Levotorsion of a unicornuate gravid uterus leading to failed
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The present case has been reported in the J Obstet Gynaecol India.

A 21 years old gravida two, para one, living one, was admitted at 24 weeks of gestation with bleeding per vaginum and loss of fetal movements for 2 days. On examination, her pulse was 116 beats/min and blood pressure was 130/80 mmHg, marked pallor present, On abdominal examination, the fundal height was 28 cm, breech presentation with absent fetal heart and mild (2/15///10/) uterine contractions were present. On per speculum examination, no active bleeding was seen. On vaginal examination, the cervix was posterior and internal os was closed.

Her Hb was 5.9 gms%. Total counts were 20.6 × 103 mmHg. Rest all her blood and urine investigations were within normal limits. Ultrasound examination showed a single intrauterine fetus of 24 weeks maturity, absent cardiac activity, placenta posterior grade I, and liquor mildly rose.

On opening the abdomen by a Right paramedian incision, pus was present in pelvic cavity, the uterus was found to be levorotated by 180° in the anticlockwise direction, uterus was bluish grey in color and flabby. The right fallopian tube and round ligament were stretched across the uterus to the left side.

The uterus was delivered outside and corrected back to a normal position. Left corneal structure not seen. There was a rudimentary non-gravid left horn seen to which left round ligament was attached. The loose uterovesical fold of peritoneum was incised and the urinary bladder pushed down by finger dissection. The lower uterine segment was not well formed.

A ‘j’ shaped incision was made on the lower uterine segment and 500 gm female fetus was delivered. The placenta was anterior low lying delivered by control cord traction. 150 gm retro placental clots were removed; The uterus and abdominal wall were sutured in layers. Abdominal drain kept.

Two units PCV, 2 units PC and 4 units of FFP were given intra-operatively. She developed pulmonary oedema intraop, and shifted to mechanical ventilator for 2 h under frusemide cover. The patient recovered well and was discharged on the 13th postoperative day with USG showing bulky uterus with empty cavity and no pelvic collection.

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