Uterine torsion with fetal death in the third trimester: Case report

Uterine torsion is a rare obstetric complication that can easily lead to fetal death. The sudden onset and atypical clinical presentation make diagnosis very difficult.

We reported a case of uterine torsion in the third trimester of pregnancy, which was mainly characterized by severe abdominal pain and shock.

The diagnosis of this case was confirmed through surgery. Neither preoperative ultrasound nor computed tomography could provide a definite diagnosis.

Anti-shock therapy and emergency cesarean section were promptly initiated. The uterus was repositioned to its normal anatomical position, followed by the delivery of a deceased baby via a standard cesarean section. Additionally, bilateral round ligament of the uterus was surgically shortened.

The abdominal pain and shock of the patient were completely relieved postoperatively, and she was discharged 4 days later. Uterus morphology and position recovered well on the 14th and 42nd day after surgery.

The rarity of uterine torsion during pregnancy and the limited clinical experience in its management underscore the clinical significance of documenting each case for improved understanding and evidence-based practice. Uterine torsion must be included in the differential diagnosis when acute abdominal pain and hemodynamic instability occur during pregnancy, particularly in cases where conventional etiologies (e.g., uterine rupture, placental abruption) fail to account for the clinical presentation. Presumptive diagnoses of uterine torsion necessitate expeditious surgical exploration, as time-critical intervention is paramount to mitigate catastrophic maternal-fetal complications including hemorrhagic shock and irreversible ischemic injuries.