The Diagnosis of a Twist: A Rare Obstetric Finding

Uterine torsion is a rare obstetric complication defined as a rotation of the uterus of more than 45 degrees on its longitudinal axis. It often presents with nonspecific symptoms and is usually diagnosed intraoperatively, most commonly during Caesarean section. While dextrorotation is more frequently observed, levorotation is less common. Predisposing factors include uterine anomalies, fibroids, malpresentation, and pelvic adhesions, although in some cases, no underlying cause is identified. Early recognition and appropriate surgical management are key to ensuring favourable maternal and fetal outcomes.

A 33-year-old woman, G2P0+1, at 39 weeks’ gestation, presented with significant bilateral lower limb oedema. Pre-eclampsia screening was initiated, and in view of term pregnancy with evolving biochemical changes indicative of mild pre-eclampsia, the decision was made to induce labour. During the course of labour, suspicious cardiotocographic (CTG) features suggestive of fetal hypoxia prompted an emergency Caesarean section. Intraoperatively, a levorotation of the gravid uterus was identified, and delivery was performed via a posterior uterine incision. Both mother and neonate recovered well and were discharged without complications.

Uterine torsion is a rare but important differential to consider during unexplained labour progress and obstetrician may deal with intraoperative challenges. This case highlights the need for heightened clinical awareness, especially in the presence of atypical labour progression or suspicious CTG findings. Prompt recognition and appropriate surgical intervention, including the option of posterior uterine incision, can ensure safe outcomes for both mother and baby. Increased reporting and awareness of such rare cases may contribute to better diagnosis and management in future obstetric practice.