A Twist in the diagnosis… and uterus! A case report of third trimester uterine torsion

We report the case of a 26-year-old lady gravida 5, with a previous Caesarean section who presented with 2 episodes of convulsions, shock and evidence of intrauterine foetal death. She was known to have epilepsy since childhood. Anticipating a scar dehiscence or rupture uterus she was posted for emergency laparotomy under spinal anaesthesia. Intra-operatively, 180o uterine torsion was evident. The uterus was untwisted and a lower segment caesarean section was performed to deliver the dead foetus. As the uterus remained flabby and did not retracted after correction of torsion, subtotal hysterectomy was done. She recovered well after surgery. The present case highlights uterine torsions, a rare but potentially dangerous and unexpected obstetric complication and reiterates the need for a timely intervention for better maternal and foetal outcome.