Extreme Torsion of a Full Term Scarred Gravid Uterus in a Morbidly Obese Patient with Breech Presentation and Pregnancy Induced Hypertension- Case report

Extreme Torsion of a Full Term Scarred Gravid Uterus in a Morbidly Obese Patient with Breech Presentation and Pregnancy Induced Hypertension

Abstract

Torsion of the uterus is a condition in which it rotates on its own axis by more than 45 degrees and rarely up to 180 degrees. We are presenting a case of torsion of a full term gravid uterus in a morbidly obese patient with breech presentation and pregnancy induced hypertension (PIH) with history of cesarean section. The exact anatomy could not be identified including the position of bladder due to morbid obesity in the patient and over distension of uterus. The incision was made on relatively thinner segment taking into consideration the surrounding vital areas and then carefully extending it to an adequate level was the only way to deliver the fetus as well as placenta and membranes. Dextro-rotation of the uterus in the pregnancy is a rule. When this becomes extreme it can be dangerous for the fetus as well as the mother. Delineating the vascular supply in the patients with above condition which predisposes to the torsion may help us to suspect torsion pre-operatively.