Description
Torsion of the uterus in advanced pregnancy is an exceptionally rare obstetric emergency that poses significant diagnostic and management challenges. Often presenting with nonspecific symptoms, it can mimic other acute abdominal conditions, leading to delays in recognition. This case discussion will delve into the clinical presentation, diagnostic approach, and surgical management of uterine torsion, emphasizing the importance of early intervention to ensure maternal and fetal safety. By exploring real-life clinical experience, we aim to enhance awareness and preparedness for this unusual yet critical scenario among healthcare professionals.
Summary Listen
- A 33-year-old pregnant woman with two previous cesarean deliveries presented at 32 weeks gestation with sudden, severe abdominal pain and vomiting, raising suspicion of uterine rupture. Initial scans at 30 weeks were normal.
- Clinical examination revealed a distressed patient with low blood pressure and a tender abdomen. Ultrasound ruled out placental abruption but fetal heart rate began to decline rapidly.
- The surgical team found the uterus twisted approximately 180 degrees along its longitudinal axis. The left fallopian tube and ovary were pulled across the uterine body.
- Uterine torsion impedes blood flow to the uterus and subsequently, to the fetus, causing fetal distress.
- Due to the advanced stage of pregnancy, the uterus could not be manually de-rotated. A transverse incision was made on the posterior uterine wall to deliver a live infant via breech extraction.
- After delivery, the uterine wall was closed in layers and the uterus was de-rotated to its correct anatomical position. This revealed the bladder and the previous cesarean scar.
- Uterine torsion is a rare but life-threatening obstetric emergency, defined as a uterine rotation of more than 45 degrees. It can be caused by fibroids or other anatomical factors.
- Prompt recognition, quick decision-making, and surgical intervention are crucial for a successful maternal and fetal outcome in cases of uterine torsion. Clinical awareness and readiness for laparotomy are essential for management.
Sample Certificate
About the Speakers
Dr. Pankaj Desai
Consultant Gynecologist, Janani Maternity Hospital, Vadodara, Gujarat
Comments
Comments
You must be logged in to leave a comment.