Guié P, Adjobi R, N'guessan E, Anongba S, Kouakou F, Boua N, Dia J, Kouyaté S, Tegnan J A, Djanhan L, Bohoussou E, Yao I
Department of Gynaecology and Obstetrics, CHU Treichville, Abidjan, Ivory Coast.
Clin Exp Obstet Gynecol. 2005;32(4):245-6.
Torsion of the gravid uterus around its cervical junction is a rare event especially in humans. In 1992, a literature review by Jensen, mentioned by Carbonne, showed 212 cases with different etiologies. Uterine torsion is more frequently dextrorotatory (2/3 of cases). The diagnosis is difficult and generally done during cesarean section because it is frequently not symptomatic. Uterine torsion signs, when present, are not specifics. Pain, nausea and vomiting may present without any sign of shock, as in our patient. Sometimes ultrasonography can lead to a correct diagnosis, showing a modification of the placenta site during pregnancy, or an abnormal positioning of the ovarian vessels which pass in front of the lower uterine segment. Some authors report cardiotocographic abnormalities probably due to the reduction of blood flow caused by the torsion. Quickness of surgical treatment is fundamental for the reduction of fetal mortality which is very frequent in a large number of cases, while maternal mortality is not so frequent but possible. A diligent anamnesis and ultrasonographic examination are surely useful to single out the rare cases of uterine torsion in pregnancy.
妊娠子宫围绕宫颈连接处发生扭转是一种罕见情况，在人类中尤为如此。1992年，卡尔博内提到的詹森的一篇文献综述显示了212例病因各异的病例。子宫扭转多为右旋（占病例的2/3）。诊断困难，通常在剖宫产时才能做出，因为它常常没有症状。子宫扭转的体征若存在，也不具有特异性。疼痛、恶心和呕吐可能出现，但没有任何休克迹象，就像我们的患者那样。有时超声检查可得出正确诊断，显示孕期胎盘位置改变，或穿过子宫下段前方的卵巢血管位置异常。一些作者报告说，可能由于扭转导致血流减少，从而出现胎心监护异常。快速进行手术治疗对于降低胎儿死亡率至关重要，在大量病例中胎儿死亡率非常高，而产妇死亡率虽不常见但也有可能发生。详细的病史询问和超声检查肯定有助于识别妊娠期间罕见的子宫扭转病例。
