Torsion In Pregnancy Research Articles

Ovarian Torsion in Pregnancy

Ovarian Torsion in Pregnancy

A case of ovarian torsion in pregnancy

A case of ovarian torsion in pregnancy

Adnexal torsion: A comprehensive review of types, pathophysiology, diagnosis, and management strategies during pregnancy

Adnexal torsion is a gynecological surgical emergency which during pregnancy can be associated with high patient morbidity and fetal mortality if not managed promptly. Fertility preservation is an essential concern. The underlying pathophysiology involves ovarian tissue torsion on its pedicle, leading to decreased venous return, stromal edema, internal hemorrhage, and infarction. It can affect females of all age groups, and they present mainly with an acute onset of pelvic pain, followed by nausea and vomiting. Multiple risks can lead to adnexal torsion, including ovulation induction, use of in vitro fertilization, and the presence of an ovarian mass. Early diagnosis is challenging and mainly depends on clinical suspicion, ultrasound, or MRI findings; however, it is necessary to preserve the function of the ovaries and fallopian tubes and prevent the occurrence of infertility. Once adnexal torsion is suspected, surgery or detorsion is the main line of treatment. This review will summarize the most relevant studies on risk factors, radiological findings, and managing maternal adnexal torsion in pregnancy.

Torsion of a Large Ovarian Dermoid Cyst in Third Trimester Pregnancy: A Case Report

Dermoid cysts are the most frequent ovarian tumours among women of reproductive age, constituting a notable 20% of all adult ovarian tumours. They are typically lined by stratified squamous epithelium and contain dermal and epidermal elements. During pregnancy, dermoid cysts are more likely to lead to infection, rupture and torsion. A 23-year-old multigravida (G2P1L1) female at 36 weeks of gestation presented with complaints of left lumbar pain persisting for one day, unrelieved by medication. Ultrasound (USG)revealed a multiloculated septated cystic lesion in the left lumbar region adjacent to the gravid uterus, just anteroinferior to the left kidney. Magnetic Resonance Imaging (MRI) showed a predominantly fat-density multiloculated cystic lesion with twisting of the pedicle. An emergency laparotomy was performed, and the left ovarian cyst was removed, revealing patchy discolored areas of gangrene, and a live healthy foetus was delivered. While torsion of an ovarian cyst is a well-known complication, its presentation during pregnancy is rare. Due to the variable symptoms of ovarian torsion, the clinical presentation can be quite confusing. Therefore, both the obstetrician and radiologist should have a lower threshold for clinical suspicion of torsion in pregnancy, enabling prompt diagnosis and management of such cases to prevent both maternal and foetal mortality.

Torsion of a Large Ovarian Dermoid Cyst in Third Trimester Pregnancy: A Case Report

Dermoid cysts are the most frequent ovarian tumours among women of reproductive age, constituting a notable 20% of all adult ovarian tumours. They are typically lined by stratified squamous epithelium and contain dermal and epidermal elements. During pregnancy, dermoid cysts are more likely to lead to infection, rupture and torsion. A 23-year-old multigravida (G2P1L1) female at 36 weeks of gestation presented with complaints of left lumbar pain persisting for one day, unrelieved by medication. Ultrasound (USG)revealed a multiloculated septated cystic lesion in the left lumbar region adjacent to the gravid uterus, just anteroinferior to the left kidney. Magnetic Resonance Imaging (MRI) showed a predominantly fat-density multiloculated cystic lesion with twisting of the pedicle. An emergency laparotomy was performed, and the left ovarian cyst was removed, revealing patchy discolored areas of gangrene, and a live healthy foetus was delivered. While torsion of an ovarian cyst is a well-known complication, its presentation during pregnancy is rare. Due to the variable symptoms of ovarian torsion, the clinical presentation can be quite confusing. Therefore, both the obstetrician and radiologist should have a lower threshold for clinical suspicion of torsion in pregnancy, enabling prompt diagnosis and management of such cases to prevent both maternal and foetal mortality.

Uterine torsion with placental abruption and fetal death at term pregnancy: A case report and literature review

Background: Uterine torsion in pregnancy is a rare event that requires urgent recognition and management. Its presentation is non-specific and ranges from asymptomatic to severe life-threatening conditions such as placental abruption with hemorrhagic shock and maternal and fetal death. Here we describe our case and reviewed similar literature on gravid uterine torsion. To our knowledge, this is the first report of term uterine torsion complicated by placental abruption and fetal death in Africa. Case Presentation: A 28 years old Ethiopian woman gravida III, para II, presented at 37 weeks of gestation with acute severe abdominal pain, mild vaginal bleeding, absent fetal movement, and shock. Emergency cesarean section was decided with a presumptive diagnosis of placental abruption with hemorrhagic shock and intrauterine fetal demise. Intraoperatively, it was realized that the placenta and the dead fetus were delivered through an inadvertent posterior lower segment hysterotomy made on 1800 levo-rotated uterine torsion. Then the uterus was restored to its anatomic position and the posterior hysterotomy was closed. Despite medical measures, the uterus became atonic and a hysterectomy was required. The patient had an uneventful postoperative and postpartum course. Conclusion: Even if gravid uterine torsion is uncommon, it should be kept in mind as one of the differentials in pregnancy-related acute abdominal emergencies due to its non-specific nature and dangerous impact. Furthermore, it can be obscured and associated with other obstetric emergencies, especially placental abruption.

EP47.05: The clinical and ultrasound characteristics of isolated fallopian tube torsion in pregnancy

EP47.05: The clinical and ultrasound characteristics of isolated fallopian tube torsion in pregnancy

Unavoidable Posterior Lower Segment Caesarean Incision Due To a 180-Degree Uterine Torsion Resulting From a Huge Anterior Uterine Fibroid: A Case Report

Background: Uterine rotation is a common occurrence in pregnancy. However, when the rotation is more than 45 degrees it is termed torsion. Uterine torsion is rare and can complicate pregnancy especially in association with uterine anatomical pathologies, pelvic masses and abnormalities and fetal anomalies. The presentation and management vary and depend on the cause, degree of torsion and age of the pregnancy. The rarity of this condition makes this case report worthwhile. Case Report: We report a case of a 30 year old primigravid woman who booked for antenatal care at 16 weeks gestational age following a 3-year history of primary infertility. The pregnancy was complicated with abdominal pain from red degeneration of uterine fibroids and was managed with pentazocine injection severally in the 2nd trimester. She presented in labour at 39 weeks but the labour was prolonged for 8 hours, having adequate contractions without any significant improvement in both descent and cervical status. She subsequently had an emergency caesarean delivery through a posterior lower segment incision due to an incidental finding of a 180-degree uterine torsion resulting from huge anterior fibroids; with an outcome of a live female neonate that weighed 3.1kg with good Apgar scores. Two pieces of fibroids were removed from the anterior surface that weighed 1.1kg. The post operative and puerperal periods were uneventful. Conclusion: Uterine torsion in pregnancy, a rare obstetric occurrence and infrequently reported complication occurs mainly in the third trimester and may complicate labour. In the presence of significant uterine fibroid, a possibility of uterine torsion may be entertained when the progress of labour is considered poor without any obvious mechanical cause. In such cases caesarean delivery with possible posterior uterine incision may be carried out. Article Details

Isolated Tubal Torsion in a Term Pregnancy: Case Report and Systematic Review of Literature of the Last 10 Years.

ObjectiveIsolated torsion of a fallopian tube is a rare event and it is extremely difficult to be diagnosed in pregnancy. The aim of this study is to present a clinical case report that occurred in our department and to summarize the latest evidence about tubal torsion in pregnancy.MethodsWe reported data, ultrasonographic features and an intra-operative image of a case report of tubal torsion in a term pregnancy. Then a review of the literature was performed following the PRISMA statement: we searched all the articles related to tubal torsion in pregnancy in the last 10 years from the international electronic bibliographic database PUBMED. We collected data regarding population characteristics, clinical features, treatment, and feto-maternal outcomes.ResultsAccording to our search strategy, 10 articles were included. The main clinical symptoms were abdominal pelvic pain (100%), nausea, and vomiting (30%). The mean gestational age at the diagnosis was 36 weeks after the last menstrual period in 50% of cases. Ultrasound images showed a cystic lesion in the adnexal area in 70% of cases. In most of the cases, a cesarean section with a contextual salpingectomy was performed. No cases of maternal and fetal death were respectively reported.ConclusionIsolated torsion of the fallopian tube is a rare obstetric condition but it should be considered in case of acute lower abdominal pain presentation during pregnancy. Depending on gestational age, surgical treatment as soon as possible could prevent a salpingectomy.

Laparoscopic Management of Ovarian Torsion in Pregnancy in 1st Trimester - Case Report

Laparoscopic Management of Ovarian Torsion in Pregnancy in 1st Trimester - Case Report

İzole tubal torsiyon nedeniyle miat gebelikte akut abdomen

Objective: Isolated tubal torsion in pregnancy is a rare condition we want to present this case. Case(s): In our study, we present a 23-year-old woman primigravida at 37 weeks of gestation with acute right lower abdominal pain. The clinical and Magnetic resonance imaging (MRI) findings led to diagnosis of acute appendicitis. Emergency exploratory laparotomy and cesarean section were performed. A twisted right Fallopian tube and Morgagni’s cyst was noted and right salpingectomy was performed. Conclusion: Although isolated tubal torsion during pregnancy is very rare, it should be included in the differential diagnosis of acute abdomen in pregnancy. Early surgical intervention will decrease obstetric morbidity.

Diagnosis of uterine torsion during cesarean section

Partial rotation of the uterus up to 45 degrees is a common physiological finding during pregnancy whereas uterine torsion is pathologic and defined as rotation greater than 45 degrees. Torsion of up to 720 degrees has been reported; with most cases occurring between 90 degrees and 180 degrees. While uterine torsion in pregnancy requires emergent intervention, the incidence is unknown. Most cases of uterine torsion are diagnosed intra-operatively at emergent cesarean section following non-specific clinical presentation, such as fetal heart rate decelerations or bradycardia, severe abdominal pain, hypotension, or vaginal bleeding. In this case series, we report on two cases of one woman with gravid uterine levorotation of 180 degrees and another with gravid uterine dextrorotation of 180 degrees.

Preoperative Predictive Score of Ovarian Torsion in Pregnancy

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.

Torsion of the gravid uterus: A rare cause of abdominal pain

Uterine torsion in pregnancy is a rare clinical entity with a non-specific clinical presentation. Here, we present a case of uterine torsion,which was diagnosed at laparotomy done for the lower segment cesarean section (LSCS) in a case of central placenta previa with thefetus in transverse lie. At 36.4 weeks period of gestation, the patient complained of severe left-sided abdominal pain which was notsuggestive of labor. This abdominal pain was refractory to analgesics. Emergency LSCS was done which confirmed uterine torsion aswell as anterior sacculation.

Uterine torsion in pregnancy: a rare but life-threatening condition

Uterine torsion in pregnancy: a rare but life-threatening condition

Báo cáo trường hợp: xoắn tử cung đang mang thai 25 tuần trên sản phụ có hai tử cung tại Bệnh viện Trung ương Huế

Case report: Uterine torsion in pregnant woman of 25 gestational week- age with 2 uterus at Hue Central Hospital Uterine torsion in pregnancy is a rare but very dangerous complication. The diagnosis of uterine torsion is often difficult due to the rare occurrence of this complication and unspecific clinical symptoms. A pregnant woman of 25gestational week came to our hospital with a severe abdominal pain, very strong uterine contraction and dead fetus. Urgent cesarean section surgery is performed with a diagnosis of severe placental abruptionand the malformation of uterus didelphys. During the caesarean section, we found the pregnant uterus on the right siteand the right appendage twisted 180 degrees to the left. The patient was untwisted, undergone the incision in the low part of the uterus to take the dead fetus out, and had a subtotal hysterectomy and rightoophorosalpingectomy after unsuccessful attempt to preserve the uterus. The postoperative condition was stable and the patient was discharged after 5 days. Keywords: Uterine torsion, pregnancy

Uterine Torsion Diagnosed at the Time of Laparotomy for a Planned Cesarean Section at Term

Background: Uterine torsion is defined as the rotation of the uterus more than 45 degrees around its long axis. The angle of rotation is usually 180 degrees, although, in the literature, there are reported cases of uterine torsion up to 720 degrees. This is a rare complication of pregnancy but associated with significant mortality and morbidity. Etiology still remains unclear and clinical diagnosis may be challenging. Symptoms can be absent or few and nonspecific as in chronic conditions or catastrophic such in case of acute presentation associated with acute abdomen. Final diagnosis is usually made at the time of laparotomy or even after delivery. In the literature, bilateral plication of round ligaments is proposed to prevent recurrences. However, there are no validated guidelines for the management of uterine torsion in pregnancy. Case: We present a 33-year-old, gravida 2 para 1. She had a previous vaginal delivery and no medical known conditions. She was admitted for a planned caesarian section at 39 weeks of gestation for breech presentation. After a difficult delivery of a healthy female neonate with normal Apgar scores and cord pH levels, a spontaneous derotation of the uterus of 180 degrees was observed. Giving the absence of pelvic anomalies, we chose to not perform any additional preventive surgical procedure. The patient was discharged on 3rd postoperative day. Finally, no complications were observed at the two-months postpartum visit. Conclusion: Uterine torsion in pregnancy is an uncommon pathology but potentially life threatening that obstetrician should be aware of. Occasionally, imaging can be helpful, but diagnosis is mostly made during surgery. In case of irreducible torsion, delivery can be made with a transverse incision in the lower posterior uterine segment. Bilateral plication of round ligaments, as previously described by other authors, may be evaluated as a taylored treatment in case of extreme uterine torsion and other pelvic anomalies, in order to prevent the recurrence of the torsion.

Adnexal Torsion in Pregnancy Managed by Laparoscopy Is Associated with Favorable Obstetric Outcomes

Most cases of adnexal torsion in pregnancy are currently managed by laparoscopy, which may be associated with increased risks for spontaneous abortion and preterm delivery. We sought to evaluate the obstetric outcomes of these women, with emphasis on their live birth rate and gestational age at delivery. Retrospective cohort study and telephone questionnaire. University-affiliated obstetrics and gynecology department. All pregnant women who underwent laparoscopy for adnexal torsion between 2007 and 2017. Their obstetric outcomes were obtained by retrospective review of medical records and a telephone questionnaire. Laparoscopy for adnexal detorsion, with or without cyst drainage or cystectomy. The study cohort included 94 women. Most torsion cases (71, 75.5%) were diagnosed in the first trimester of pregnancy, whereas 21 (22.3%) cases and 2 (2.1%) cases were diagnosed in the second and third trimesters, respectively. Conception was achieved by in vitro fertilization or by ovulation induction in 45 (47.9%) cases. The information on pregnancy outcomes was available for 93 women. Of those, live birth was reported for 86 (92.5%) pregnancies, while 6 (6.5%) women had a spontaneous abortion, and 1 woman experienced an intrauterine fetal death. Five cases of spontaneous abortion were diagnosed in the first trimester, all within 3 weeks of surgery. Preterm delivery before 37 gestational weeks was reported for 18 (19.4%) pregnancies and was significantly associated with twin pregnancy (p = .002) and with conception following in vitro fertilization and ovulation induction (p = .03). On logistic regression analysis, preterm delivery was only associated with twin vs singleton gestation (odds ratio, 6.7; 95% confidence interval, 1.3-34.8; p = .02). The obstetric outcomes of pregnant women who underwent laparoscopy for adnexal torsion are generally favorable. However, there is a risk for preterm delivery, which is primarily associated with multiple gestations.

Effect of Pregnancy on the Management and Outcomes of Ovarian Torsion: A Population-Based Matched Cohort Study

Study ObjectiveTo compare the treatment and surgical outcomes of ovarian torsion in pregnant and nonpregnant women. DesignA population-based matched cohort study (Canadian Task Force classification II.1). SettingThe United States Health Care Cost and Utilization Project Nationwide Inpatient Sample from 2003 to 2011. PatientsAll cases of ovarian torsion among pregnant women and nonpregnant women with ovarian torsion (matched by age in a ratio of 1:1). InterventionsOutcomes of interest included the type of treatment received for ovarian torsion and the complications of surgery. Measurements and Main ResultsThere were 1366 women diagnosed with ovarian torsion among 8 532 163 pregnant women for an incidence of 1.6 in 10 000. Surgery was the predominant treatment, with laparotomy being more commonly performed on pregnant women versus nonpregnant women (57.0% vs 51.0%; odds ratio = 1.28; 95% confidence interval, 1.08–1.51; p < .01). Overall conservative management was less likely performed; however, it was more common among pregnant women versus nonpregnant women (odds ratio = 1.85; 95% confidence interval, 1.44–2.37; p < .01). In general, adverse events were uncommon in both groups although ovarian infarction was more commonly reported among nonpregnant women. ConclusionThe diagnosis of ovarian torsion in pregnancy is rare. Compared with nonpregnant women, laparotomy and conservative management are more common among pregnant women. Treatment of ovarian torsion in pregnancy has comparable outcomes with treatment in nonpregnant women.

Laparoscopic Treatment of Tubal Torsion in Pregnancy

Abstract Background: Isolated tubal torsion in pregnant women is a rare diagnosis often treated with laparotomy. Case: A 37-year-old woman at 25 weeks of gestation presented with severe lower abdom...