Case Report: Management of Large Uterine Fibroids Causing Uterine Torsion During Delivery
A 29-year-old pregnant patient (primigravida) at 38+6 weeks of gestation was evaluated after the discovery of large uterine fibroids. This case study, published in BMC Pregnancy and Childbirth, shows how unexpected ultrasound findings during pregnancy led physicians to weigh overall risk and proceed carefully according to the best available evidence.
Prior to conception, the patient experienced regular menstrual cycles. At 6+5 weeks of gestation, a transvaginal ultrasound showed a viable embryo, but physicians also noted a uterine fibroid in the anterior uterine wall measuring 75 mm x 67 mm x 74 mm.
The patient experienced abdominal pain for 2 days at 16 weeks of gestation. At 22+2 weeks, a repeat ultrasound showed that the fibroid had grown dramatically, now measuring 106 mm x 87 mm x 93 mm, with the placenta located on the posterior wall.
At 38+2 weeks, another ultrasound indicated a transverse fetal lie. By this point the placenta had moved to the anterior uterine wall, and the uterine leiomyoma was located in the right anterior wall of the lower uterine segment, measuring 86 mm x 81 mm x 95 mm.
“Given the transverse lie and fibroid obstructing the lower uterine segment, elective cesarean delivery was planned,” the authors wrote.
Because of the transverse fetal lie and the leiomyoma blocking the lower uterine segment, Zhu and colleagues anticipated several possible challenges, including difficulty extracting the fetus, iatrogenic injury, and postpartum hemorrhage. In view of this spectrum of outcomes, the surgical team made advanced preparations for all possible scenarios.
Intraoperative findings and delivery
During surgery, the team determined that the uterus had twisted to the right by more than 90 degrees, while the fetal head remained in the left iliac fossa. Attempts at manual uterine repositioning failed. Because uterine torsion repositioning can dislodge thrombi in the vessels and lead to severe complications, the physicians prioritized fetal delivery.
After a few further manual adjustments, the surgeons performed a posterior lower uterine segment incision to facilitate delivery. A live male infant (3.2 kg) with Apgar scores of 10 at both 1 and 5 minutes was delivered. Because leiomyoma removal at that time was judged to carry a significant bleeding risk, myomectomy was deferred.
Postpartum management
Three months postpartum, the mass in the anterior wall of the uterus measured 85 mm x 73 mm x 82 mm. The patient was advised to use contraception for 2 years and to undergo follow-up ultrasounds to monitor fibroid size. If it causes persistent symptoms such as menorrhagia or impaired quality of life, laparoscopic myomectomy is recommended between 6 months and 1 year postpartum.
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Reference
Zhu, et al. Uterine torsion caused by a giant uterine fibroid in late pregnancy: a case report and literature review. BMC Pregnancy Childbirth. Published online 2026. doi:10.1186/s12884-026-09442-1
