Uterine torsion is defined as rotation of the uterus of more than 45 degrees on its long axis. It is a rare but potentially life threatening complication of pregnancy. This is a case report of uterine torsion in the third trimester of pregnancy and a review of the relevant literature.
The patient, a 40 year old Para 1 at 38+6 weeks gestation, was admitted to hospital with uterine cramping and fetal malpresentation. She had been booked for elective caesarean section on the morning of her admission. This lady had a complicated previous obstetric history which included an IVF pregnancy resulting in caesarean section for twins in 2006, and subsequent return to theatre with intrabdominal haemorrhage. She was then readmitted post delivery with retained placenta and required an evacuation of uterus.
In her current admission, following 6 hours of observation, during which time her pain settled, she underwent an elective caesarean section. At time of surgery, a diagnosis of uterine torsion was made. The gravid uterus was found to be 100° levorotated anticlockwise with the utero-cervical junction acting as the pivot. The poorly formed lower segment was deemed unsuitable for lower transverse incision and therefore a modified classical incision was performed. A male infant weighing 3.6kg was delivered by breech extraction. The patient made an uneventful recovery postnatally.
Uterine torsion is an infrequent and potentially dangerous complication of pregnancy that often presents in the third trimester with possible adverse maternal and neonatal consequences.
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