A Case of Torsion of Gravid Uterus Caused by Leiomyoma
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Rotation of the pregnant uterus is common during pregnancy but rarely exceeds 45 degrees and is most often to the right. When the uterus rotates on itself, its blood supply decreases, which is called uterine torsion. Uterine venous obstruction causes increased pressure in placental cotyledons leading to abruption and fetal distress. When it progresses to uterine artery obstruction placental perfusion reduces which can lead to fetal demise. Uterine leiomyoma complicate 1.4% of pregnancies. Myoma complication depends on their location and size. These include red or carneous degeneration presenting with fever and leucocytosis and torsion of subserosal myomas. In this case, one-sided large intramural myoma caused uterus to rotate 180 degrees.

Case Presentation
A 25-years-old primigravida at 38 weeks of gestation reported to our hospital with severe intermittent and colicky abdominal pain of one-day duration. It started acutely but gradually increased in intensity involving all the abdomen. On examination, the patient was hemodynamically stable and afebrile. The uterus was term size and tender on palpation. A large mass of 10 × 10?cms was palpated on its right upper part. On vaginal examination os was 1?cm dilated and 30% effaced. Nonstress test (NST) was reactive on admission. Hemogram was normal and ultrasonography (USG) showed a single live intrauterine fetus with cephalic presentation with an intramural fibroid 10 × 10?cms on the right fundal region. Magnetic resonance imaging (MRI) confirmed the findings but torsion was not suspected since the classical sign on MRI was not seen as the films were not taken at the level of the vagina. Carneous degeneration of the fibroid or abruption placentae was suspected....