Volume 8, Issue 6, November 2020, Page: 211-213
Uterine Torsion Diagnosed at the Time of Laparotomy for a Planned Cesarean Section at Term
Ninni Filippo, Department of Obstetrics and Gynecology, Azienda Ospedaliera Toscana Nord-Ovest, Ospedali Riuniti di Livorno, Livorno, Italy
Guiggi Ilaria, Department of Obstetrics and Gynecology, Azienda Ospedaliera Toscana Nord-Ovest, Ospedali Riuniti di Livorno, Livorno, Italy
Landucci Edi, Department of Obstetrics and Gynecology, Azienda Ospedaliera Toscana Nord-Ovest, Ospedali Riuniti di Livorno, Livorno, Italy
Masoni Stefano, Department of Obstetrics and Gynecology, Azienda Ospedaliera Toscana Nord-Ovest, Ospedali Riuniti di Livorno, Livorno, Italy
Tosi Veronica, Department of Obstetrics and Gynecology, Azienda Ospedaliera Toscana Nord-Ovest, Ospedali Riuniti di Livorno, Livorno, Italy
Abate Sergio, Department of Obstetrics and Gynecology, Azienda Ospedaliera Toscana Nord-Ovest, Ospedali Riuniti di Livorno, Livorno, Italy
Received: Oct. 7, 2020;       Accepted: Oct. 26, 2020;       Published: Dec. 31, 2020
DOI: 10.11648/j.jgo.20200806.19      View  31      Downloads  16
Abstract
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.
Keywords
Uterine Torsion, Cesarean Section, Pregnancy, Plication of Round Ligaments
To cite this article
Ninni Filippo, Guiggi Ilaria, Landucci Edi, Masoni Stefano, Tosi Veronica, Abate Sergio, Uterine Torsion Diagnosed at the Time of Laparotomy for a Planned Cesarean Section at Term, Journal of Gynecology and Obstetrics. Vol. 8, No. 6, 2020, pp. 211-213. doi: 10.11648/j.jgo.20200806.19
Copyright
Copyright © 2020 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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