Uterine Torsion Associated with Previable Preterm Premature Rupture of Membranes Diagnosed at Cesarean Section

Abstract

Ab s t r Ac t Background: Torsion of gravid uterus is a rare and sporadic event, and its association with previable preterm premature rupture of membrane (PPROM) is not reported in literature. Case description: A 35-year-old third gravida with previous two early pregnancy losses was managed conservatively following previable rupture of membranes at 20 + 6 weeks of gestation. Torsion of gravid uterus to 180° was diagnosed at elective cesarean section performed at 32 + 2 weeks in view of Breech presentation with severe oligoamnios and tubular cervix. An alive baby of 1.48 kg with good APGAR score was extracted through a low vertical incision given on anterior surface of uterus after detortion. Discussion: Torsion is diagnosed when uterus rotates itself on its long axis 45° or more, and the etiology may be fibroid uterus adhesions and ovarian cysts. Preoperative diagnosis is rare except when magnetic resonance imaging is performed. Most of the cases reported in the literature are diagnosed at cesarean section undertaken for fetal distress or nonprogress of labor. In the case presented here, there were no predisposing factors except that she was on prolonged bed rest due to PPROM, and there was a cornual implantation of placenta. Conclusion: Conservative management of maternal position may predispose to uterine torsion, and in such cases, vigilant monitoring and timely termination can save the fetus. Clinical significance: Presence of a tubular cervix with mal-presentation is one of the clinical features to suspect torsion during pregnancy and labor.