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Findings that shed new light on the possible pathogenesis of a disease or an adverse effect
CASE REPORT
Uterine torsion and subsequent rupture in a gravid bicornuate uterus associated with an elevated alpha-fetoprotein
  1. Jennah LaHood1,
  2. Whitney You2
  1. 1Department of Family and Community Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  2. 2Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  1. Correspondence to Dr Jennah LaHood, jelahood{at}gmail.com

Summary

Uterine torsion is a rare obstetric complication with a non-specific presentation. We describe a patient with a bicornuate uterus and a pregnancy complicated by a markedly elevated second-trimester maternal serum alpha-fetoprotein (MSAFP), intermittent pelvic pain and fetal growth restriction. At 24 weeks gestational age, she presented to labour and delivery with an acute abdomen. A subsequent exploratory laparotomy revealed torsion and rupture of her right uterine horn. Uterine torsion can be difficult to diagnose because it is not associated with specific symptoms or characteristic imaging findings. In patients with a bicornuate uterus who present with abdominal pain, an elevated mid-trimester MSAFP may be a harbinger of placental ischaemia as a result of uterine torsion.

  • obstetrics and gynaecology
  • pregnancy

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bcr-2018-224388

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    Footnotes

    • Contributors JL conducted the initial literature review and produced the initial draft of the case report. WY contributed with further literature review, the design of the case report and addition of important intellectual content. They worked together to revise the work. Both authors gave final approval for the published version and agreed to be accountable for all aspects of the work to ensure its accuracy and integrity.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.