Uterine torsion during cesarean section coinciding with HELLP syndrome

Czech version

Authors: Monika Skuhrovcová ; Miroslava Sládková; Stanislav Martan
Authors‘ workplace: Gynekologicko-porodnické oddělení, Nemocnice Nymburk s. r. o.
Published in: Ceska Gynekol 2025; 90(1): 48-51
Category: Case Report
doi: https://doi.org/10.48095/cccg202548

Overview

Uterine torsion belongs to one of the most dangerous labor complications also because of its rarity. As it is not common for an obstetrician to come across this state, it is usually not at the very top of the differential diagnostics list when solving acute child delivery complications. However, it is serious enough to pose a lethal threat to both mother and child. In this case, the term gravidity was ended by acute cesarean section because of HELLP syndrome. During the operation, as well as after a complicated delivery and hysterotomy suture uterine torsion of 120 degrees to the right, the patient was diagnosed with detorsion. The rest of the operation was done according to normal standards. Thanks to this very prompt procedure, the aftermath of the described state meant little to no harm to the mother and her child. This case study should highlight the importance of including uterine torsion into differential diagnostics of acute abdominal pain and vomiting to prevent fatal labor complications for the mother and her child.

Keywords:

HELLP syndrome – cesarean section – uterine torsion

Sources

1. Darido J, Grevoul Fesquet J, Diari J et al. Hemorrhagic shock due to irreducible uterine torsion in a third trimester twin pregnancy: a case report. Clin J Obstet Gynecol 2020; 3: 085–089. doi: 10.29328/journal.cjog. 1001055.

2. Guie P, Adjobi R, N’guessan E et al. Uterine torsion with maternal death: our experience and literature review. Clin Exp Obstet Gynecol 2005; 32 (4): 245–246.

3. Thubert T, Abdul Razak R, Villefranque V et al. Uterine torsion in twin pregnancy. J Gynecol Obstet Biol Reprod 2011; 40 (4): 371–374. doi: 10.1016/j.jgyn.2010.12.005.

4. Liang R, Gandhi J, Rahmani B et al. Uterine torsion: a review with critical considerations for the obstetrician and gynecologist. Transl Res Anat 2020; 21. doi: 10.1016/j.tria.2020. 100084.

5. Cook KE, Jenkins SM. Pathologic uterine torsion associated with placental abruption, maternal shock and intrauterine fetal demise. Am J Obstet Gynecol 2005; 192 (6): 2082–2083. doi: 10.1016/j.ajog.2004.09.003.

6. Carbonne B, Cabrol D, Viltart JP et al. Torison de lęuterus gravide. J Gynecol Obstet Biol Reprod 1994; 23 (6): 717–718.

7. Veselská A, Havelka P. Torze dělohy u dvojčetného těhotenství. Ceska Gynekol 2023; 88 (2): 96–99. doi: 10.48095/cccg202396.

8. Namkung J, Park JH, Byun JH et al. Elevated aspartate aminotransferase and alanine aminotransferase in the torsion of ovarian mature cystic teratoma: normalised after operation for torsion. J Obstet Gynaecol 2021; 41 (4): 612–615. doi: 10.1080/01443615.2020.1787966.

9. Rood K, Markham KB. Torsion of a term gravid uterus: a possible cause of intrauterine growth restriction and abnormal umbilical artery Doppler findings. J Ultrasound Med 2014; 33 (10): 1873–1875. doi: 10.7863/ultra.33.10. 1873.

10. Nicholson WK, Coulson CC, McCoy MC et al. Pelvic magnetic resonance imaging in the evaluation of uterine torsion. Obstet Gynecol 995; 85 (5 Pt 2): 888–890. doi: 10.1016/0029-7844 (94) 00283-j.

ORCID autorky

M. Skuhrovcová 0009-0004-1912-860X

Doručeno/Submitted: 16. 9. 2024

Přijato/Accepted: 10. 10. 2024

MUDr. Monika Skuhrovcová

Gynekologicko-porodnické oddělení

Nemocnice Nymburk s. r. o.

Boleslavská třída 425/9

288 02 Nymburk

monikaskuhrovcova@gmail.com