Uterine torsion in a full-term pregnancy presenting as prolonged latent phase and fetal intolerance of labor: A case report

BACKGROUND: Uterine torsion is defined as torsion of the uterus around its longitudinal axis exceeding 45 degrees. It is a rare obstetric complication. It is a dangerous complication that can lead to placental abruption and intrauterine fetal death. Although rare, early diagnosis is crucial to expedite intervention and optimize outcomes. While the few cases in the current literature have documented acute presentations of uterine torsion, our case is unique in that it had a slower evolution. CASE: A 38-year-old woman, G2P0, was admitted at 37 weeks 0 days of gestation for induction of labor for gestational diabetes mellitus, pre-eclampsia, and maternal BMI of 60. Due to a prolonged latent phase of labor and fetal intolerance of labor, primary cesarean was recommended. Through a sub-umbilical approach, the uterus was dextro-rotated almost 180 degrees and blanched with engorged uterine vessels. A vertical uterine incision was made, and a asphyxiated female infant was delivered via breech extraction. APGAR scores were 2, 7, and 8. The infant required brief respiratory support following delivery. The postoperative course was uncomplicated, with normal recovery time. CONCLUSION: Uterine torsion poses significant risk to both mother and fetus. The phenomenon is so rare that epidemiological data are difficult to gather. In our case, the presentation was gradual compared with the acute presentations that have been reported, which may mislead clinicians toward more benign diagnoses. Our case report aims to add to the literature on uterine torsion, providing a unique presentation, clinical features, and treatment.