Uterine torsion in pregnancy: A case report

Abstract

Introduction and importance: Uterine torsion are extremely rare in pregnancy as few cases have been reported. Torsion of the pregnant uterus is defined as the rotation more than 45 degrees around the long axis of the uterus. It has been referred as, once-in-a-lifetime diagnosis by obstetricians and gynecologists. This paper reports a case of uterine torsion and velamentous cord insertion from our obstetrical practice, along with a review of reported cases.

Case presentation: The 30-year-old patient (G2P1) at 38 weeks' gestation with a singleton pregnancy, was admitted to the Obstetrical Unit with uterine cramping and decreased fetal movement. Her prior obstetrical history included one uncomplicated term Cesarean section (2016), the current pregnancy had been velamentous cord insertion at 20 weeks' gestation and intra-uterine growth restriction at the 33rd -week gestation until the presentation date. Emergency Cesarean section was performed the 90 degrees uterine torsion and was diagnosed intra-operatively. This patient and her baby recovered and were discharged home on the fifth post-operative day.

Clinical discussion: Uterine torsion, a rare pregnancy complication, should be considered when evaluating acute abdominal pain or performing a Cesarean delivery, especially in cases of abnormal fetal presentation, pelvic adhesions, uterine fibroids, malformations, or ovarian tumors. Early diagnosis and proper treatment are crucial due to the negative prognosis for both mother and baby.

Conclusion: Uterine torsion along with velamentous cord insertion is difficult to diagnosis due to its rarity. It is essential to focus on uterine malformations during ultrasound examinations in the first, second, and third trimesters.

Keywords: Obstetric complications; Pregnancy; Uterine torsion; Velamentous cord insertion.

Fig. 1

Image of CTG at admision.

Fig. 2

The uterus twisted to the right at 90 degrees, showing the Fallopian tube and the round ligament in front of the incision site, with many enlarged blood vessels.

Fig. 3

The post-partum image of velamentous cord insertion (the cord is attached to the membrane disc, 2-3 cm away from the edge of the disc).

Fig. 4

Baby condition: weight 2300 g Apgar scores 8/9.