Managing extreme uterine torsion at term. A case report.

BACKGROUND: Extreme uterine torsion at term is a rare obstetric event and raises several critical management considerations.

CASE: At the time of repeat cesarean section at term for fetal malpresentation, 180 degrees torsion of the uterine corpus was diagnosed. At laparotomy, the gravid uterus would not yield to anatomic repositioning, necessitating delivery through a deliberate posterior transverse hysterotomy. No maternal abdominopelvic pathology or fetal abnormalities were demonstrated. Prophylactic bilateral shortening of the round ligaments was performed at delivery to prevent recurrent torsion in the immediate puerperium. The patient recovered uneventfully.

CONCLUSION: Deliberate posterior cesarean hysterotomy is an option for fetal delivery with irreducible torsion, and round ligament plication may prevent recurrent torsion in the immediate puerperium.