Uterine torsion: A rare differential diagnosis for acute abdominal pain in pregnancy

Uterine torsion: A rare differential diagnosis for acute abdominal pain in pregnancy

15^th World Congress on Gynecology, Obstetrics and Womens Health & 17^th International Conference on Traditional Medicine and Acupuncture & 9^th World Summit on Cancer Science and Oncology
May 26, 2022 | Joint Webinar

Tin Yee Ling

Auburn Hospital, Australia

Scientific Tracks Abstracts : Arch Gen Intern Med

Abstract:

Introduction: Uterine Torsion (UT) in pregnancy of >45-degree along the longitudinal axis is a rare occurrence and the aetiology remains unclear. Case: 34-year-old G2P1 woman with history of one previous caesarean section presented at 36+2 weeks with sudden onset lower abdominal pain and syncopal episode. She was otherwise haemodynamically stable. Cardiotocography showed pathological trace with an initial prolonged bradycardia followed by tachycardia with reduced variability. An initial diagnosis of uterine dehiscence was made. She underwent an emergency caesarean section which revealed a 180-degree UT along the longitudinal axis. Detorsion of uterus was performed prior to delivery of the foetus, and anterior uterine wall was intact with no signs of rupture and no anatomical uterine abnormalities were found. Discussion: UT is rare as the uterus is supported by uterine ligaments which limit the mobility of the structure. There are only a few hundred cases reported worldwide. Causes are unknown, but risk factors such as uterine abnormalities, increased uterine ligaments’ flexibility in pregnancy and foetal malposition have been identified1. UT causes occlusion of uterine vessels, which leads to ischaemic injury of the placenta causing premature separation of placenta, preterm labour and foetal morbidity and mortality if delivery is delayed2. Diagnosing UT is difficult clinically as most women present with symptoms mimicking placenta abruption or uterine rupture and one third are asymptomatic1. The management of UT involves detorsion of the uterus and delivery of foetus via caesarean section. Extra vigilance should be taken to identify the anatomy of the uterus experiencing torsion prior to hysterotomy1. There have been cases reported with hysterotomy on posterior uterine wall as it may be difficult to identify and reverse a gravid UT when foetal well-being is at stake3. Conclusion: It is crucial to identify and address UT in pregnancy as it is associated with maternal and foetal morbidity and mortality.

Biography:

Tin Yee Ling is an obstetrics and gynaecology registrar working with NSW Health in Australia. She is also a Diplomate of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

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