Uterine torsion in pregnancy: a case report and systematic review

INTRODUCTION: Uterine torsion in pregnancy is a rare condition but is associated with significant negative outcomes to the pregnant women and their babies. This study is to systematically review the literatures and analyse the clinical presentations, management and complications of uterine torsion in pregnancy.

MATERIALS AND METHODS: We searched across multiple databases (PubMed, Google Scholar, ScienceDirect, Academia.edu, ResearchGate and Semantic Scholar) and suitable articles from 1993 to 2022 were systematically chosen according to PRISMA guideline. The analysis was performed on the maternal characteristics, signs and symptoms of the uterine torsion, management, complications and outcomes of both the mothers and infants. All case reports or case series reporting uterine torsion in pregnancy from English language journals were included without restriction on the geographical origin.

RESULTS: A total of 149 cases from 146 publications and one from our centre were included for analysis. Most of the cases were seen in the third trimester and presented with acute abdominal symptoms and signs. It presented a challenge in diagnosis and had a myriad of complications to the mothers and infants. The maternal mortality is 2.0% while the perinatal mortality stands at 38.2%.

CONCLUSION: Uterine torsion in pregnancy is a rarely encountered but serious condition with no specific precipitating factor or diagnostic criteria. It can occur at any gestation, has a wide range of non-specific clinical presentations, and carries a significant risk to the mother and child.