Acute uterine torsion complicated by severe placental abruption resulting in maternal cardiopulmonary arrest

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.