Tubo-Ovarian Abscess in Second Trimester of Pregnancy after Transvaginal Oocyte Retrieval: Challenges in Management

Andrikopoulou M

doi:10.23937/2469-5742/1510016

Abstract

A 39-year-old primigravida female presented at 16 weeks gestation, with new onset of severe abdominal pain with nausea and vomiting. Her medical history was significant for infertility and ovarian endometrioma during oocyte retrieval. Current gestation was complicated by an emergent laparoscopy with drainage of a ruptured endometrioma in the first trimester. On examination, she had acute abdomen and sonogram showed a viable pregnancy and a 10 cm left adnexal mass. Emergent laparoscopy was performed with aspiration of abdominopelvic pus, ovarian cystectomy and lysis of adhesions. She delivered a live infant at 39.4 weeks via cesarean delivery secondary to arrest of dilation. We believe that when surgical intervention is required, laparoscopy should be considered in the management of tubo-ovarian abscess in pregnancy in the hands of a skilled laparoscopic surgeon.

Highlights

Development of tubo-ovarian abscess (TOA) in pregnancy secondary to transvaginal oocyte retrieval (TVOR) constitutes a very rare entity, with incidence ranging from 0.03-0.5% [1]
We present a rare case of a large TOA in pregnancy, in a patient with a pre-existing endometrioma during TVOR, which was managed successfully using a laparoscopic approach followed by antibiotic therapy
We believe that laparoscopy should be considered in all cases of first and second trimester of pregnancy for the management of TOA, in the hands of a skilled laparoscopic surgeon

Summary

Introduction

Development of tubo-ovarian abscess (TOA) in pregnancy secondary to transvaginal oocyte retrieval (TVOR) constitutes a very rare entity, with incidence ranging from 0.03-0.5% [1]. A preexisting endometrioma at the time of oocyte retrieval appears to be a predisposing factor to pelvic inflammatory disease and subsequent development of pelvic abscess. The approach and management of such complication can be challenging given the severity of the disease and the existing pregnancy.

Results

Conclusion