Unavoidable Posterior Lower Segment Caesarean Incision Due To a 180-Degree Uterine Torsion Resulting From a Huge Anterior Uterine Fibroid: A Case Report

Background: Uterine rotation is a common occurrence in pregnancy. However, when the rotation is more than 45 degrees it is termed torsion. Uterine torsion is rare and can complicate pregnancy especially in association with uterine anatomical pathologies, pelvic masses and abnormalities and fetal anomalies. The presentation and management vary and depend on the cause, degree of torsion and age of the pregnancy. The rarity of this condition makes this case report worthwhile.

Case Report:

We report a case of a 30 year old primigravid woman who booked for antenatal care at 16 weeks gestational age following a 3-year history of primary infertility. The pregnancy was complicated with abdominal pain from red degeneration of uterine fibroids and was managed with pentazocine injection severally in the 2^nd trimester. She presented in labour at 39 weeks but the labour was prolonged for 8 hours, having adequate contractions without any significant improvement in both descent and cervical status. She subsequently had an emergency caesarean delivery through a posterior lower segment incision due to an incidental finding of a 180-degree uterine torsion resulting from huge anterior fibroids; with an outcome of a live female neonate that weighed 3.1kg with good Apgar scores. Two pieces of fibroids were removed from the anterior surface that weighed 1.1kg. The post operative and puerperal periods were uneventful.

Conclusion: Uterine torsion in pregnancy, a rare obstetric occurrence and infrequently reported complication occurs mainly in the third trimester and may complicate labour. In the presence of significant uterine fibroid, a possibility of uterine torsion may be entertained when the progress of labour is considered poor without any obvious mechanical cause. In such cases caesarean delivery with possible posterior uterine incision may be carried out.