A RARE CAUSE OF ACUTE OBSTETRIC EMERGENCY

Torsion uterus is one of the cause of acute obstetric emergency. Torsion uterus is defined as rotation of 45 degree around the long axis of uterus at the level of junction between cervix and corpus.It is very uncommon, but a life threatening condition. The uterus may rotate from 60 -720 degree , but usually rotates to 180 degree. Its rare in human beings. In two third of patients it is dextrorotated.Jensen analysed the reports from 1966-2006, and he found only 212 cases in literature.It is associated with increased perinatal and maternal mortality. And the mortality depends on the gestational age and degree of rotation.35 year old G4P1L1A2 admitted with the complaints of abdominal pain and not able to perceive fetal movements since evening .On examination the patients vitals were stable and had over distended uterus , and the uterus was neither acting nor tense,tender.And fetal heart sounds could not be localized.She was not in labour Seven hours after admission , the patient became pale,dyspnoeic with feeble pulse and hypotension.Abdominal distention made out and uterine contour lost.And the patient was not in labour.Bed side Ultrasonogram showed minimal free fluid abdomen and uterine contour not made out.On paracentesis blood stained fluid drawn and with suspicion of rupture uterus abruption patient was taken up for emergency laparatomy after resuscitation. Intra operatively the uterus appeared haemorrhagic, edematous with distorted pelvic anatomyIncision made on the uterusRetro placental clot of about 750 gms removedUterus found to be dextro rotated to 180 degreeIncision made during surgery found to be in the posterior aspect of uterus after derotationUterus was flabby and not responded to oxytocicsProceeded with hysterectomy for atonic PPHPost operative period was uneventful.