Torsion of the gravid uterus is a rare condition. It can result in fetal and/or maternal deaths.


Definition: rotation around the longitudinal axis of the uterus > 45 degrees


The rotation is usually dextrorotary (Guie et al).


Clinical symptoms in the mother may include:

(1) abdominal pain

(2) vaginal bleeding

(3) hypotension

(4) nausea and vomiting

(5) decreased fetal movements

Sometimes the mother is asymptomatic.


Some cases may be related to a uterine lesion such as a leimomyoma or uterine malformation.


Changes seen on ultrasound:

(1) shift of placental implantation site (if there is a previous exam)

(2) ovarian blood vessesl passing in front of the lower uterine segment


Sometimes the diagnosis is completely unexpected and at cesarean section the obstetrician encounters an unexpected anatomy.


Goals after diagnosis include:

(1) saving the fetus if possible

(2) saving the uterus (preventing ischemic necrosis)

(3) preventing recurrence


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