Comparison of Clinical Characteristics and Sonographic Findings of Adnexal Torsion between Pregnancy Trimesters.

Abstract

Study Objective To compare the clinical characteristics and sonographic findings of adnexal torsion between pregnancy trimesters. Design A retrospective cohort study between 2011 and 2020. Setting A tertiary, university affiliated medical center. Patients or Participants Overall, 122 pregnant women with 131 separate episodes of surgically proven adnexal torsion. Interventions Laparoscopy for confirmation and treatment of adnexal torsion. Measurements and Main Results We collected demographic and clinical characteristics as well as sonographic findings and laboratory results of all adnexal torsion episodes. We compared the three trimesters of pregnancy. Overall, 92 of the episodes occurred during 1st trimester, 29 and 10 occurred during 2nd and 3rd trimester, respectively. The majority of cases were right sided (61%). Pregnancy achieved following assisted reproductive technology (ART) was more common in the 1st trimester group (p 6 was more common in 1st and 3rd trimester, compared to 2nd trimester (p=0.02). Gastrointestinal symptoms were also more common among patients in the 1st trimester (p The mean diameter of affected adnexa was similar in all trimesters, while the non-affected adnexa was marginally significantly smaller in the 2nd and 3rd trimesters. In approximately one third of all cases ultrasound findings included at least one specific feature: edematous ovary, absent doppler flow or presence of whirlpool sign. Absent doppler flow was more common in the 2nd and 3rd trimester compared to the 1st trimester (p Duration from admission to surgery was significantly longer in the 2nd and 3rd trimesters (p=0.002). Conclusion We found differences in the clinical, sonographic and laboratory manifestations of adnexal torsion in each trimester of pregnancy. When assessing pregnant patients with suspected adnexal torsion, these differences may assist in ameliorating an accurate diagnosis.