Uterine torsion in pregnancy, expect the unexpected: case report

Huda Nabihah Mokhtar, Sumayyah Mohammed Faridz, Rohana Ismail, Nasuha Yaacob, Roziana Ramli


Uterine torsion in pregnancy is a rare condition, but potentially life-threatening. The non-specific clinical features make preoperative diagnosis difficult and most cases are discovered during caesarean deliveries done for other obstetric indications. Authors present 2 cases of uterine torsion with different clinical presentation and outcome. Case 1 was a G3P2 at 36 weeks with twin pregnancy presented in active labour with a prolapsed cord. A 180 degrees uterine torsion was discovered only after delivery of the foetuses, resulting in inadvertent posterior uterine wall incision. Case 2 was a G6P5 at 35 weeks who presented with an acute abdomen and went into shock. At laparotomy, a 360 degrees uterine torsion was discovered complicated with placental abruption, causing a fresh stillborn baby. These cases highlight uterine torsion as a rare but important diagnosis in obstetrics, which could be associated with potentially devastating outcome.



Inadvertent posterior uterine wall incision, Uterine torsion during pregnancy, 180 degrees uterine torsion, 360 degrees uterine torsion

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Jensen JG. Uterine torsion in pregnancy. Acta Obstet Gynaecol Scand. 1992;71:26-5.

Kawakami S, Togashi K, Sagoh T, Kimura I, Noguchi M, Takakura K, et al. Uterine deformity caused by surgery during pregnancy. J Comput Assist Tomogr. 1994;18:272-4.

Omurtag K, Session D, Brahma P, Matlack A, Roberts C. Horizontal uterine torsion in the setting of complete cervical and partial vaginal agenesis: a case report. Fertil Steril. 2009;91:1957.e13-5.

Nesbitt REL, Corner GW. Torsion of the human pregnant uterus. Obstet Gynecol Surv. 1956;11:311-32.

Salani R, Theiler RN, Lindsay M. Uterine torsion and foetal bradycardia associated with external cephalic version. Obstet Gynaecol. 2006;108(3):820-2.

Duplantier N, Begneaud W, Wood R, Dabezies C. Torsion of a gravid uterus associated with maternal trauma: a case report. J Reprod Med Obstet Gynecol. 2002;47(8):683-5.

Achanna S, Monga D, Hassan MS. Case report: torsion of a gravid horn of didelphic uterus. J Obstet Gynaecol Res. 1996;22(2):107-9.

Wilson D, Mahalingham A, Ross S. Third trimester uterine torsion: case report. J Obstet Gynaecol Canada. 2006;28(6):531-5.

Devi YL, Singh KHJ. Uterine torsion in pregnancy. J Obstet Gynaecol India. 1979;29:1260-1.

Guie P, Adjobi R, N'guessan E, Anongba S, Kouakou F, Boua N, et al. Uterine torsion with maternal death: our experience and literature review. Clin Exp Obstet Gynecol. 2005;32:245-6.

Qureshi S, Singh U, Bansal B, Singh N. Torsion of preterm gravid uterus: a case report. Int J Case Reports Images. 2013;4(7):392-5.

Fatih FF, Gowri V, Rao K. Uterine torsion in second trimester of pregnancy followed by a successful term pregnancy. BMJ Case Rep. 2012;2012:1-3.

Siegler SL, Silverstein LM. Torsion of a pregnant uterus with rupture. Am J Obstet Gynecol. 1948;55(6):1053-7.

Bakos O, Axelsson O. Pathologic torsion of the pregnant uterus. Acta Obstet Gynaecol Scand. 1987;66:85-6.

Kremer JAM, van Dongen PWJ. Torsion of the pregnant uterus with a change in placental localization on ultrasound: a case report. Eur J Obstet Gynecol Reprod Biol. 1989;31:273-5.

Nicholson WK, Coulon CC, McCoy MC, Semelka RC. Pelvic magnetic resonance imaging in the evaluation of uterine torsion. Obstet Gynecol. 1995;85:888-90.

Moores KL, Wood MG, Foon RPA. Rare obstetric emergency: acute uterine torsion in a 32-week pregnancy. Case Reports. 2014;2014:2013202974.

Rudloff U, Joels L. Irreducible uterine torsion at caesarean section: How to deliver?. J Obstet Gynaecol. 2003;23:76-7.

Pelosi MA, Pelosi MA. Managing extreme uterine torsion at term. A case report. J Reprod Med. 1998;43(2):153-7.

Mustafa MS, Shakeel F, Sporrong B. Extreme torsion of the pregnant uterus. Aust N Z J Obstet Gynaecol. 1999;39(3):360-3.