Case Of Uterine Torsion Research Articles

Uterine torsion in Simmental crossbreed cow

This case report describes the treatment of uterine torsion in Simmental crossbreed cattle. The dam was five years old, twice parity, in nine months and ten days pregnancy. Based on the anamnesis, it is known that the cows show signs of restlessness, straining, more robust by the time. However, there was no visible edema in the vulva, no ruptured membranes, no legs and head of the fetus coming out of the dam's vulva. Tretment was carried out by traditional rolling until the maximum uterine lumen opening was obtained. The position of the fetus is head flexion posture, so to remove it vaginally, the head is repositioned first and then forced to pull it out until the fetus comes out. Post-treatment, the dam's condition was still weak, unable to stand up, did not want to eat, and only drank a little. The drugs given were analgesics-antipyretics (repeated in the afternoon), long-acting antibiotics, vitamin B1, and vitamins and minerals mixed. After a few hours, the dam was up and walking around, feeding and drinking, and the placenta completely separated. The fetus's condition was alive, female sex, weak condition, the condition improves after being given milk from the dam. It can be concluded that the case of uterine torsion in Simmental crossbreed cows has been successfully treated 24 hours after the signs of birth using the traditional rolling technique, and the fetus can be expelled vaginally. The condition of the dam and fetus after the treatment of uterine were torsion gradually became healthy.

Казуистика в акушерстве: перекрут матки во время беременности

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

Uterine torsion and intrauterine growth restriction: Case report and systematic literature review

Uterine torsion (UT) in pregnancy is a rare condition in obstetric practice. It is defined as a rotation of the uterus of more than 45° around its long axis. Presentations are varied and, most of the time, this condition is recognized at laparotomy or cesarean section (CS). The aim of this study is to summarize the latest evidence about UT in pregnancy. A systematic research of the literature was conducted fetching all papers published from March 2006 to June 2020. We collected data regarding clinical features, treatment, and feto-maternal outcomes. Finally, we reported data of a case of UT associated with intrauterine growth restriction (IUGR) diagnosed and treated at our institution. According to our search strategy, 38 articles were included. In 66% of the cases, acute symptomatology was present at the onset, most frequently abdominal pain was reported. In one-third of the cases, UT was diagnosed during CS without clinical suspicion. Only in two cases, including our case, IUGR was reported. Most (66%) of the cases presented a 180° torsion. In the majority of the cases, a CS was performed also with a deliberate or accidental posterior hysterotomy. One and six cases of maternal and fetal death were, respectively, reported. UT is an infrequent obstetric condition but should be considered in case of abdominal pain, vomiting, or shock presentation during pregnancy. It could lead to a reduction in uterine blood flow contributing to poor placental perfusion, even though more evidence is needed to clarify this link.

Diagnosis of uterine torsion during cesarean section

Partial rotation of the uterus up to 45 degrees is a common physiological finding during pregnancy whereas uterine torsion is pathologic and defined as rotation greater than 45 degrees. Torsion of up to 720 degrees has been reported; with most cases occurring between 90 degrees and 180 degrees. While uterine torsion in pregnancy requires emergent intervention, the incidence is unknown. Most cases of uterine torsion are diagnosed intra-operatively at emergent cesarean section following non-specific clinical presentation, such as fetal heart rate decelerations or bradycardia, severe abdominal pain, hypotension, or vaginal bleeding. In this case series, we report on two cases of one woman with gravid uterine levorotation of 180 degrees and another with gravid uterine dextrorotation of 180 degrees.

Uterine Torsion Diagnosed at the Time of Laparotomy for a Planned Cesarean Section at Term

Background: Uterine torsion is defined as the rotation of the uterus more than 45 degrees around its long axis. The angle of rotation is usually 180 degrees, although, in the literature, there are reported cases of uterine torsion up to 720 degrees. This is a rare complication of pregnancy but associated with significant mortality and morbidity. Etiology still remains unclear and clinical diagnosis may be challenging. Symptoms can be absent or few and nonspecific as in chronic conditions or catastrophic such in case of acute presentation associated with acute abdomen. Final diagnosis is usually made at the time of laparotomy or even after delivery. In the literature, bilateral plication of round ligaments is proposed to prevent recurrences. However, there are no validated guidelines for the management of uterine torsion in pregnancy. Case: We present a 33-year-old, gravida 2 para 1. She had a previous vaginal delivery and no medical known conditions. She was admitted for a planned caesarian section at 39 weeks of gestation for breech presentation. After a difficult delivery of a healthy female neonate with normal Apgar scores and cord pH levels, a spontaneous derotation of the uterus of 180 degrees was observed. Giving the absence of pelvic anomalies, we chose to not perform any additional preventive surgical procedure. The patient was discharged on 3rd postoperative day. Finally, no complications were observed at the two-months postpartum visit. Conclusion: Uterine torsion in pregnancy is an uncommon pathology but potentially life threatening that obstetrician should be aware of. Occasionally, imaging can be helpful, but diagnosis is mostly made during surgery. In case of irreducible torsion, delivery can be made with a transverse incision in the lower posterior uterine segment. Bilateral plication of round ligaments, as previously described by other authors, may be evaluated as a taylored treatment in case of extreme uterine torsion and other pelvic anomalies, in order to prevent the recurrence of the torsion.

A Rare Case of Complete Uterine Torsion in a Postmenopausal Woman

We present a rare case of uterine torsion caused by an 18-cm subserosal myoma weighing 3.9 kg in a postmenopausal lady in a tertiary center. A 52-year-old postmenopausal lady presented with abdominal pain and no bowel movements of 3 days duration. Multiplanar computed tomography (CT) of abdomen and pelvis showed uterine torsion, while initial pelvis ultrasound was unremarkable. Patient underwent laparotomy and was found to have torsion of the uterus at the level of the isthmus with a large subserosal myoma. She underwent total hysterectomy and bilateral salpingo-oophorectomy. Post-operatively, patient recovered well. Subserosal myoma causing uterine torsion is extremely uncommon, but in a known case of large subserosal myoma in a postmenopausal lady, high index of suspicion is needed when they present with acute abdominal pain. However, prompt identification with advanced radiological imaging is important to minimize associated morbidity and mortality. J Med Cases. 2019;10(6):164-167 doi: https://doi.org/10.14740/jmc3314

Surgical management of uterine torsion through ventral celiotomy in eleven mares

This article describes the surgical management of uterine torsion by midline celiotomy for cesarean section in 11 mares presented with signs of colic at a teaching veterinary hospital. The mares were either in full term of gestation (n = 6) or in advanced stage of pregnancy (n = 5). Majority of the mares (44.5%) were in fourth parity. 78% cases of uterine torsion were post cervical and clockwise and (22%) cases were post cervical and anticlockwise. For surgical intervention, mares were anesthetized using a combination of xylazine (1.1 mg/kg) and ketamine (2.2 mg/kg), intravenously and maintained on isoflurane inhalation anesthesia. Midline celiotomy was performed, and foals were delivered by cesarean section. Before closing the abdominal wound, the uterus was detorted manually and confirmed per-vaginally for its normal position. After long-term follow-up, the study reported 90.0% (10/11) survival rate out of which, seven were bred successfully.

Uterine twist in Nellore cow: case report

Uterine torsion is the rotational movement of the uterus about its longitudinal axis, being more frequent in the bovine species than in any other. As reproductive performance directly reflects the reproductive rates of a herd, distocias are the targets of studies, since they result in economic losses for the producer. Uterine torsion results in dystocia and its etiopathogenesis is still not well understood, but are among the risk factors: excessive fetal movement in the early stages of delivery, fetal excess weight, deeper abdomen in some races, age and number of deliveries, causing flaccidity of the muscles and uterine ligaments. The diagnosis is based on obstetric examination, vaginal and / or transrectal palpation. The prognosis depends on the degree of rotation, time of evolution, and sequelae on the uterus and fetus. Usually the veterinary intervention is necessary, being able to be corrected only with obstetrical maneuvers and in more serious cases it needs cesarean section. The present study aims to describe the case of a Nellore cow approximately 2 ½ years old, referred to the Uberaba Veterinary Hospital, in labor and uterine twist. After the transvaginal palpation and the infeasibility of success only with obstetric maneuvers the animal was submitted to cesarean section. Several cases of uterine torsion in cattle are described in European breeds, but little is known about this type of disease in Nellore cattle.

A case of uterine torsion in term pregnancy associated with placental abruption and intrauterine fetal demise

Uterine torsion is defined as rotation of the uterus of more than 45° on its long axis. It is an unusual complication of pregnancy and probably represents a once-in-a-lifetime diagnosis. Fetal mortality up to 12 % and occasional maternal mortality are reported. The authors report a case of 180 degrees dextrogyre torsion at 38 weeks of gestation complicated by placental abruption with resultant maternal hypovolemic shock and intrauterine fetal demise. Emergency cesarean section was performed. After exteriorization of the uterus the authors observed the anterior crossing over of the proper ovarian ligaments, and at that time they realised that the uterus was axially rotated by 180 degrees. They performed a counterclockwise detorsion of the uterus and confirmed a low transverse incision of the posterior wall of the organ. Intraoperative plication of the uterosacral ligaments should be performed for prevention of recurrent torsion.

Studies on the Types and Prognostic Approaches for Uterine Torsion among Cattle

In the present study 20 cases of uterine torsion in cows presented to the TVCC of the department were evaluated for type, direction and degree of torsion as well as for liver and kidney function tests to determine prognosis. Of the total, 65% cases were of pre-cervical type and 35% post-cervical. In 75% cases direction of torsion was to the right side than to the left (25%). Forty per cent cases were of 180–360° than 90–180° (25%) and few were of ≤90° (20%) and >360° (15%). Ninety five per cent cases were reported at full term pregnancy. Out of all 65% cases could be delivered per-vaginum while 35% needed laparohysterotomy. The values of plasma GOT/AST at the time of presentation of case, 1-hr and 24-hr following delivery and in control group on delivery were 150.68 ± 3.03, 119.46 ± 1.27, 89.33 ± 1.23 and 69.96 ± 1.00 U/L, respectively. The corresponding values of plasma GPT/ALT were 112.90 ± 3.95, 85.18 ± 0.96, 62.44 ± 1.72 and 39.35 ± 1.20 U/L. The values of plasma bilirubin for the corresponding stages/groups were 1.68 ± 0.07, 1.13 ± 0.03, 0.75 ± 0.03 and 0.34 ± 0.02 mg/dl, respectively. The value of plasma creatinine at the time of presentation, and 1-hr and 24-hr following delivery and in control group were 2.03 ± 0.06, 1.51 ± 0.04, 0.80 ± 0.02 and 0.40 ± 0.02 mg/dl, while the values of BUN were 56.61 ± 1.44, 35.71 ± 0.37, 29.04 ± 0.27 and 17.56 ± 0.70 mg/dl, respectively.

English

A number of 30 buffaloes with uterine torsion were described in a period of 2010 to 2011 in our clinic in Basrah Province Alnashwa. All animals were treated first by rolling but only four cases responded and were corrected by this method, 86.67% of cases were corrected by caesarian section (CS). We found that the right uterine torsion was more incidence 73.33% than left uterine torsion, from the result, we found 4 cases of uterine torsion with malprsentation. The fetus survivability after caesarian section was only 46.51%. The study concluded that caesarian operation in early diagnosed uterine torsion in buffaloes is the best method for saving the fetal and maternal life in case of rolling failure. Key words: Buffaloes, Basrah Province, uterine torsion.

Torsion of preterm gravid uterus: A case report

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.

Torsion utérine au cours d’une grossesse gémellaire

A case of uterine torsion in a 37-years-old woman during twin pregnancy is described. Diagnosis was made during caesarean section and the torsion successfully reduced through a standing laparotomy. Detorsion was accomplished by rotating the uterus to the left. A severe post-partum haemorrhage occurred and hysterectomy was required. The patient recovered and was discharged home with her baby. Uterine torsion at term is a rare obstetric event that occurs mainly in the third trimester with adverse maternal and neonatal consequences and raises several critical management considerations. We review possible diagnostic signs and management of this rare complication from literature.

A case of uterine torsion with a huge calciferous uterine leiomyoma in a postmenopausal (non-gravid) woman

A case of uterine torsion with a huge calciferous uterine leiomyoma in a postmenopausal (non-gravid) woman

Third Trimester Uterine Torsion: Case Report

BackgroundRotation of the gravid uterus is a normal finding in the third trimester of pregnancy. However, a pathologic rotation of the uterus beyond 45 degrees—torsion of the entire uterus—is rarely seen in obstetrical practice. We report here a case of uterine torsion from our obstetrical practice and a review of reported cases. CaseThe patient, a 36-year-old gravida 3 para 2 at 36 weeks’ gestation with a singleton pregnancy, was admitted to the obstetrical unit with uterine cramping and decreased fetal movement. Her prior obstetrical history included two uncomplicated term vaginal deliveries, and the current pregnancy had been uncomplicated until the date of presentation. After 3 hours’ observation, uterine cramping and tenderness increased, and fetal tachycardia developed. The presumptive diagnosis was a concealed placental abruption. The patient was not in labour, so an emergency Caesarean section (CS) was carried out. At the time of CS, the diagnosis of uterine torsion was made. The patient recovered and was discharged home with her baby on the third postoperative day. ConclusionUterine torsion is an infrequently reported and potentially dangerous complication of pregnancy that occurs mainly in the third trimester with adverse maternal and neonatal consequences.

Studies on serum progesterone levels in relation to occurrence of uterine torsion in buffaloes ( [formula omitted][formula omitted

Serum samples from 32 buffaloes suffering from uterine torsion at approximately the completion of the gestation period were analyzed for progesterone concentrations by radioimmunoassay. Fifteen buffaloes had progesterone concentrations of more than 1.0 ng/ml (1.65 ± 0.13 ng/ml; 1.1 to 2.8 ng/ml), while the serum progesterone concentrations of the remaining 17 buffaloes were below 1.0 ng/ml (599 ± 59 pg/ml; 200 to 900 pg/ml). The occurrence of uterine torsion was associated with labour and/or abdominal pain around the expected time of parturition at the completion of the gestation period. High progesterone concentrations at labour in cases of torsion in almost half of the buffaloes may suggest that there were instances of premature labour resulting from an impaired hormonal milieu. Disturbances in the onset of labour owing to hormonal imbalance as evidenced by high progesterone levels may also contribute to the causation of uterine torsion. Cases of uterine torsion having low progesterone values are also discussed in this study.

Non-surgical correction of a uterine torsion in the mare.

A case of uterine torsion is described and its correction under general anaesthesia by a method described by Schaffer for the cow. The degree of torsion was 180 degrees and in a clockwise direction. After correction the foal was found to be alive and in anterior presentation and ventral position; it was born normally 84 days later.

Torsion of fibroid uterus resulting in profound shock

Abstract A case of uterine torsion of a severe degree, due to fibromyoma and causing profound hypovolemic shock, is presented with discussion of the incidence and diagnosis of this rare gynecological emergency. It is suggested that the cases reported in the literature be classified according to the causes producing torsion rather then whether the uterus was gravid or otherwise. The possibility of chronic uterine torsion is mentioned.