Preoperative Predictive Score of Ovarian Torsion in Pregnancy

Abstract

Study ObjectiveTo develop a risk score calculator for the prediction of adnexal torsion during pregnancy.DesignA retrospective cohort study between 3.2011-4.2020.SettingTertiary medical center.Patients or ParticipantsAll women who underwent surgical diagnostic procedure due to suspected adnexal torsion in pregnancy. Overall, 156 women were included.InterventionsOperative laparoscopy.Measurements and Main ResultsWe collected demographic and clinical characteristics. The presence or absence of adnexal torsion during the surgical procedure was recorded.Adnexal torsion was identified in 131 (83.9%) of the surgical procedures.The rate of previous ovarian torsion was lower in the torsion group [OR(95%CI) 0.29(0.11-0.79), p=0.01]. Pregnancy following assisted reproductive technology (ART) was more common in the torsion group [OR(95%CI) 7.0(1.99-24.54), p<0.001]. Reported left sided pain was lower in the torsion group [OR(95%CI) 0.41(0.17-0.97), p=0.04], while duration of symptoms <8 hours was higher [OR(95%CI) 7.31(1.65-32.43), p=0.002], as was pain score (0-10) (mean 8.5 vs. 7.2, p=0.007).On physical examination, women appeared in more pain in the torsion group, had more peritoneal irritation, and less left adnexal tenderness [OR(95%CI) 4.34(1.74-10.8), p=0.001; 4.59(1.67-23.23), p=0.02; 0.27(0.11-0.66), p=0.003, respectively]. In blood analysis, white blood cells concentration was higher in the torsion group (11.3 vs. 9.9 K/microL, p=0.01), as was the neutrophils to lymphocytes ratio (3.4 vs. 2.5, p=0.01) and the maximal diameter of the affected ovary (70 vs. 55 mm, p=0.02).After multivariate analysis, three risk factors remained significantly independently associated with ovarian torsion; previous ovarian torsion was negatively associated [aOR(95%CI) 0.24(0.04-0.80), p=0.03], while ART and women that appeared in pain were positively associated [aOR(95%CI) 9.8(2.22-43.6), p=0.003; 3.8 (1.23-12.18), p=0.02, respectively].Calculated risk for adnexal torsion was 0%, 68.2%, 90.4% and 100% in the presence of 0, 1, 2 and 3 risk factors respectively.ConclusionOur risk score calculator may assist clinicians in the prediction of adnexal torsion during pregnancy.