Asymptomatic uterine torsion during pregnancy

Background: Torsion of the uterus is defined as its rotation of more than 45° along its vertical axis. This pathology is extremely rare. Most obstetricians are faced with this situation once in a lifetime. Uterine torsion is a potentially dangerous obstetric situation. The main factors predisposing to uterine torsion are uterine leiomyoma or malformations, abnormal fetal positions, polyhydramnios, multiple pregnancies, cesarean section history, but any known cause is absent in 16-30% of cases. The clinical manifestations of uterine torsion are nonspecific and variable. There are often clinical presentations of an acute abdomen, in which a differential diagnosis is made in the presence of premature placental abruption, uterine scar rupture, torsion of the uterine appendages, acute appendicitis, and peritonitis. However, asymptomatic uterine torsion has been described in 11% of cases. The authors have not found any publications related to this problem in the Russian literature. Case report: The article describes a clinical case of asymptomatic uterine torsion with favorable maternal and fetal outcomes. A 29-year-old secundipara underwent cesarean section delivery at 34 weeks and 5 days, as concomitantly indicated. Attention is drawn to the fact that after hysterotomy, there is a large (3-4 cm) thickness of the uterine wall, the edges were separated with difficulty; a live premature girl (weight 2280 g; height 46 cm) with an Apgar score of 7/8 was extracted by the head with technical difficulties, by using a Kiwi vacuum cup after an additional incision in the center. The uterus was removed into the wound and its torsion was found in the lower segment by 180° to the right. Uterine derotation was done. It was found that hysterotomy was performed on the posterior uterine wall. The total blood loss was 750 ml. The postoperative period was uncomplicated. Conclusion: Uterine torsion is an extremely rare complication of pregnancy. Uterine torsion can occur in the absence of known risk factors and be asymptomatic. It should be remembered that during any cesarean section operation, it is necessary to carefully evaluate anatomical landmarks in order to avoid injury to large vessels, ureters, and bladder.

uterine torsion, uterine rotation, pregnancy complications, dystocia, posterior hysterotomy, cesarean section