Low transverse caesarean section through the posterior uterine wall in a pregnant patient with asymptomatic uterine torsion of 180°: A case report

Abstract

Excessive torsion of a pregnant uterus is a rare and potentially extremely dangerous pathology for both the mother and fetus. The diagnosis is most often made intraoperatively.The main aim was to show that when it is impossible to detort the uterus, a low transverse caesarean section through the posterior uterine wall can be safely performed.We report a case of a 41-year-old multiparous woman at G II P II 39/40 weeks' gestation, who presented to the Gynecology and Obstetrics Department for an elective caesarean section due to a breech presentation of the fetus. During the caesarean section, a uterine torsion of 180° was found. As the uterus could not be detorted to its normal position, a low transverse caesarean section was performed through the posterior uterine wall. At follow-up visits after 8 weeks and 12 months, normal healing of the uterine muscle was confirmed.The treatment of torsion of the pregnant uterus depends on gestational age and symptoms, in particular the presence of significant hemodynamic and ischemic lesions.The procedure of choice in a full-term pregnancy should be an attempt to detort the uterus to its normal position and then perform a cesarean section through the anterior uterine wall. If detorsion of the uterus is not possible, a caesarean section through the posterior uterine wall should be performed. Based on the literature review and the case presented, it appears that this procedure is safe.