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 5min 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.

Uterine torsion is an extremely rare obstetric emergency with potentially severe maternal and fetal outcomes. We describe the case of a 36‐year‐old multiparous woman who arrived with sudden, severe abdominal pain and hemodynamic instability. Ultrasound confirmed intrauterine fetal demise (IUFD). Emergency laparotomy revealed an extreme uterine torsion exceeding 360°, along with complete placental abruption and a Couvelaire uterus. Stepwise detorsion was necessary to restore proper uterine anatomy. After partial detorsion and identification of both adnexa, an anterior upper vertical uterine incision was made to enable delivery of the fetus and placenta. Hemorrhage was managed using uterotonics, tranexamic acid, fibrinogen concentrate, and temporary intrauterine tamponade. Despite the high bleeding risk, uterine preservation was successfully achieved. The patient recovered well postoperatively without significant complications. This case adds to the limited literature on severe uterine torsion and highlights the diagnostic and surgical challenges involved in high‐degree torsion complicated by placental abruption and Couvelaire uterus. It emphasizes the importance of anatomy‐guided intraoperative decision‐making and early, structured hemorrhage control. However, no definitive conclusions about the best surgical approach can be drawn from a single case.

Spontaneous Uterine Torsion and Detorsion in a Patient with Massive Uterine Leiomyomas.

Compared to domestic ruminants, dystocia is uncommon in alpacas. Uterine torsion is the most frequent obstetrical emergency and also a leading concern in late pregnancy. North American studies report favorable outcomes for dams and guarded outcomes for crias; comparable data for European populations are lacking. This study thus evaluated causes and outcomes of late-pregnant and obstetrical cases at a veterinary teaching hospital. A retrospective cohort study included all alpacas presented between January 2009 and August 2025. Cases of antepartal uterine torsions and manual and surgical obstetrical interventions were identified and retrospectively analyzed. Thirty-five alpacas were included. Two cases involved antepartal uterine torsions, while 33 were obstetrical in nature. Gestation length ranged from 332 to 374 days. Dystocia (n=4) or antepartal torsion (n=2) were corrected manually in 6 cases, while 29 underwent cesarean (c-) section. Thirty-two dams (91.4%) were discharged after a mean hospitalization of 3.7 days; 24 of the 30 long-term survivors (80%) recovered without complications. Uterine torsion was the main problem (12/35, 34.3%), followed by fetal maldisposition (8/35, 22.9%) and insufficient cervical dilation (6/35, 17.1%). Counterclockwise torsions were diagnosed in 6 cases and clockwise torsions in 5, while the direction was unrecorded in one. Retained placenta was frequent but rarely clinically relevant. Wound healing after c-section was excellent, with only one dehiscence 10 days postoperatively. Thirteen crias (37.1%) were stillborn. Of 22 live-born fetuses, 5 (22.7%) died or were euthanized. Ten of the 25 surgical cases (40%) were re-mated, with 8 conceiving successfully (80%). Uterine torsion is common, and determining the direction is essential before correction. Manual resolution of fetal maldisposition is often difficult due to the long neck and limbs and vulnerability of the genital tract. To maximize dam and cria survival, c-section should be performed in a timely manner if manual correction fails. The left flank approach under local anesthesia is practical in the field and provides good maternal survival and postoperative fertility.

Asymptomatic uterine torsion at term due to multiple uterine fibroids with incidental posterior wall delivery and cesarean myomectomy: Case report.

A pregnant woman at 32 weeks' pregnancy presented to the Emergency Department with cardiopulmonary arrest requiring active cardiopulmonary resuscitation and perimortem caesarean section. Operative findings revealed a fresh stillborn foetus and a completely detached placenta with 4 L of retroplacental blood and blood clots, suggesting a severe case of placental abruption. An inadvertent posterior uterine wall incision was detected upon uterine closure. A formal exploratory laparotomy was performed after the patient was well-stabilised following the return of spontaneous circulation. The inadvertent posterior uterine wall incision indicated a 135° uterine torsion. The mother survived but suffered severe brain injury.

Ultrasonography has emerged as a transformative tool in buffalo reproduction, offering non-invasive, real-time insights into the anatomical and physiological aspects of the reproductive tract. In addition to its routine application for preg nancy diagnosis, ultrasonography is crucial for monitoring fetal development, diagnosing fetal anomalies, and identify ing conceptus loss. This helps in timely interventions by diagnosing non-pregnant animals or those having pregnancy issues, which can significantly improve reproductive outcomes. The ability of ultrasonography to enhance our under standing of follicular dynamics in buffaloes has significantly improved fertility management practices. By closely moni toring follicle development and ovulation timing, veterinary professionals can optimize breeding schedules and improve the success rates of artificial insemination. The combination of high-resolution B-mode imaging and Doppler modal ities aids in predicting fertility outcomes in various obstetrical conditions such as uterine torsion. Clinicians can make informed decisions regarding treatment options and prognosis by assessing blood flow to the reproductive organs and evaluating the uterine health. This review emphasises the routine application of ultrasonography for pregnancy diagnosis and the identification of reproductive disorders, while also exploring its advanced use in obstetrics, assisted reproductive technology, and male reproduction. As this technology continues to evolve, it promises to play an increasingly vital role in advancing buffalo reproduction.

Uterine torsion due to a giant broad ligament fibroid

Horse breeding is a fundamental component of economic and social development in many countries. Maintaining high fertility rates and ensuring the birth of healthy foals is crucial for the sustainability of the equine industry. However, both infectious and non-infectious factors contribute significantly to reproductive losses, including miscarriages, stillbirths, and postpartum fetal deaths. Infectious agents such as bacteria, viruses, fungi, and parasites play a significant role, while non-infectious causes include stress, transportation, hormonal imbalances, and uterine torsion. Early and accurate diagnosis of these factors is critical for effective treatment and prevention. In this context, the implementation of comprehensive preventive strategies, such as routine vaccination (e.g., against equine herpesvirus), isolation of pregnant mares, regular veterinary checkups, ongoing monitoring, and appropriate nutritional management, is crucial. This review aims to inform breeders and veterinarians about the underlying causes of miscarriage, infertility, and foal deaths in horses and to emphasize the importance of preventive medicine in reducing these risks.

The association between adenomyosis and uterine torsion, a rare, serious obstetric condition, remains unclear and has not been systematically investigated. This study aimed to elucidate the incidence, risk factors, and clinical characteristics of uterine torsion in pregnancies complicated by adenomyosis. We conducted a retrospective cohort study of women with adenomyosis undergoing cesarean section at The University of Tokyo Hospital from 2010 to 2023. Adenomyosis was diagnosed via magnetic resonance imaging and/or ultrasonography before and/or during early pregnancy. Uterine torsion was defined as > 45° rotation around the long uterine axis during cesarean section. We compared the clinical characteristics, adenomyotic features and surgical details of women with and without uterine torsion. Among 135 pregnant women with adenomyosis, 70 underwent cesarean section. Within this cesarean delivery cohort, uterine torsion was identified in six (8.6%) women. All torsion cases were asymptomatic and involved focal type adenomyosis; these six cases represented 13.6% (6/44) of the 44 women with focal type adenomyosis in this cesarean cohort. The torsion group required supraumbilical skin incisions (50.0% [3/6] vs. 0% [0/64], P < 0.001) and atypical uterine incisions (83.3% [5/6] vs. 23.4% [15/64], P = 0.006) significantly more often. This study highlights a high incidence (8.6%) of asymptomatic uterine torsion in a cohort of women with adenomyosis undergoing cesarean delivery. These findings suggest that focal adenomyosis may be a key risk factor and generate an important hypothesis that requires further investigation. Surgical planning should consider the possibility of uterine torsion, which may require tailored intraoperative strategies involving non-standard incisions.

BackgroundUterine torsion is a leading cause of dystocia in large domestic animals. However, there is no systematic comparison of its clinical presentation, epidemiological data, risk factors, or outcomes in camelids, buffalo, and cattle.MethodsBetween 2008 and 2023, data were collected from closed and open housing systems in multiple regions (Qassim region, Saudi Arabia and Minia Governorate, Egypt). A total of 3,557 camels (Camelus dromedarius), 7,157 buffaloes (Bubalus bubalis), and 5,251 cattle (Bos indicus) were examined. Detailed clinical records from 80, 262, and 129 diagnosed torsion cases were examined for parity, torsion characteristics, intervention methods, and survival outcomes. Logistic regression models were used to determine risk factors for fetal and maternal mortality.ResultsClosed housing led to significantly higher rates of uterine torsion in all species (p < 0.001), with multiparous females being more likely to experience it. Gestational timing, torsion direction, anatomical location, and severity all differed significantly between species. Torsion occurred primarily during parturition in camels and cattle, but was evenly distributed between late gestation and parturition in buffaloes. Despite left-horn pregnancies, camels exhibited almost exclusively right-sided torsion, whereas buffaloes and cattle exhibited torsion in the direction of the gravid horn. Camels (96.3%) and buffaloes (98.6%) had more post-cervical torsion, whereas cattle had a higher rate of pre-cervical torsion (35.7%). Camels had the highest percentage of severe torsion (85.0%), buffaloes had severe (45.8%) and moderate (48.9%) torsions, and cattle had moderate (67.4%) to mild (24.8%) torsions. Severe torsion and delayed intervention (>48 h) were the strongest risk factors for fetal and maternal mortality across all species.ConclusionThis study reveals significant species-specific differences in the clinical presentation and epidemiology of uterine torsion. The identified patterns in timing, direction, location, and severity provide critical evidence for developing tailored diagnostic and management strategies in camels, buffaloes, and cattle.

An acute surgical, fertility-related condition―torsion of the uterine appendages in children―is associated with necrosis of the follicles and requires emergency surgical intervention to preserve the ovarian reserve of a child. In half of cases, according to literature, torsion is caused by a bulky ovarian formation; most often they are functional ovarian cysts and mature teratomas. The article presents two clinical cases of uterine appendage torsion in children with paraovarial cysts. The girls were initially admitted to a pediatric surgical hospital with a clinical picture of acute abdomen and suspected acute appendicitis as a leading preliminary diagnosis. Unfortunately, torsion of the uterine appendages does not have a specific clinical picture. Instrumental diagnostics (ultrasound and magnetic resonance imaging of the pelvic organs) revealed paraovarial cysts in both cases, but until the diagnostic laparoscopy, the diagnosis of uterine appendage torsion remained unclear and was not suspected at the diagnostic search stage in any of the girls. To keep to the organ-preserving tactics, an operating surgeon decided to completely remove membranes of the formation in order to eliminate any relapses in the future, and at the same time to spare viable uterine appendages, as far as it was possible, in each specific case. Such an approach minimizes possible complications in the postoperative period and increases chances of a valid reproduction in the future. Outcomes of our clinical observations allow us to conclude that timely diagnostics during monitoring and treatment of patients with clinical manifestations of acute abdomen can increase chances of girls to preserve uterine appendages, and hence their ovarian reserves. If the diagnosis of acute appendicitis in girls is excluded, it is also mandatory to exclude acute gynecological pathologies. Thus, it highlights the importance of integrated approach to the diagnosis and treatment of gynecological acute conditions in adolescents. Such children should be under the observation of not only pediatric surgeons, but also of gynecologists. The discussed clinical cases will help to improve diagnostics, management, and tactics of surgical treatment of adolescent girls with diagnosed uterine appendage torsion.

Uterine appendage torsion in children is an urgent problem of pediatric gynecology and surgery. An increase in the ovarian volume is associated with the risk of uterine appendage torsion, while tumor stem torsion is one of the main complications of ovarian tumors. Any newly identified lesion should be evaluated for malignancy which defines the type of surgical intervention. If the malignancy of the formation is excluded, ovarian-sparing surgery can be successfully applied. The paper presents a case of uterine appendage torsion in a teenage girl with a benign germinogenic ovarian tumor who had been initially hospitalized with a clinical picture of an acute abdomen and non-specific symptoms for torsion. During laparoscopic detorsion, it was decided to refrain from removing the cystic formation from the affected ovary. In 3 months at the repeated hospitalization, the child was examined with ultrasound, magnetic resonance imaging with contrast to determine the concentration of a number of markers (alpha-fetoprotein, lactate dehydrogenase, chorionic gonadotropin). The patients was also consulted by an oncologist: a teratoma was detected and removed laparoscopically. The patient’s management was staged: first, detorsion of the right uterine appendages, then removal of the bulky formation of the ovary using the technique of relaparoscopy. After morphological examination, diagnosis of mature teratoma was put; an immunohistochemical assay confirmed it. The presented clinical observation underlines the importance of early diagnostics and an individual approach to choosing a curative modality in case of uterine appendage torsion in girls. Laparoscopic organ-preserving surgery is the preferred approach so as to minimize tissue injury and to preserve ovarian reserves. Presenting this clinical case is an important step so as to raise doctors’ awareness of the complications of ovarian tumors in children and adolescents (in particular, torsion of uterine appendages) which will help to improve diagnostics and treatment of such conditions in adolescent girls.

Objective: Uterine torsion is defined as a rotation of the uterus exceeding 45° around its longitudinal axis. This study aims to present two cases of uterine torsion diagnosed during cesarean section. Material and Method: Two cases diagnosed with uterine torsion during cesarean section were evaluated. Results: In both cases, the fetuses were delivered through a transverse incision in the lower posterior uterine segment. The patients recovered well and were discharged home with their newborns. In the first case, a cesarean scar defect was observed during follow-up, whereas in the second case, the uterus showed complete recovery. Conclusion: The potential complications and long-term sequelae of a posterior hysterotomy scar in future pregnancies remain unclear.

Twist of Fate: Managing Asymptomatic Uterine Torsion in a Triplet Pregnancy

Uterine torsion, although rare, can occur during pregnancy, especially in the presence of a uterine myoma. It is important to have a high level of suspicion and timely management to avoid maternal morbidity and perinatal mortality. We discuss a case of a primigravida with chronic hypertension at 31+6 weeks of pregnancy with imminent signs of eclampsia. An emergency caesarean was done. The intraoperative course was uneventful until the baby's extraction, when it was observed that there was uterine torsion of 180°, and the uterine incision was in fact on the posterior uterine wall. One 6*5 cm International Federation of Gynaecology and Obstetrics type 6 fibroid on the right anterolateral wall was noted. Uterine torsion is unpredictable, with diagnosis mostly done intraoperatively. Although torsion was an incidental finding in our case, it can be associated with maternal and fetal complications if not managed on time.

Background: Uterine torsion is a rare obstetric complication defined as a rotation of the uterus of more than 45 degrees on its longitudinal axis. It often presents with nonspecific symptoms and is usually diagnosed intraoperatively, most commonly during Caesarean section. While dextrorotation is more frequently observed, levorotation is less common. Predisposing factors include uterine anomalies, fibroids, malpresentation, and pelvic adhesions, although in some cases, no underlying cause is identified. Early recognition and appropriate surgical management are key to ensuring favourable maternal and fetal outcomes. Case Presentation: A 33-year-old woman, G2P0+1, at 39 weeks’ gestation, presented with significant bilateral lower limb oedema. Pre-eclampsia screening was initiated, and in view of term pregnancy with evolving biochemical changes indicative of mild pre-eclampsia, the decision was made to induce labour. During the course of labour, suspicious cardiotocographic (CTG) features suggestive of fetal hypoxia prompted an emergency Caesarean section. Intraoperatively, a levorotation of the gravid uterus was identified, and delivery was performed via a posterior uterine incision. Both mother and neonate recovered well and were discharged without complications. Conclusion: Uterine torsion is a rare but important differential to consider during unexplained labour progress and obstetrician may deal with intraoperative challenges. This case highlights the need for heightened clinical awareness, especially in the presence of atypical labour progression or suspicious CTG findings. Prompt recognition and appropriate surgical intervention, including the option of posterior uterine incision, can ensure safe outcomes for both mother and baby. Increased reporting and awareness of such rare cases may contribute to better diagnosis and management in future obstetric practice.

The future fertility of the postpartum buffalo depends upon healthy peri-partum period subsequently leading to timely uterine involution and lesser development of uterine infections. Dystocia is one of the most important obstetrical con ditions, and requires immediate attention of the veterinarians, to prevent severe economic losses to the farmers arising from postpartum complications. The present study was planned with objective to design a score card for assessing uter ine involution in dystocia affected buffaloes and its validation. The score card was based on six parameters (location of uterus, diameter of cervix, uterine body, gravid and non-gravid uterine horns, and presence of types of uterine fluid) which were evaluated by the per-rectal and USG examination. Uterine torsion was found to be the most common cause of dystocia (50.00%; 15/30) followed by feto-maternal disproportion (20.00%; 6/30), fetal mal-dispositions (20.00%; 6/30) and fetal monstrosity (10.00%; 3/30), respectively. The average uterine involution score on day 20, 45 as well as combined score of all animals and speed of uterine involution was assessed. It was observed that 36.67% animals had delayed uterine involution indicating negative impact of dystocia on uterine health. So, it was concluded that devised uterine involution scorecard in this study could be beneficial for assessment of speed as well as extent of uterine involu tion in dystocia affected animals.

Uterine torsion in mares belongs to maternal pregnancy disorders, accounting for 5-10% of complications in the last trimester of pregnancy. Two surgical techniques for repositioning uterine torsion are used: flank laparotomy in local anesthesia on a standing mare (SFL) and midline laparotomy carried out under general anesthesia (MI). The study aims to present the exact protocol used by the authors to qualify a mare with uterine torsion for surgery using one of the above-mentioned methods.A total of 19 mares were operated on, of which 13 underwent midline laparotomy under general anesthesia, and the flank approach in a standing position operated on 7. Of the seven mares operated on in standing position under local anesthesia, six recovered and gave birth to healthy foals. In one of the operated mares by this approach, repositioning of the uterus was unsuccessful, and torsion was finally resolved after performing a laparotomy in the midline. Out of 13 operated mares in the midline (including the last-mentioned case), seven mares recovered and gave birth to normal foals. Another mare underwent c.s. because of the impossibility of twisted uterus reposition, but its outcome was good. 2 other mares with dead fetuses at admission underwent c.s. as well. One of them was in a critical general condition and died during surgery; the outcome of the other one was good. 3 following mares from this group aborted dead fetuses during the first week after the operation. One of them was euthanized after abortion, because of post-operative complications, the other two recovered without complications.Based on their own experience and available literature, the authors currently use the following key when selecting an appropriate surgical technique for uterine torsion repositioning in the mare:A mare of a balanced character promising approval of the procedure in sedation and local anesthesia with pregnancy up to 320 days with a living fetus and no apparent advanced circulatory changes within the uterine wall and/or broad ligament (diagnosed by rectal palpation and/or ultrasound examination) and no suspicion of comorbidities - flank approach in standing position (standing flank laparotomy SFL).Nervous, unpredictable mare, pregnancy over 320 days, dead fetus and/or severely compromised uterine wall, suspicion of concomitant abdominal problems - midline incision in general anesthesia (MI).

ABSTRACTSigmoid volvulus and uterine torsion are both rare and challenging conditions in pregnancy, and the coexistence of these conditions is particularly difficult to diagnose. Herein, we report a case of a 38‐year‐old pregnant woman at 30 weeks of gestation, with a history of two prior cesarean sections, who presented with severe abdominal pain, vomiting, and constipation, and was eventually diagnosed with both sigmoid volvulus and uterine torsion during surgery. Clinicians should consider the possibility of bowel obstruction when a pregnant woman presents with severe abdominal pain, vomiting, and constipation, as early diagnosis is crucial. Early imaging, prompt intervention, and a multidisciplinary approach are essential for preventing severe maternal and fetal complications.