Complete axial torsion of the gravid uterus by 180 degrees

Minimal rotation of the gravid uterus, till 45 degrees, is a normal finding in the third trimester of pregnancy. However, a pathologic rotation of the uterus beyond 45 degrees-torsion of the entire uterus-is rarely seen in obstetrical practice. We present a case of uterine torsion in pregnancy diagnosed at caesarean section. A 25-years-old primigravida was admitted with pain abdomen and tenderness over the lower abdomen. She underwent emergency LSCS (lower segment caesarean section) for foetal bradycardia. Intra-operatively, the uterus was rotated 180 degrees right to left. There was an urgency to deliver the foetus due to bradycardia and hence, an incision on the posterior wall of the uterus was made as there was no time to delineate the anatomy. Torsion was corrected and the uterus was sutured. Prompt recognition and management of this condition is necessary for better maternal and foetal outcome. Uterine torsion is an infrequently reported and potentially dangerous complication of pregnancy that occurs mainly in the third trimester with adverse maternal and neonatal consequences