Bilateral Adnexal Torsion during the Third Trimester of Pregnancy

Abstract

Acute pelvic pain during pregnancy can pose a problem for differential diagnosis. We report a case of bilateral adnexal torsion in the third trimester of pregnancy. Indeed, this diagnosis may go unnoticed in front of pelvic pain associated with a pregnancy and only an early management can avoid irreversible lesions due to ischemia, which may jeopardize the subsequent prognosis of fertility. Our patient is 28 years old, primiparous, with polycystic ovary syndrome, followed for a pregnancy stimulated by clomiphene citrate. She developed preeclampsia with intrauterine growth retardation during the follow-up of her pregnancy. She presented to the maternity emergency room with sustained uterine contractions at 36 weeks' gestation. The patient had a code red cesarean section for suspected retroplacental hematoma. Intraoperatively, no retroplacental hematoma was found but bilateral torsion of the adnexa with huge polycystic ovaries. Conservative treatment was recommended and the postoperative follow-up of the cesarean section was simple. Adnexal torsion is an emergency that should not be ignored in the presence of any acute pelvic pain in a pregnant woman.