Pathologic torsion of the pregnant uterus

Torsion of the human pregnant uterus is a very rare complication. This presentation describes repeated episodes of pathological CTG patterns in a woman whose uterus showed a levotorsion of 150 degrees at cesarean delivery. To our knowledge, such a pattern has never previously been ascribed to uterine torsion.     

Pathologic torsion of the pregnant uterus

A case of 90 degrees C dextro-torsion of the uterus in the 36th gestational week is reported. The case was asymptomatic and was discovered at cesarean section carried out because of transverse lie following rupture of the membranes. Mother and child were discharged in perfect health.     

Pathologic torsion of the pregnant uterus. Case report

A case of pathologic torsion of the pregnant uterus in the 35th gestational week has been reported and compared with literature. Aetiology, pathogenesis, diagnosis, treatment and perinatal mortality of this rare condition have been discussed.     

Metabolism of prostaglandins within the pregnant uterus.

The metabolism of E and F prostaglandins has been studied in both fetal and maternal tissues obtained from the pregnant human uterus. Both 15-hydroxyprostaglandin dehydrogenase and 13,14-prostaglandin reductase are shown to be widely distributed in these tissues. Comparison of the levels of enzyme activity in different tissues demonstrates that the greatest metabolism of prostaglandins takes place in the membranes and placenta and that there is much less in the myometrium and the decidua. The lowest enzyme activity was found in the umbilical cord, and no metabolism could be demonstrated in amniotic fluid or in umbilical venous blood. The significance of these findings is discussed.     

Rupture of the pregnant uterus: a review.

This paper reviews the literature since 1967 on rupture of the pregnant uterus and presents findings from a series of 47 uterine ruptures (35 of which were complete) managed by the authors. Uterine rupture accounts for 5% of maternal mortality in the US and there is some evidence that its incidence is increasing. The incidence of uterine rupture is 1:1000-1:1500 deliveries in the US but far lower if only cases of spontaneous rupture of the intact uterus are included. In the author's series, spontaneous ruptures accounted for about 25% of the total and only 17% of these occurred before the onset of labor. A uterine scar, particularly one from a previous cesarean section, is the most common predisposing factor. Age and parity are alos related to the incidence of uterine rupture in most series. Ruptures occuring during labor generally involve the lower segment whereas those prior to labor are usually corporal. Symptoms are estremely variable, ranging from none to complete collapse. The amount of intraperitoneal spill, degree of fetal and placental extrusion, condition of the patient, and degree of retraction of the uterine musculature and important factors in symptamatology. The classical clinical picture includes abdominal pain and tenderness, cessation of labor, shock, and vaginal bleeding. Immediate surgical intervention, with institution of appropriate supportive measures to combat shock and hemorrhage, is the cornerstone of treatment of uterine rupture. The choice of surgical procedure depends on the type, extent, and location of the rupture as well as the patient's condition and desire to preserve her childbearing capacity. Hysterectomy is the procedure of choice in cases of spontaneous or traumatic rupture with no uterine scar. It is doubtful that the incidence of spontaneous rupture of the unscarred uterus can be reduced until more is known about its etiology. Traumatic and spontaneous ruptures are most dangerous, with maternal mortality rates of 20% and 8%, respectively. Knowledge of uterine rupture would be significantly enhanced by a collaborative type study collecting data from several institutions over a given time period.     

Torsion of the pregnant uterus]

Torsion of a 6-month gravid uterus in a secundigravida, showing the clinical shape of an acute abdomen and shock, is described. The uterus was twisted 180 degrees from left to right, with a retroplacental haematoma and dead foetus. The symptoms occurred while the patient was sleeping. Sectio caesarea was performed and no other pathologic changes were found in the uterus, ovaries, or minor pelvis.