Uterine torsion mimicking supine hypotension syndrome after regional anaesthesia

A 40-year-old gravida 5 para2 +2 was admitted at 38 weeks +5 days of gestation for elective caesarean section in view of unstable lie. After spinal anaesthesia, when the patient was positioned supine for caesarean section, she developed acute onset breathlessness and dizziness. Blood pressure was unrecordable. She remained symptomatic with hypotension and bradycardia despite lateral tilt and intravenous atropine. On entering the peritoneal cavity, a congested uterus with torsion in a clockwise direction to almost 180° with the posterior wall facing anteriorly was noted. Immediate attempt to detort the uterus was successful. The patient immediately became symptomatically better and the uterine congestion resolved. Uterine incision was given in the anterior lower segment delivering a healthy baby. High index of suspicion and detorsion of the uterus avoided the inadvertent incision in the congested posterior uterine wall which could have resulted in massive postpartum haemorrhage.