Torsion of a gravid uterus associated with maternal trauma. A case report.

BACKGROUND

Torsion of the gravid human uterus is rarely encountered. Reported cases include uterine leiomyomata, ovarian tumors, uterine anomalies and fetal malpresentation as contributing factors. No case has been reported before in association with maternal trauma.

CASE: A 20-year-old woman, gravida 2, para 1, presented to the emergency room at 38 1/7 weeks' gestation after being involved in an automobile collision. Two hours after admission, she experienced a severe, prolonged fetal heart rate deceleration, which was unresponsive to conservative measures. An emergency cesarean section was performed. Following delivery of the fetus, it was noted that the uterus had levorotated 180 degrees, and posterior hysterotomy was performed. Placental inspection disclosed a 30% abruption. The mother recovered uneventfully, but the infant suffered acute and long-term morbidity.

CONCLUSION

Uterine torsion should be considered in cases of blunt abdominal trauma to the gravid uterus.