A RARE CAUSE OF ACUTE OBSTETRIC EMERGENCY

Abstract

Abstract :
Torsion uterus is one of the cause of
acute obstetric emergency. Torsion
uterus is defined as rotation of 45 degree
around the long axis of uterus at the level
of junction between cervix and corpus.It
is very uncommon, but a life threatening
condition. The uterus may rotate from 60
-720 degree , but usually rotates to 180
degree. Its rare in human beings. In two
third of patients it is dextrorotated.Jensen
analysed the reports from 1966-2006,
and he found only 212 cases in literature.
It is associated with increased perinatal
and maternal mortality. And the
mortality depends on the gestational age
and degree of rotation.35 year old
G4P1L1A2 admitted with the complaints
of abdominal pain and not able to perceive
fetal movements since evening .On
examination the patients vitals were stable
and had over distended uterus , and
the uterus was neither acting nor
tense,tender.And fetal heart sounds
could not be localized.She was not in labour
Seven hours after admission , the patient
became pale,dyspnoeic with feeble pulse
and hypotension.Abdominal distention
made out and uterine contour lost.And the
patient was not in labour.Bed side Ultrasonogram
showed minimal free fluid abdomen
and uterine contour not made out.On
paracentesis blood stained fluid drawn and
with suspicion of rupture uterus abruption
patient was taken up for emergency laparatomy
after resuscitation. Intra operatively
the uterus appeared haemorrhagic, edematous
with distorted pelvic anatomyIncision
made on the uterusRetro placental
clot of about 750 gms removedUterus
found to be dextro rotated to 180 degreeIncision
made during surgery found to be in
the posterior aspect of uterus after derotationUterus
was flabby and not responded
to oxytocicsProceeded with hysterectomy
for atonic PPHPost operative period was
uneventful.