Torsion In Pregnancy Research Articles

Torsion of Normal Adnexa in the Third Trimester of Pregnancy Mimicking Acute Appendicitis

Maternal ovarian torsion in pregnancy is very rare. Non-specific symptoms, signs, and imaging findings make the diagnosis difficult. A delay in diagnosis can lead to irreversible damage to adnexa and fetal compromise. Difficulties encountered in the diagnosis and management of adnexal torsion in the third trimester of pregnancy are highlighted in this article.

Isolated Fallopian Tube Torsion in Pregnancy: An Uncommon Event

Isolated Fallopian Tube Torsion in Pregnancy: An Uncommon Event

Ovarian Torsion in Pregnancy: A Case Report

Torsion of the ovary is the total or partial rotation of the adnexa around its vascular axis or pedicle. Although the exact etiology is unknown, common predisposing factors include moderate size cyst, free mobility and long pedicle. Torsion of ovarian tumors occurred predominantly in the reproductive age group. The majority of the cases presented in pregnant (22.7%) than in non-pregnant (6.1%) women. Here, we report a case of ovarian torsion in pregnancy. Ovarian torsion is an urgent gynecological surgery and can occur during pregnancy. Surgical techniques should be considered in the development of the adnexal torsion regardless of the gestational age.

Adnexal torsion in a first trimester pregnant patient

Adnexal torsion in pregnancy represents an obstetrical emergency. However, the diagnosis is often delayed due to nonspecific clinical findings leading to maternal morbidity as well as, fetal morbidity and mortality. We present an interesting case of adnexal torsion in a first trimester pregnant patient who developed adnexal infarction and required salpingo-oophorectomy.

Laparoscopic management of adnexal torsion in a twin, in vitro fertilization pregnancy at 23 weeks.

Maternal adnexal torsion in pregnancy, with a reported incidence of 1–10 per 10,000 spontaneous pregnancies, is very uncommon. Since it has been described as a severe complication after controlled ovarian hyper-stimulation for in vitro fertilization (IVF), it is more common in IVF pregnancies. This condition mainly occurs in the first trimester; it is rare during the late second trimester. Conservative management of adnexal torsion by laparoscopy is extended for the management of such conditions during pregnancy. An enlarged uterus could cause operational difficulties in the second trimester. In this paper, we report a case of adnexal torsion in a twin, 23 weeks with IVF pregnancy, that was successfully untwisted by laparoscopy.

Ovarian Torsion in a Patient with One Ovary Resulting in Bilateral Salpingo-Oophorectomy during Pregnancy

This case presentation describes a primigravid patient at 24 weeks and 2 days who presented with ovarian torsion in the setting of a prior ovarian loss. She was managed laparoscopically and underwent a salpingo-oophorectomy. This case reiterates the importance of early identification of torsion in pregnancy for greatest chance of ovarian preservation with detorsion.

Case Report: Ovarian Torsion in Pregnancy – Diagnosis and Management

BackgroundOvarian torsion (OT) is one of the most common gynecologic surgical emergencies. All age groups can be affected, but ovarian stimulation, as found during early pregnancy or infertility treatment, is a major risk factor. ObjectiveDiagnosing OT in early pregnancy can be challenging. Patients frequently present with abdominal pain and non-specific symptoms. Missed diagnosis of OT could lead not only to ovarian necrosis and sepsis, but also threaten the pregnancy. The objective of this article is to present a case of OT in early pregnancy and to review its epidemiology, diagnosis, and treatment. Case ReportA 30-year-old woman at 10 weeks gestational age presented to the Emergency Department (ED) with 2 h duration of abdominal pain, nausea, and vomiting. The patient was not on ovarian stimulation treatments. A bedside ED ultrasound showed an enlarged edematous right ovary with a large cyst, but without flow on color Doppler. Immediate obstetric consultation was initiated. Eventual radiology ultrasound showed decreased but present flow in the right ovary. The patient underwent emergent laparoscopic surgery, during which the necrotic right ovary was removed. She was placed on progesterone therapy upon hospital discharge and eventually delivered a healthy term infant. ConclusionsOvarian torsion in pregnancy is increasing in frequency due to the growing prevalence of ovarian stimulation treatment. Although diagnostic ultrasound is a frequently used imaging tool in patients with suspected OT, the mere presence of blood flow on Doppler ultrasonography of the adnexa has a poor negative predictive value. A high clinical suspicion and early laparoscopic management correlate with favorable maternal and fetal outcomes.

Uterine torsion in pregnancy

Uterine torsion in pregnancy

Adnexal Torsion in Pregnancy after Assisted Reproduction - Case Study and Review of the Literature.

Purpose: Aim of the study was to investigate the incidence, progress, management and outcome of adnexal torsion after controlled ovarian hyperstimulation in embryo transfer cycles. Materials and Method: A retrospective analysis was done of 1007 patients of a private IVF centre. The literature on adnexal torsion is reviewed. Results: In the literature, the incidence of adnexal torsion after assisted reproductive technologies (ART) is given as around 0.2 %. A significant increase of up to 33 % has been reported for cases with additional ovarian hyperstimulation syndrome (OHSS) and in pregnant women. In our retrospective analysis of 1007 women (incidence 0.46 %) with 1411 fresh embryo transfer cycles, we found an incidence of 0.35 % per embryo transfer. All adnexal torsions were treated by laparoscopic derotation to preserve fertility. All 5 cases with torsion were pregnant, 2 patients had mild OHSS. We recorded 3 term deliveries, 1 induced abortion for sirenomelia, and 1 missed abortion. Conclusion: Adnexal torsion must be kept in mind after hyperstimulation and embryo transfer, especially when pregnancy or OHSS is also present. With early diagnosis, it should be possible to preserve fertility using laparoscopic derotation.

Stomach torsion in pregnancy as a complication of laparoscopic adjustable gastric banding.

Laparoscopic Adjustable Gastric Banding (LAGB) was done for the first time in Belgium in 1993. Gastric torsion after band slippage is extremely rare. Literature review of gastric banding and complications in pregnancy did not reveal any case of gastric torsion. Hence, we report this rare case of gastric torsion in a pregnant lady following gastric banding.

Surgical intervention for maternal ovarian torsion in pregnancy

Objective Maternal ovarian torsion in pregnancy is a rare complication. This study was conducted to review the clinical manifestations, and to compare the outcome between laparoscopy and laparotomy in women undergoing surgery for ovarian torsion (OT) during pregnancy. Materials and Methods Using the International Classification of Disease, Ninth Revision, and Clinical Modification, we reviewed the clinical records of patients with OT during pregnancy between 1997 and 2008 at a university hospital. Results Twenty pregnant women were identified with surgically proven OT, 10 in the first trimester, eight in the second, and two in the third. Thirteen (65%) cases were suspected before operation to be adnexal torsion. The most common symptom and sign were pelvic pain (95%) and an adnexal or pelvic mass (95%), followed by nausea and vomiting (65%), elevated white blood cell count >12 × 10 9/L (45%), and fever (10%). Most patients in the first trimester (75%) and a minority in the second and third trimesters (37.5%) received management via laparoscopy. Patients undergoing laparoscopy treatment had smaller ovarian masses and a shorter postoperative hospital stay than those receiving laparotomy. None of these patients had significant complications during or after surgery. However, the outcomes of pregnancy varied: 12 (60%) term deliveries, three (15%) preterm deliveries at over 31 gestational weeks, one missed abortion and four elective abortions in the first trimester. Conclusion The diagnosis of OT during pregnancy is often missed due to nonspecific clinical features and uncommon objective findings. Detorsion only or detorsion plus ancillary procedures via laparoscopy is recommended to treat pregnant women suffering from OT, owing to the advantages of a shorter hospital stay and favorable surgical and pregnancy outcomes.

P28.03: Ovarian torsion in pregnancy: ultrasound characteristics and histopathology

P28.03: Ovarian torsion in pregnancy: ultrasound characteristics and histopathology

Conservative surgery for left-sided isolated tubal torsion in pregnancy

We report a case of severe lower abdominal pain in a pregnant woman at 35 weeks and 4 days of gestation. Early diagnosis of an isolated left-sided tubal torsion was established by ultrasound and emergency magnetic resonance imaging (MRI). Subsequent detorsion surgery was able to prevent the need for salpingectomy. The role of emergency imaging and conservative surgery in isolated tubal torsion is discussed.

A Case of Torsion of Gravid Uterus Caused by Leiomyoma

Uterine torsion during pregnancy is only sporadically reported in the literature. Here we present a case of leiomyoma causing uterine torsion in pregnancy and review the literature on etiology, diagnosis, and management. A 25-years-old primigravida with leiomyoma complicating pregnancy was admitted in our hospital with abdominal pain and uterine tenderness. She underwent emergency LSCS (lower segment cesarean section) for fetal bradycardia. Intraoperatively, the uterus was rotated 180 degrees left to right. Inadvertent incision on the posterior wall was avoided by proper delineation of anatomy. Torsion was corrected by exteriorization of leiomyoma and uterus, and lower segment cesarean was carried out safely. Prompt recognition and management of this condition is necessary for better maternal and fetal outcome.

The Clinical Characteristics and Sonographic Findings of Maternal Ovarian Torsion in Pregnancy

Maternal ovarian torsion is a very rare complication in pregnant women that may be misdiagnosed because signs and symptoms such as abdominal pain and nausea/vomiting are nonspecific and are present in a number of obstetric and surgical conditions. There is limited information in the medical literature on ovarian torsion in pregnancy. Most previous studies have been isolated case reports and small case series. This retrospective study investigated the incidence, risk factors, and sonographic findings of maternal ovarian torsion in pregnancy. The participants were 33 pregnant women with 38 episodes of surgically proven torsion who were examined and managed surgically at a tertiary referral center between the years 1993 and 2007. Ultrasound examination was performed upon admission in all cases. The primary outcome measures were clinical and sonographic findings of ovarian torsion in pregnancy. Seventeen (51.5%) of the pregnancies were spontaneously conceived and 16 (48.5%) were conceived by ovulation induction or in vitro fertilization. The majority of cases of torsion (55.3%, n = 21) occurred in the first trimester; 34.2% (n = 13) occurred in the second trimester and 10.5% (n = 4) in the third trimester. At presentation, all patients had abdominal pain and 57.9% (n = 22) reported nausea/vomiting. The preoperative ultrasound findings were ovaries with unilocular cysts in 15 (39.5%) cases, multicystic ovaries in 14 (36.8%) cases, and normally appearing ovaries without cystic components in 9 (23.7%) cases. Compared to the cystic and normal appearing ovaries, the multicystic ovary occurred more frequently in the first trimester than in second and third trimester torsion (47.6% vs. 23.5%), whereas the normal appearing ovary components occurred more frequently in second and third trimester torsion (35.3% vs. 14.3%). The median duration from admission to surgery, 6 hours (range: 1 hour to 3.7 days), was significantly shorter in the first trimester compared with the second and third trimester. The investigators recommend that patients with relevant clinical presentation and on ovarian mass or enlarged ovary should be followed throughout pregnancy to rule out the possibility of ovarian torsion. The correct diagnosis of maternal ovarian torsion may be delayed in the second half of pregnancy.

P351 A rare case of gastric torsion in pregnancy after gastric banding

International Journal of Gynecology & ObstetricsVolume 107, Issue S2 p. S515-S515 Poster presentations P351 A rare case of gastric torsion in pregnancy after gastric banding C. Mallappa Saroja, C. Mallappa SarojaSearch for more papers by this author C. Mallappa Saroja, C. Mallappa SarojaSearch for more papers by this author First published: 20 November 2009 https://doi.org/10.1016/S0020-7292(09)61842-7AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume107, IssueS2Abstracts of XIX FIGO World Congress of Gynecology and ObstetricsOctober 2009Pages S515-S515 RelatedInformation

Maternal Adnexal Torsion in Pregnancy Is Associated with Significant Risk of Recurrence

Study Objectives To investigate the phenomenon of recurrent adnexal torsion during the same pregnancy, describe its risk factors, and suggest possible management of this entity. Design Retrospective case-control study (Canadian Task Force classification II-3). Setting Gynecologic endoscopy unit in a university hospital. Patients and interventions Pregnant women with surgically proved adnexal torsion were retrospectively identified from 1993 to 2007. Details of clinical presentation, method of conception, preoperative ultrasound findings, and operative findings were analyzed. Intervention Comparison of characteristics of patients with recurrent episodes of adnexal torsion during the same pregnancy vs a single episode of torsion. Measurements and Main Results Thirty-three pregnant women with 38 episodes of adnexal torsion were included in the study. Seventeen pregnancies (51.5%) were spontaneously conceived. Twenty-eight women had a single episode of torsion, and 5 women (15.1%) had recurrent episodes of torsion during the same pregnancy. No significant differences were found between the 2 groups in age, method of conception, and gestational age at time of torsion. However, ultrasound studies demonstrated that multicystic ovaries were significantly more common in women with recurrent torsion compared with women with a single episode of torsion (80% vs 25%; p = .02). The interval between the first and second episodes of torsion ranged from 1 to 4 weeks. Conclusion Pregnant women are at risk for recurrent torsion, especially when the ovaries are enlarged and ultrasound studies demonstrate multiple cysts. Cyst aspiration may prevent recurrent torsion during the same pregnancy.

Ovarian torsion in in vitro fertilization–induced twin pregnancy: Combination of Doppler ultrasound and laparoscopy in diagnosis and treatment can quickly solve the case

To diagnose and treat adnexal torsion in pregnancy. Case report. Obstetrics and Gynecology Department of Perugia Hospital. A 38-year-old woman, gravida 2, para 1 with bichorial twin pregnancy in the 10th week of gestation who was admitted for abdominal pain. She conceived after an IVF attempt. Even if symptoms compared 2 days before the admission, they aggravated just 2 hours before. An ovarian torsion was suspected, and Doppler ultrasound showed a complete absence of vascular flow. The dimension of the right ovary and the absence of ovarian blood flow were strong arguments in favor of the diagnosis of adnexal torsion, and laparoscopic ovarian adnexectomy was performed. The ovarian torsion was confirmed, and right adnexectomy was necessary. The patient had a quick convalescence and was discharged on the third postoperative day. She had no more pain. She underwent a cesarean section for placenta previa. She and her children have remained well. Considering the increased number of IVF pregnancies, an ovarian torsion should be less uncommon than in the past. Doppler ultrasound should be considered as a first-line exam. The complete absence of vascular flow in the ovary may be an indication for adnexectomy. An ovarian torsion in pregnancy should be treated laparoscopically.

Management of the acute abdomen in pregnancy: a review

The acute abdomen remains a challenge for all physicians who take part in the care of women in pregnancy. Obstetricians must be abreast of current topics, especially critical when having to consult other specialties for assistance in managing these conditions. We will highlight recent observations in the literature concerning the ability to perform laparoscopy safely in pregnancy, the accuracy of diagnosing appendicitis, and new methods to accurately diagnose urolithiasis with less ionizing radiation effect on the fetus. Finally, with the proficiency of laparoscopy and choledochoscopy improving, we will review several articles underlining their safety. Laparoscopy appears to be well tolerated in pregnancy, but larger multicenter prospective studies are required to make better recommendations concerning its use, with a registry needed to facilitate this endeavor. Conservative management of gallstone pancreatitis may fall out of favor, and choledochoscopy for symptomatic gallstones in the biliary tree may become the treatment of choice. Most cases of urolithiasis resolve with conservative management, but the possibility of preterm labor in these patients must be recognized and newer imaging techniques for diagnosis containing less radiation be used. Adnexal torsion in pregnancy may be another condition that is managed through the laparoscope as the gynecologic community's laparoscopic skills improve.

The clinical characteristics and sonographic findings of maternal ovarian torsion in pregnancy

To investigate the incidence, risk factors, and sonographic findings of maternal ovarian torsion in pregnancy. Retrospective study. Department of Obstetrics/Gynecology of a tertiary referral center. Thirty-three pregnant women with 38 episodes of surgically proven torsion between the years 1993 to 2007. Surgical confirmation and treatment of torsion. Clinical and sonographic findings of ovarian torsion in pregnancy. Sixteen (48.5%) pregnancies were conceived by ovulation induction or in vitro fertilization. Twenty-one torsion events occurred in the first trimester (55.3%) versus 13 (34.2%) and 4 (10.5%) in the second and third trimester, respectively. All patients were admitted with abdominal pain, whereas 22 (57.9%) reported nausea/vomiting. The preoperative ultrasound examination showed unilocular ovarian cysts in 15 (39.5%) cases, multicystic ovaries in 14 (36.8%), and normally appearing ovaries in 9 (23.7%) cases. The multicystic ovary was more common in the first trimester torsion, whereas the "normal" appearing ovary was more common in the second and third trimester torsion (47.6% vs. 23.5% and 14.3% vs. 35.3%, respectively). The median duration from admission to surgery was 6 hours (range, 1 hour to 3.7 days), being significantly shorter in the first trimester. Ovarian torsion in pregnancy is more common in the first trimester, and induction of ovulation is a major risk factor.