What is torsion of the uterus and what causes it?
For torsion to be regarded as physiological, it has to be mild. When it is severe - which is rare - it becomes pathological and that is a serious condition which may require an emergency operation.
Mild rotation of the uterus is in fact quite common, probably occurring in the majority of pregnancies. Because a pregnant uterus is much bigger on the upper part (fundus), it is not unusual for it to rotate on its axis, usually towards the right.
When the rotation (or torsion) goes beyond a certain degree, which happens from time to time, it may be perceived as discomfort or pain. This usually occurs late in the pregnancy, normally well beyond the halfway mark. It could possibly occur earlier, in the presence of predisposing factors such as fibroids or uterine abnormalities.
Mild torsion does not require any specific measures.
What causes severe torsion of the uterus?
We have discussed mild torsion of the uterus as a ‘physiological’ cause of pain and said this is not uncommon. Fortunately, severe torsion is extremely rare. The causes are not always immediately apparent but the presence of benign tumours, such as fibroids or large ovarian cysts, are predisposing factors.
Torsion is usually quite difficult to diagnose before operating and exposing the uterus.
Even though it is usually quite painful, it does not always affect the well-being of the fetus and can be managed conservatively, as long as painkillers are effective. Remember, this is a rare condition, and rare things happen rarely.
Pathological pain in pregnancy
So what are the pathological causes of pain in pregnancy?
Pathological pain is caused by a disease, as opposed to physiological pain, which is caused by the changes to the body brought about by pregnancy. There are several potential causes and no list can by any means be exhaustive. Here we can try to highlight the more common ones.
The pregnancy-specific causes of pain include:
Severe torsion of the uterus
Preterm labour as a cause of pain?
Yes. Preterm labour is one of the most common causes of pain in pregnancy. Contractions of the uterus are painful at whatever stage of the pregnancy they occur. Labour can only be known as such after 24 weeks of gestation (20 weeks in the United States). If contractions occur before this stage of pregnancy and if the mother goes on to lose the baby, this is a miscarriage. The process of miscarriage is also painful but the degree of pain, as with labour, is widely variable.
What is placental abruption?
The placenta - or afterbirth, as it is commonly known could detach prematurely in the course of a pregnancy. This is a serious condition which could lead to the loss of the baby. It is usually painful but again, the degree of pain varies between individuals and depends on the extent of the abruption. It is normally, but not necessarily, accompanied by vaginal bleeding. This is discussed further in Chapter 19, "Bleeding in pregnancy"