Spearing (1978) recommended extending the abdominal

incision above the umbilicus and delivering the entire uterus

from the abdomen before hysterotomy. This will restore correct
anatomical relationships and prevent inadvertent incisions into
and through the vagina and bladder. Unfortunately, this may
not always be possible (Singh, 2007).
Friedman and associates (1986) described a rare case of posterior
sacculation following aggressive treatment for intrauterine
adhesions. Finally, uterine retroversion and a true uterine
diverticulum have been mistaken for uterine sacculations (Hill,
1993; Rajiah, 2009).
■ Uterine Torsion
It is common during pregnancy for the uterus to rotate to the
right side. Rarely, uterine rotation exceeds 180 degrees to cause
torsion. Most cases of torsion result from uterine leiomyomas,
müllerian anomalies, fetal malpresentation,
pelvic adhesions, and laxity of the
abdominal wall or uterine ligaments.
Jensen (1992) reviewed 212 cases and
reported that associated symptoms may
include obstructed labor, intestinal or
urinary complaints, abdominal pain,
uterine hypertonus, vaginal bleeding,
and hypotension. Both maternal and
fetal complications were more common
with early gestation and with greater
degrees of torsion.
Most cases of uterine torsion are
found at the time of cesarean delivery.
In some women, torsion can be confirmed
preoperatively with MR imaging,
which shows a twisted vagina
that appears X-shaped rather than its
normal H-shape (Nicholson, 1995).
As with uterine incarceration, during
cesarean delivery, a severely displaced
uterus should be repositioned
anatomically before hysterotomy. In
some cases, an inability to reposition may require that a posterior
hysterotomy incision be done (Albayrak, 2011; De Ioris,
2010; Picone, 2006).
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