In the presence of an ovarian cyst, a simple cystectomy can be performed in the absence of overt malignancy. Diagnosis can usually be made on the basis of the characteristic clinical presentation in conjunction with ultrasound evidence of a unilaterally enlarged adnexal mass. . Arena S, Canonico S, Luzi G, Epicoco G, Brusco GF, Affronti G. Fertil Steril. 2009 Oct;92(4):1496.e9-1496.e13. Recurrence of ovarian torsion after bilateral synchronous torsion and oophoropexy: A case report and review of the literature 27. Case report of ovarian torsion in the first trimester of pregnancy The patient was counseled concerning the risk of abortion and the possibility of adnexal torsion, and informed consent for lap-aroscopy and /or abdominal exploration with the possible need for salpingo-oophorectomy was obtained. 2011 Dec;50(4):458-62. doi: 10.1016/j.tjog.2011.10.010. Likewise, if the "chocolate" contents of an endometrioma or the fluid content of a potentially malignant cyst spills within the peritoneal cavity, prolonged irrigation with warmed saline is judicious. 1993;38:465-468. In all cases, definitive diagnosis must await careful examination of permanent sections. Epub 2008 Nov 5. Epub 2019 May 8. 16. Ovarian pregnancy torsion. Due to this reason, in most of the cases, the diagnosis is made late, causing severe damage to the ovary. . 6. If not treated quickly, it can result in loss of an ovary. Physical examination showed she was diaphoretic. © 2021 MJH Life Sciences and HCPLive - Clinical news for connected physicians. After ovarian stimulation, the incidence of AT in pregnancy rises to 6%, reaching up to 16% in cases of ovarian hyperstimulation syndrome [4, 5]. 1989;28:21-25. Feng JL, Zheng J, Lei T, Xu YJ, Pang H, Xie HN. Eventual radiology ultrasound showed decreased but present flow in the right ovary. An ovarian cyst (≥25 mm simple or complex cyst) can be found in up to 5% of pregnancies, 19 with a 1–3% torsion rate. 26. USA.gov. It contained a 14-cm simple-appearing cyst. 2019 Jul;49(3):221-223. doi: 10.1177/0049475519847327. Adnexal mass occurring with intrauterine pregnancy: report of 54 patients requiring laparotomy for definitive management. 2004;270:119-121. 2018 Nov;44(11):2110-2114. doi: 10.1111/jog.13758. The decision to proceed to surgery during pregnancy is somewhat complex, since the well-being of both mother and fetus must be taken into account. 1999;6:139-143. | Hurd WW, Smith AJ, Gauvin JM, et al. Physicians should be aware of a high risk of malignancy in women with an adnexal mass of over 15 cm. Laparoscopic detorsion allows sparing of the twisted ischemic adnexa. Adnexal masses in pregnancy: a review of eight cases undergoing surgical management. Ovarian torsion is the total or partial rotation of the adnexa around its vascular axis. Symptoms typically include pelvic pain on one side. Torsion of ovarian tumors occurred predominantly in the reproductive age group. VTE after ovarian torsion-detorsion in pregnancy is an infrequent event and is more likely to occur in the first and second trimester. Reapproximation with internal sutures may help subsequent reformation of the normal ovarian profile, but sutures on the external ovarian surface should be avoided to minimize the subsequent risk of adhesion formation.19. Uterine monitoring in the immediate postanesthesia period for patients in the second or third trimester is an important method for the early detection of regular uterine contractile activity. Crit Ultrasound J. She was placed on progesterone therapy upon hospital discharge and eventually delivered a healthy term infant. Fall in blood pressure and heart rate is another common response to visceral and deep somatic nociception.7, Ultrasound is the diagnostic modality of choice and will most often reveal a unilateral ovarian enlargement that appears solid, cystic, or complex, with or without fluid collections in the pouch of Douglas. 1999;19:124-126. She also presented with one of the most recognized risk factors for ovarian torsion: ovarian hyperstimulation syndrome with consequent cystic increase in ovarian volume (being the other main risk factors for ovarian torsion the hypermobility of the ovary, the presence of adnexal masses and pregnancy ). Chang SD, Yen CF, Lo LM, Lee CL, Liang CC. | Pregnancy is also a risk factor for torsion. 1988;158:1029-1034. Comparison of ovarian torsion between pregnant and non-pregnant women at reproductive ages: sonographic and pathological findings. 2001;357:176-182. Pediatric patients with torsion are more likely to have a normal ovary and their increased risk is thought to be due to an elongated utero-ovarian ligament. To find the risk factors of torsion and malignancy for adnexal tumors during pregnancy. . Key Words: Maternal ovarian torsion, pregnancy, ultrasound Maternal ovarian torsion in pregnancy is a very rare compli- COVID-19 is an emerging, rapidly evolving situation. Thus, ovarian torsion needs to be considered as a differential diagnosis. 2004;1019:237-245. A 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. As the woman is likely to present with nonspecific symptoms of lower abdominal pain, nausea, and vomiting, ovarian torsion can often be misdiagnosed as appendicitis or preterm labour. Objective: National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. The diagnosis depends mainly on the clinical manifestation, D-dimer level and imaging tests such as compression ultrasonography and computed tomography pulmonary angiogram. Jayr C, Beaussier M, Gustafsson U, et al. Hurd WW, Himebaugh KS, Cofer KF, et al. Early diagnosis of ovarian torsion by color Doppler sonography. Chapron C, Capella-Allouc S, Dubuisson JB. Another significant risk factor for ovarian torsion is the presence of cysts or abnormal masses. The pain started 6 hours earlier, waking her from sleep early in the morning. 5. Diagnosis of Ovarian Torsion. She reported no vaginal bleeding or discharge, nausea, vomiting, fever, diarrhea, or constipation. 4. Lee CH, Raman S, Sivanesaratnam V. Torsion of ovarian tumors: a clinicopathological study. Ovarian torsion in pregnancy is more common in the first trimester, and induction of ovulation is a major risk factor. Cohen SB, Oelsner G, Seidman DS, et al. All age groups can be affected, but ovarian stimulation, as found during early pregnancy or infertility treatment, is a major risk factor. If a dermoid is accidentally ruptured, every effort should be made to avoid spilling the very irritating sebaceous contents into the peritoneal cavity. Uterine monitoring during surgery is controversial, since fetuses appear to do well as long as the mother is well oxygenated.13 In a maternal crisis, resuscitation of the mother rather than delivery is the ideal approach. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. Evidence suggests that ovarian cysts are very common in the asymptomatic pregnant cohorts; however, they spontaneously resolve as the pregnancy progresses. Pelvic examination revealed a 16-week sized uterus, with a closed cervix, and a tender 10-cm left adnexal mass. This most often happens in the first trimester, usually between weeks 6-14 of gestation (Martin & Magee). However, reestablishing ovarian circulation by untwisting the ovarian pedicle has recently been shown to result in viable ovarian tissue on the affected side, with no systemic complications reported to date.9,14,15 Conservative treatment appears to be warranted to preserve fertility, even for adnexa that initially appear nonviable and purple or black in color.16,17. It is frequently associated with ovarian stimulation for in vitro fertilization (IVF) or with ovarian masses, mainly of functional origin. 1991;78:249-253. Pediatric emergency medicine point-of-care ultrasound: summary of the evidence. The incidence of ovarian torsion rises 5-fold during pregnancy to approximately 5 per 10,000 pregnancies. Visser BC, Glasgow RE, Mulvihill KK, et al. 2. Retrospective, historical cohort study. Ovarian torsion is a medical emergency. Trop Doct. The incidence of ovarian torsion varies in pregnancy. Background: nancy have been mostly reported previously in isolated case reports and small case series (3–6), and there appears METHODS to be limited information on the subject. After untwisting the ovarian pedicle, the ovary returned to its normal color and showed no signs of hemorrhage or necrosis. Ovarian torsion during pregnancy is a fairly uncommon complication with a high patient morbidity and fetal mortality if not immediately treated. Quant Imaging Med Surg. Ovarian torsion, also sometimes termed adnexal torsion or tubo-ovarian torsion, refers to rotation of the ovary and portion of the fallopian tube on the supplying vascular pedicle.. Euvolemic hypoosmolar hyponatraemia may be due to hypothyroidism, adrenal insufficiency or SIADH. The loss of an ovary can compromise the following fertility. The patient was not on ovarian stimulation treatments. Epub 2016 Nov 3. Many anatomic and physiologic factors predispose a woman to experience torsion of the ovary, but the true etiology is not always identified. Whether there are differences in the ultrasonic features and histological diagnosis of ovarian torsion among pregnant and non-pregnant women is still unclear, but a better characterization of ovarian torsion may be helpful … We report a case of ovarian torsion in pregnancy. 1985;152:456-461. Malignant tumors occur in less than 6% of cases.2 Serous cystadenofibromas, as in our patient, are relatively common, accounting for approximately 8% of ovarian neoplasms.3, The incidence of ovarian torsion rises 5-fold during pregnancy to approximately 5 per 10,000 pregnancies.4 Its most common cause in pregnancy is a corpus luteum cyst, which usually regresses spontaneously by the second trimester.5 Ovarian torsion, therefore, occurs most frequently in the first trimester, occasionally in the second, and rarely in the third.6, Ovarian torsion can sometimes be difficult to diagnose in pregnancy. Venous or lymphatic blockade could result in potentially massive enlargement of the ovary caused by continued arterial inflow to the ovary without venous outflow. Your risk of developing an ovarian cyst is heightened by: • Hormonal problems. 1990;76:403-406. Ovarian cysts and torsion in assisted reproduction and pregnancy. Torsion occurs due to two main reasons 2: 1. hypermobility of the ovary: <50% 2. adnexal mass: ~50-80% 2.1. most lesions are dermoid cysts or paraovarian cysts 2.2. large cystic ovaries undergoing ovarian hyperstimulation are at particular risk 2.3. masses between 5-10 cm are at most risk 13 It is a gynecological emergency and requires urgent surgical intervention to prevent ovarian necrosis. If this occurs, prolonged peritoneal irrigation with warmed saline will prevent peritonitis. Risks of torsion and malignancy are not directly proportional to increasing mass size in pregnant women. The cyst was excised in a usual fashion (Figure 2). Risk factors. VTE after ovarian torsion-detorsion in pregnancy is an infrequent event and is more likely to occur in the first and second trimester. 19. Other risk factors of ovarian torsion include: Woman suffering from polycystic ovarian syndrome Have had a surgery for closing fallopian tubes (tubal litigation) Her general and gynecologic history was noncontributory. 3. Cavun S, Goktalay G, Millington WR. Ovarian torsion is when an ovary twists on its attachment to other structures, such that blood flow is decreased. n ovarian torsion in our hospital from January 2012 to June 2018. Djavadian D, Braendle W, Jaenicke F. Laparoscopic oophoropexy for the treatment of recurrent torsion of the adnexa in pregnancy: case report and review. Since these symptoms are similar to those of a urinary tract infection, kidney stones, appendicitis, ovarian abscess, and ectopic pregnancy, it becomes difficult for the doctor to diagnose the ovarian torsion. The incidence of ovarian torsion rises 5-fold during pregnancy to approximately 5 per 10,000 pregnancies. Thirty-three pregnant and 72 nonpregnant patients diagnosed with surgically proven ovarian torsion were assessed during the study period. The remainder of her pregnancy was unremarkable, and she delivered a healthy infant vaginally at term. 1998;81:887-892. Patients with actue inferior MIs should be monitored closely for preload because RV dysfunction is common. Torsion of ovarian tumors occurred predominantly in the reproductive age group. Background: Ovarian torsion (OT) is one of the most common gynecologic surgical emergencies. Fertil Steril. Initial Actions and Primary Survey. Diagnose with ultrasound and Doppler. Ovarian torsion (OT) is one of the most common gynecologic surgical emergencies. Prognostic importance of degree of differentiation and cyst rupture in stage I invasive epithelial ovarian carcinoma. It’s unclear how often ovarian torsion occurs, … Contact us to talk with a fertility expert and determine an effective plan of action if you are experiencing symptoms of this complication. All rights reserved. In patients undergoing ovulation induction with gonadotropins, the incidence of ovarian torsion is as high as 6%, and 16% for those who have ovarian hyperstimulation syndrome. Ovarian torsion in in vitro fertilization-induced twin pregnancy: combination of Doppler ultrasound and laparoscopy in diagnosis and treatment can quickly solve the case. Risk factors include ovarian cysts, ovarian … Torsion of normal-sized ovary during late pregnancy: A case report and review of the literature. Horrigan TJ, Villarreal R, Weinstein L. Are obstetrical personnel required for intraoperative fetal monitoring during nonobstetric surgery? Adnexal torsion is a rare cause of acute abdominal pain during pregnancy. 7. Adnexal masses (Table) are among the most common indications for surgery during pregnancy.10 For years, the treatment of choice for ovarian torsion was salpingooophorectomy, taking special care to avoid untwisting the ovarian pedicle to prevent emboli and toxic substances related to hypoxia from entering the peripheral circulation. 1. A few series of studies have focused on ovarian torsion during pregnancy or have compared ovarian torsion in pregnant and non-pregnant women (6,9,17,18). 2009 Dec;92(6):1983-7.doi: 10.1016/j.fertnstert.2008.09.028. Our patient had received ovulation induction prior to pregnancy and there was an excessive response (16 oocytes retrieved), but she was not complicated by ovarian hyperstimulation. The risk is greater in pregnant women and those suffering from menopause. Ovarian torsion does occur in normal ovaries. Pan HS, Huang LW, Lee CY, et al. Risk factors for ovarian torsion are pregnancy, ovulation induction during fertility treatment, and ovarian masses (especially if >5cm). PCA morphine. Diagnosing OT in early pregnancy can be challenging. Turk J Emerg Med. Laparoscopic management of twelve consecutive cases of ovarian torsion: Four years experience 29. She had no history of recent illnesses, urinary complaints, or treatment for infertility. Having a cyst on your ovary is the biggest risk factor for ovarian torsion, because a cyst can make the ovary unbalanced and cause it to twist on itself. When present, microscopic examination of frozen sections can help determine if intraoperative staging is required. Pregnancy is a risk factor for torsion (odds ratio: 18:1); however, it remains an uncommon event (0.167%). Seidman DS, et al to this reason, in most of the ovary? is it really rare. Sohss in a hypercoagulable state ovary twists on its attachment to other structures, such as luteomas diagnosis usually. 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