Poster Session

P147. Uterine torsion in pregnant uterus: case report

Flavia Marcelle Maia (BR), Maria da Conceicao Simoes (BR), Valeria Nascimento (BR), Yasmim Fittipaldi (BR), Maria Melisande Pires (BR), Edegard Borges (BR), J├ęssica Caroline Santos (BR)

[Maia] Maternidade Municipal Mae Esperanca, [Simoes ] Maternidade Municipal Mae Esperanca, [Nascimento] Maternidade Municipal Mae Esperanca, [Fittipaldi] UNIR, [Pires] Maternidade Regina Pacis, [Borges] UNIR, [Santos] UNIR

Context: Diagnosis of uterine torsion in gravid uterus confused with uterine rupture due to similarities of associated symptoms. Objective: Report a rare case of uterine torsion discovered only during the cesarian indicated due to suspicious of uterine rupture. Methods: Case report. Patient (s): Patient C.F.S, 26-years-old, pregnant 2, gestacional age 39 weeks 6 days, accompanied in low risk prenatal care, was admitted to the Mae Esperanca Municipal Birth Center (Brazil), presenting in an analgesic position, fascies of pain, intense and painful contractions of sudden onset and progressive character. On physical examination, uterine palpation showed a soft and painful uterus on the uterine fundus, showing a sensation of palpable fetal parts in the maternal abdomen. The case progressed rapidly to acute abdomen and hypotension. Intervention (s): Emergency cesarean section was performed due to suspected uterine rupture. In the intraoperative period, uterine integrity was observed, there was no malformation in the uterus, only complete uterine rotation was observed 180 degrees around its own axis, followed by a segmental transverse hysterotomy with withdrawal of active and active NB. Soon after, placental deconditioning, hysterorrhaphy and careful uterine distortion were performed for anatomical position, confirming that the raffia was posteriored and there was no vascular impairment, thus making possible new gestation. Main Outcome Measure (s): None. Result (s): The patient progressed steadily and was discharged 72 hours after the surgical approach. Conclusions: Uterine torsion is a very rare condition, and in the pregnant uterus it is rarer still (about than 0.5%). Torsion of the pregnant uterus is defined as rotation more than 45 degrees around the long axis of the uterus, there are usually correlations with uterine abnormalities, increased uterine volume by pregnancy itself, polyhydramnios, giant fibroids or other pathologies in combination with exacerbated fetal movements. The clinical picture is very nonspecific, and in this case report, it could be easily confused with uterine rupture according to the characterization of the pain and similarity of the presented symptoms. Uterine torsion is an infrequently reported and potentially dangerous complication of pregnancy that occurs mainly in the third trimester with adverse maternal and neonatal consequences.

 

 

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