Uterine Torsion in Obstetric and Gynecological Contexts

Uterine torsion refers to the rotation of the uterus more than 45 degrees around its longitudinal axis. Although physiological slight rotation can occur in late pregnancy, pathological torsion is rare but potentially life-threatening. It may present in gravid uteri—most commonly in the third trimester—or in non-gravid uteri, often in association with large fibroids or adnexal masses. Predisposing factors include uterine leiomyomata, congenital uterine anomalies, prior surgery and connective tissue disorders. Clinical features are nonspecific: acute abdominal pain, nausea, vomiting, hypertonic uterus or signs suggestive of placental abruption. Foetal distress, intrauterine growth restriction and perinatal death are serious obstetric sequelae, while ischaemic necrosis may necessitate hysterectomy in gynaecological cases. Preoperative diagnosis is challenging; advances in ultrasonography, Doppler flow studies and cross-sectional imaging have improved recognition. Management encompasses prompt surgical exploration, detorsion and assessment of uterine viability, followed by repair or resection as indicated. Global reporting remains fragmented, yet a growing body of case literature underscores the need for heightened clinical suspicion, multidisciplinary planning and tailored operative strategies to optimise maternal and foetal outcomes.

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Uterine Torsion in Obstetric and Gynecological Contexts publication trend

The graph below shows the total number of articles in uterine torsion in obstetric and gynecological contexts across all publications each year (not limited to Nature Index journals).

Technical terms

Uterine torsion: Pathological rotation of the uterus around its longitudinal axis exceeding 45°, leading to vascular compromise.

Placental abruption: Premature separation of a normally implanted placenta, resulting in maternal bleeding and foetal distress.

Leiomyoma: Benign smooth-muscle tumour of the uterus (fibroid), which can serve as a fulcrum for torsion.

Uterine atony: Failure of the uterus to contract effectively after delivery, risking haemorrhage.

Bilateral salpingo-oophorectomy: Surgical removal of both fallopian tubes and ovaries, often performed when uterine viability is compromised.

References

1. Uterine torsion complicated by severe placental abruption in the second trimester: a case report and literature review. BMC Pregnancy and Childbirth (2023).
2. Uterine torsion in twin pregnancy with complete bicorporeal uterus, double cervix, longitudinal non-obstructing vaginal septum - a case report. Frontiers in Surgery (2023).
3. Non-gravid uterine torsion associated with small bowel obstruction. Journal of Surgical Case Reports (2024).