Posterior Hysterotomy in a Full-Term Gravid Uterine Torsion: Clinical and Educational Insights from a Rare Obstetric Emergency

Background: Uterine torsion during pregnancy is an extremely rare obstetric condition defined as rotation of the uterus of more than 45° around its longitudinal axis. Severe torsion may lead to maternal and fetal morbidity due to distortion of pelvic anatomy and compromise of uterine blood flow. Because of its rarity and nonspecific presentation, uterine torsion is often diagnosed intraoperatively during caesarean section. From an educational perspective, such cases highlight the importance of surgical vigilance and adaptability in obstetric training. Case Presentation: We report the case of a 33-year-old gravida 3 para 2 woman at 38+3 weeks of gestation who underwent an elective caesarean section. Intraoperatively, the uterus appeared slightly rotated and was repositioned to the midline. Due to altered anatomical landmarks, an incision was inadvertently made on the posterior uterine wall. After delivery of a healthy male neonate weighing 2.6 kg using vacuum assistance, the uterus was exteriorized and found to have undergone torsion exceeding 180°. The uterus was detorsed and the posterior uterine incision was repaired in three layers using Vicryl sutures. The patient had an uneventful postoperative recovery. Conclusion: This case highlights the diagnostic challenges associated with uterine torsion and emphasizes the need for awareness of this rare condition during obstetric surgical training. Incorporating such case-based learning into obstetric education can enhance surgical preparedness and improve maternal and fetal outcomes.