: Narrative literature review shows that the WHO recommends effective and reliable antenatalultrasound services to be available to all pregnant women to optimize maternal and newborn healthoutcomes and at least one ultrasound scan up to 24 weeks of pregnancy. That there are deliberateefforts in Kenya to introduce POCUS with pilot training and implementation. Where obstetrical POCUS isimplemented, it is useful in diagnosing fetal malpresentation, placenta previa, congenital malformations,or multiple pregnancies. Appropriate interventions, such as reduction of cesarean delivery, induction oflabor, reduction of small for gestational age, low birthweight, preterm birth, and stillbirths, can improve thehealth outcome of the mother and neonate. There is a need to develop national POCUS guidelines.Conclusions: Implementation of POCUS may be riddled with difficulties, particularly where frontlineworkers’ current scope of practice may not allow them to perform such procedures, regulatoryframework, lack of knowledge, awareness, negative attitude, or behavior. The proposed guidelines willaddress these barriers.

Risk factors for cesarean section of the second twin after vaginal delivery of the first twin.

To document risk factors for combined delivery, defined as unplanned cesarean section for the second twin after vaginal delivery of the first twin, particularly focusing on delivery interval between twins. A multi-center cross-sectional study among a cohort of 5411 women with twin pregnancy experiencing vaginal delivery of the first twin in 2007-2016 at 191 tertiary referral hospitals in Japan was conducted. Primary outcome was the occurrence of combined delivery, and data were collected through the Japan Society of Obstetrics and Gynecology perinatal database. Risk factors for combined delivery were investigated using Poisson regression analysis. Combined delivery occurred in 235 women (5.1%) and was significantly associated with delivery interval (P < 0.001). Multivariate analysis showed women with ≥ 25kg/m2 pre-pregnancy body mass index (BMI) and with birthweight < 1500g of the second twin had significantly higher risk for combined delivery than women with 18.5-25kg/m2 pre-pregnancy BMI and with birthweight ≥ 2500g of the second twin (adjusted risk ratio (aRR) 1.72, 95% confidence interval (CI) 1.15-2.57, and aRR 2.06, 95% CI 1.14-3.72, respectively). Breech and transverse presentation of the second twin were also risk factors for combined delivery compared with cephalic presentation (aRR 3.60, 95% CI 2.67-4.85, and aRR 9.94, 95% CI 6.50-15.0, respectively). Although association of combined delivery with pre-pregnancy BMI was attenuated after adjustment by delivery interval, association with birthweight of the second twin was strengthened. Delivery interval was significantly associated with combined delivery and mediated the association between combined delivery and some other risk factors.

Incidence and characteristics of developmental dysplasia of the hip in a Saudi population: A comprehensive retrospective analysis.

Developmental dysplasia of the hip (DDH) is a common hip disorder in infants. Ultrasonographic screening is considered the most reliable method for early detection of DDH in newborn infants. This study aimed to determine the incidence of DDH at King Abdulaziz University Hospital. From January 2017 to December 2018, this retrospective study analyzed the data of 8031 infants who underwent an early clinical examination of the hips. At the initial evaluation, 212 infants referred to the ultrasound department had risk factors for DDH and/or clinical instability. Different well-known risk factors of DDH have been identified including breech position, skeletal deformities, positive family history, hip side, sex and clicky hip. The findings revealed an incidence rate of 93 cases of DDH among 8031 infants (11.58 per 1000) births. Among the infants diagnosed with DDH, 55 were females (59.14 %), and 38 were males (40.86%). The results of the current study revealed that 45% of infants with DDH exhibited bilateral involvement. Moreover, results showed that the IIa hip joint was more prevalent in female than in male newborns, but without any significant difference. The incidence rate of DDH in this study was 11.58 per 1000 live births, and it was more prevalent among female than male newborns. Ultrasonography (US) should be used as a complementary imaging modality for clinical examination of DDH. Infants with breech presentation, clicky hip, and skeletal deformity should be scanned by US. Further prospective studies are recommended.

The influence of MRI-based pelvimetric measurements in mother’s choice of delivery in fetal breech position

IntroductionAt term, about 3–4% of all singleton pregnancies present as breech. MRI-based pelvimetry is a valuable tool to support selection of adequate candidates for a trial-of-labor in women expecting term breech babies. Shared decision-making is playing an increasingly important role in obstetrics. Since the divergent existing knowledge of breech term delivery needs to be discussed with the pregnant woman, we examined the influence of MRI results on the shared decision-making process in women with term breech presentation.MethodsBetween 08/2021 and 12/2022, anamnestic and clinical parameters were collected from singleton pregnancies expecting term breech babies resulting in birth at the Hanover Medical School. After information, written consent and inclusion, clinical parameters, the course of birth and the maternal and fetal outcome were collected retrospectively. 32 women participated in a postpartum questionnaire study on inquiry. The subsequent acquisition of information and the arguments in the decision-making process were determined. In addition, the sense of security and self-determination was asked both before and during birth.Results50% of the respondents had not decided for a mode of delivery before having MRI pelvimetry. After imaging and information, about the own pelvic dimensions and predictors for a successful vaginal birth, 80% of this subgroup decided to give birth vaginally. Over 40% of the collective descripted that they made a decision based on the result of MRI pelvimetry. None of the women felt to be insecure after having talked about the MRI results. The elective cesarean section group and the group of those who delivered vaginally were approximately equally highly satisfied with their feeling of self-determination of the birth mode. Overall, the study population had a very positive birth experience. The group of women who had delivered by elective cesarean showed a wider range in their assessment and appeared to perceive the experience more negative than the group of women who had a vaginal birth or emergency cesarean. Fetal and maternal outcomes did not differ between the groups.DiscussionMRT pelvimetry measurements can be used as a predictor for a successful vaginal breech delivery. The additional information obtained from the MRI measurements can be used in the shared decision-making process to decide more easily on the mode of delivery while improving women's awareness and safety. A balanced education on rare and frequently adverse events of vaginal delivery and cesarean section and patient expectations about labor processes must be taken into account.

Risk factors of developmental dysplasia of the hip in infants: A meta-analysis based on cohort studies

IntroductionDevelopmental dysplasia of the hip (DDH) is a prevalent condition in children. Currently, the exact etiology of DDH remains uncertain. The objective of this study was to conduct a meta-analysis to investigate the risk factors associated with DDH in infants. The findings would provide a theoretical foundation for targeted early screening and diagnosis. HypothesisSeveral indicators, such as gender, intrauterine position, family history of DDH, gestational age, delivery mode, amniotic fluid levels, swaddling, parity, fetus number, combined musculoskeletal deformities, birth weight, and physical examination results, may serve as risk factors for DDH. Materials and methodsCohort studies investigating the risk factors of DDH in infants through logistic regression analysis were searched in the Wanfang, VIP citation, China National Knowledge Infrastructure (CNKI), China Biology Medicine disc, Excerpta Medica Database (Embase), PubMed, and Cochrane Library databases up to May 2023. After extracting the data from eligible literature and assessing them using the Newcastle-Ottawa Scale (NOS), articles were selected based on pre-established inclusion and exclusion criteria. ResultsA total of eleven literature reports covering 979,757 infants were included in this meta-analysis. The publication bias did not significantly influence the results. The incidence rate of DDH was 47.99‰ among infants with risk factors compared to 3.21‰ in the general population. Risk factors for DDH included being female (OR=6.97, 95% CI: 5.18–9.39, p<0.001), breech delivery (OR=4.14, 95% CI: 3.09–5.54, p<0.001), positive family history (OR=4.07, 95% CI: 2.20–7.52, p<0.001), cesarean section (OR=1.11, 95% CI: 1.01–1.21, p=0.032), oligohydramnios (OR=3.93, 95% CI: 1.29–12.01, p=0.016), swaddling (OR=6.74, 95% CI: 1.25–36.31, p=0.026), firstborn status (OR=1.84, 95% CI: 1.49–2.53, p<0.001), combined musculoskeletal malformations (OR=2.27, 95% CI: 1.58–3.27, p<0.001), and physical signs of DDH (OR=8.71, 95% CI: 2.44–31.07, p=0.001). Premature delivery (OR=0.91, 95% CI: 0.88–0.95, p<0.001) was a protective factor for DDH. The relationship between multiple pregnancies (OR=0.58, 95% CI: 0.33–1.02, p=0.060) and low birth weight (OR=0.62, 95% CI: 0.14–2.76, p=0.529) in relation to DDH remained uncertain. DiscussionThis meta-analysis shows that female, breech delivery, positive family history, cesarean section, firstborn status, oligohydramnios, swaddling and combined musculoskeletal malformations are associated with DDH. Premature delivery appeared to be a protective factor against DDH. Nevertheless, the other factors need more research to reach more conclusive results. Level of evidenceIII; meta-analysis.

Does overweight and obesity have an impact on delivery mode and peripartum outcome in breech presentation? A FRABAT prospective cohort study

Does overweight and obesity have an impact on delivery mode and peripartum outcome in breech presentation? A FRABAT prospective cohort study

Maternal and neonatal outcome after vaginal breech delivery at term of children weighing more or less than 3.8 kg: follow up of a frabat prospective cohort study

Maternal and neonatal outcome after vaginal breech delivery at term of children weighing more or less than 3.8 kg: follow up of a frabat prospective cohort study

An update on maternal and neonatal outcome after vaginal breech delivery at term after cesarean section – a prospective cohort study of the Frankfurt breech at term cohort (frabat)

An update on maternal and neonatal outcome after vaginal breech delivery at term after cesarean section – a prospective cohort study of the Frankfurt breech at term cohort (frabat)

Sonographic examination in breech delivery predicts birth outcome – A prospective blinded study

Sonographic examination in breech delivery predicts birth outcome – A prospective blinded study

Low transverse caesarean section through the posterior uterine wall in a pregnant patient with asymptomatic uterine torsion of 180°: A case report

IntroductionExcessive torsion of a pregnant uterus is a rare and potentially extremely dangerous pathology for both the mother and fetus. The diagnosis is most often made intraoperatively.AimThe main aim was to show that when it is impossible to detort the uterus, a low transverse caesarean section through the posterior uterine wall can be safely performed.Case studyWe report a case of a 41-year-old multiparous woman at G II P II 39/40 weeks' gestation, who presented to the Gynecology and Obstetrics Department for an elective caesarean section due to a breech presentation of the fetus. During the caesarean section, a uterine torsion of 180° was found. As the uterus could not be detorted to its normal position, a low transverse caesarean section was performed through the posterior uterine wall. At follow-up visits after 8 weeks and 12 months, normal healing of the uterine muscle was confirmed.Results and discussionThe treatment of torsion of the pregnant uterus depends on gestational age and symptoms, in particular the presence of significant hemodynamic and ischemic lesions.ConclusionsThe procedure of choice in a full-term pregnancy should be an attempt to detort the uterus to its normal position and then perform a cesarean section through the anterior uterine wall. If detorsion of the uterus is not possible, a caesarean section through the posterior uterine wall should be performed. Based on the literature review and the case presented, it appears that this procedure is safe.