Uterine torsion caused by a giant uterine fibroid in late pregnancy: a case report and literature review

Uterine torsion during pregnancy is a relatively rare obstetric emergency that can occur in all stages of pregnancy. Among all kinds of acute abdomen during pregnancy, uterine torsion during pregnancy is a special type that is rare and poses a significant threat to the safety of mothers and infants. Failure to recognize clinical signs promptly and the absence of established diagnostic and treatment protocols represent persistent difficulties in managing obstetric emergencies.

This study presents a case of uterine torsion caused by a giant uterine leiomyoma during the third trimester of pregnancy, in which the fetus was presented in the transverse position. Intraoperative examination revealed that the uterus had undergone a clockwise rotation of > 90°. Manual detorsion was initially attempted; however, owing to the obvious space-occupying effect of fibroids, restricted operative space, and markedly increased myometrial tone, multiple reductions were unsuccessful. The uterus was then rotated to the right about 45°, and an incision was created in the lower uterine segment on the posterior wall. A viable neonate was delivered in the cephalic presentation. The newborn achieved an Apgar score of 10 at both 1 and 5 min post‑delivery. Postoperatively, the patient made an uneventful recovery and was discharged according to the planned schedule.

Uterine torsion is a rare yet life-threatening obstetric emergency, characterized by a lack of specific clinical manifestations. The present case underscores the importance of early recognition, particularly in patients presenting with large fibroids and an abnormal fetal lie. Meticulous intraoperative decision-making is essential to optimize maternal and neonatal outcomes. When manual or surgical reduction proves unfeasible intraoperatively, a posterior cesarean delivery or other tailored surgical strategies may be employed to safeguard maternal and fetal well‑being and thereby enhance pregnancy prognosis.