@babies_after_35: Uterine torsion in pregnancy: a case report and systematic review,Med J Malaysia, 2025 From UpToDate: Uterine torsion is rare and has been described in all trimesters (however, approximately 85 percent occur in the third trimester), as well as in nonpregnant females. It can be defined as rotation greater than 45 degrees around the longitudinal axis of the uterus. Most patients have risk factors, such as fibroids, müllerian anomalies, fetal malpresentation, pelvic adhesions, and abdominal or ligamentous laxity. According to literature reviews, rotation is 180 degrees in most cases, but can be up to 360 degrees, and the uterus is usually in dextrorotation. Clinical manifestations vary depending on the degree of torsion: Abdominal pain, nausea and vomiting, obstructed labor, intestinal or urinary complaints, uterine hypertonus, vaginal bleeding, fetal bradycardia, and maternal shock have been reported. Ultrasonography can lead to a correct diagnosis before delivery if a change in the previously determined placental site is noted (eg, from anterior to posterior) or the ovarian vessels are observed to pass in front of the lower uterine segment. However, in almost all cases, the signs and symptoms of torsion lead to emergency cesarean birth, resulting in the correct diagnosis. If derotation of the uterus with the fetus in situ is not possible, the fetus can be delivered through a transverse incision in the lower posterior uterine segment. The uterus is then untwisted to its normal position. Several cases of fetal death (presumably due to ischemia), one maternal death, and one case of abruption have been reported.Postpartum hemorrhage seems to be a frequent complication. #uterinetorsion #pregnancy

Shannon M. Clark, MD, FACOG

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Sunday 20 July 2025 13:58:24 GMT