Introduction:
Excessive torsion of a pregnant uterus is a rare and potentially extremely dangerous pathology for both the mother and fetus. The diagnosis is most often made intraoperatively.

Aim:
The main aim was to show that when it is impossible to detort the uterus, a low transverse caesarean section through the posterior uterine wall can be safely performed.

Case study:
We report a case of a 41-year-old multiparous woman at G II P II 39/40 weeks' gestation, who presented to the Gynecology and Obstetrics Department for an elective caesarean section due to a breech presentation of the fetus. During the caesarean section, a uterine torsion of 180° was found. As the uterus could not be detorted to its normal position, a low transverse caesarean section was performed through the posterior uterine wall. At follow-up visits after 8 weeks and 12 months, normal healing of the uterine muscle was confirmed.

Results and discussion:
The treatment of torsion of the pregnant uterus depends on gestational age and symptoms, in particular the presence of significant hemodynamic and ischemic lesions.

Conclusions:
The procedure of choice in a full-term pregnancy should be an attempt to detort the uterus to its normal position and then perform a cesarean section through the anterior uterine wall. If detorsion of the uterus is not possible, a caesarean section through the posterior uterine wall should be performed. Based on the literature review and the case presented, it appears that this procedure is safe.