Uterine torsion in pregnancy: a rare but life-threatening condition

Uterine torsion is defined as the torsion of the organ on the longitudinal axis of more than 45 degrees and it can occur both in pregnancy at any gestational age and in non-pregnant women. Risk factors for uterine torsion reported in the literature are non specific and quite common among pregnant women. The maternal mortality is 9% and the foetal mortality is around 12%. The main differential diagnosis is placental abruption, which can happen simultaneously with uterine torsion. Diagnosis is clinical or intra-operative; ultrasounds can suggest torsion if there are changes in the described position of the placenta or the myomas. Computed tomography scan (CT) or Magnetic resonance imaging (MRI) can be helpful if they do not delay surgery. During a caesarean section (c/s), it is important to recognize the anatomical landmarks before the uterine incision. Ideally, derotation of the uterus should be done before delivery of the baby to avoid posterior wall incision, but incision on posterior wall is feasible if needed or the torsion is not recognised. Plication of the round ligament has been suggested to avoid recurrence. Here we describe a case of suspicion of scar dehiscence that revealed to be a complete uterine torsion at the moment of the c/s in a 32-year-old 3 gravida 2 para woman admitted at 38 weeks of pregnancy for uterine contractions and caesarean's scar pain. She had a history of two previous c/s, one of which corporeal. Uterotomy was made on the posterior uterine wall because the torsion was diagnosed after the birth. Outcome was uneventful for both mother and baby. For this patient, we could not find any risk factors, except the two uterine scars, one of which was corporeal.