TITLE:
A Case of Uterine Rupture with Hemorrhage Caused by Torsion of a Pedunculated Uterine Fibroid in Late Pregnancy, with a Review of the Literature
AUTHORS:
Huanqin Zhang, Weihua Yang, Jingjie Ma, Huifen Gao, Xiaoju Liang
KEYWORDS:
Uterus, Leiomyoma, Pedicle Torsion, Uterine Rupture, Late-Stage Pregnancy
JOURNAL NAME:
Journal of Biosciences and Medicines,
Vol.13 No.11,
October
30,
2025
ABSTRACT: Uterine rupture and hemorrhage resulting from torsion of a pedunculated uterine fibroid represent a rare clinical condition occurring during pregnancy. Due to the lack of specificity and the diversity of clinical manifestations, clinical diagnosis is challenging and may only be confirmed during emergency surgery. It is recognized as one of the severe acute abdominal emergencies in obstetric practice. In this case report, the patient was diagnosed with a subserosal uterine fibroid prior to pregnancy, which exhibited significant enlargement following conception. In the late stage of pregnancy, she was admitted due to premature rupture of membranes, with no signs of acute abdomen. After complete cervical dilation, due to failure of fetal head descent, a cesarean section was performed. Intraoperatively, the uterine fibroid was found to have undergone a 720˚ torsion; as a result of the traction from fibroid torsion, partial rupture of the uterine myometrium occurred, with a rupture measuring approximately 3 cm × 1 cm and active bleeding observed. The fibroid was completely excised, and the wound was sutured and hemostasis achieved, with a favorable prognosis. This case highlights that for pregnant patients with subserosal uterine fibroids, there is an increased risk of pedunculated fibroid torsion, particularly after labor onset, when the degree of torsion more readily increases; traction between the pedicle and uterine myometrium can result in uterine rupture. Therefore, if obstetric indications arise during the trial of labor, or if the patient experiences significant abdominal pain, dynamic ultrasound monitoring during labor may be necessary to assess for conditions such as intra-abdominal bleeding. In such cases, transitioning to a cesarean section should be considered to avoid adverse pregnancy outcomes. This article reviews relevant domestic and international literature to summarize the clinical characteristics of this condition, thereby enhancing clinical recognition.