NIH The incidence of the disease increases after ovarian stimulation for the treatment of fertility. Hasson J, Tsafrir Z, Azem F, Bar-On S, Almog B, Mashiach R, Seidman D, Lessing JB, Grisaru D. Am J Obstet Gynecol. The majority of ovarian torsion cases affect women of reproductive age, but girls can have the condition as well. This twisting can cut off blood flow to the ovary and fallopian tube. The diagnosis of OT during pregnancy is often missed due to nonspecific clinical features and uncommon objective findings. Smorgick N, Pansky M, Feingold M, Herman A, Halperin R, Maymon R. The clinical characteristics and sonographic findings of maternal ovarian torsion in pregnancy. The incidence of ectopic pregnancies after an in- vitro fertilization (IVF) procedure is 3 to 5 times higher than that of the general population and is reported to be in the range of 1 - 5 %. Introduction Ovarian torsion refers to the complete or partial rotation of the ovary on its ligamentous supports, which often leads to an impedance of its blood supply [1].Adnexal torsion during pregnancy is very rare and the incidence is reported to be in the range of 0,01-0,05 per hundred [2].It occurs in all three trimesters, but is most common in the first trimester. 2003 Oct;32(6):535-40. It can be intermittent or sustained and results in venous, arterial and lymphatic stasis. BMC Pregnancy Childbirth. A quick and confident diagnosis is … 2008 Dec;34(6):1020-5. doi: 10.1111/j.1447-0756.2008.00806.x. Although the etiology of the disease is not fully understood, predisposing factors include increased ovarian size, free mobility, and long pedicle. Bouguizane S, Bibi H, Farhat Y, Dhifallah S, Darraji F, Hidar S, Lassoued L, Chaieb A, Khairi H. J Gynecol Obstet Biol Reprod (Paris). Ovarian torsion in IVF twin pregnancy. Oophorectomy is commonly performed for adnexal torsion with a possible negative impact on fertility in women of reproductive age. Diagnosis of ovarian torsion in pregnancy can be made with clinical presentations in conjunction with ultrasound with color Doppler. Traditionally adnexal torsion presenting as acute abdomen is managed by laparotomy. When the patient is pregnant this can also lead to fetal mortality and potential loss of fertility for the patient. Women who were pregnant after IVM were younger (28.6 ± 3.4 years vs 29.3 ± 3.6 years, P = 0.005) and had ... such as ovarian hyperstimulation syndrome or ovarian torsion. The clinical presentation is often nonspecific with few distinctive physical findings, commonly resulting in delay in diagnosis and surgical management. Case Report . Ovarian torsion is most common in the first trimester of pregnancy, but can happen well into the third trimester, and torsion early in pregnancy seems to increase the risk for recurrence at a later gestational age . pregnancies, occurring more frequently in the first trimester after ovarian hyper stimulation. The diagnosis depends mainly on the clinical manifestation, D-dimer level and imaging tests such as compression ultrasonography and computed tomography pulmonary angiogram. Overall, most women recover well from ovarian torsion and the chances of it reoccurring are slim. To compare the clinical manifestation, management, and outcome of adnexal torsion in pregnant and nonpregnant women. Maternal ovarian torsion in pregnancy is a rare complication. Ovarian torsion (OT) during pregnancy is a rare condition that can cause maternal and fetal morbidity. 2020 Aug 24;20(1):483. doi: 10.1186/s12884-020-03173-7. Delayed diagnosis and treatment can cause ovarian necrosis and fetal loss. De‐torsion is a more conservative surgical approach that should be considered in … What every radiologist should know about adnexal torsion. They can occur during the childbearing years or after menopause.Most ovarian cysts are benign (not cancer) and go away on their own without treatment. 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. Copyright © 2011. Thirty six episodes of adnexal torsion in the pregnant group (56%) developed after treatment for infertility, compared with only 14 such episodes (7%) in the nonpregnant group (p < .001). Conservative management of ovarian torsion in pre-pubertal girl 3. It can also cause an infection (peritonitis) in the abdominal cavity. Patients undergoing laparoscopy treatment had smaller ovarian masses and a shorter postoperative hospital stay than those receiving laparotomy. 2010 Jun;202(6):536.e1-6. Epub 2014 Dec 11. Ovarian torsion during pregnancy is a rare condition, more common in the third trimester, and exceptional during the first trimester(1). The larger the cyst, the more likely that ovarian torsion will occur. Fertility and Sterility 1496.e10. The left side is thought to barely have space because of the sigmoid colon. An ovarian cyst is a fluid-filled sac in or on the surface of an ovary. Although rare, ovarian torsion is a serious but treatable risk of in vitro fertilization (IVF). Would you like email updates of new search results? Ovarian torsion seldom occurs during pregnancy. 2021 Jan 11. doi: 10.1007/s00404-020-05864-0. Open torsion, right salpingectomy and cystectomy were performed. It can cause internal bleeding. Pregnancy is a risk factor for torsion (odds ratio: 18:1) but remains an uncommon event (0.167%). The most common clinical presentation is acute onset of severe, colicky unilateral pelvic pain that is usually unremitting but can wax and wane in cases of incomplete, intermittent torsion. Pregnancy after treatment for infertility is a risk factor for adnexal torsion. Sixty-four pregnant women and 198 nonpregnant women with episodes of adnexal torsion. ruthieruthuk Mon 14-May-18 19:36:30. Adnexal torsion of hyperstimulated ovaries in pregnancies after gonadotropin therapy. Laparoscopy versus open surgery for adnexal masses in pregnancy: a meta-analytic review. The patient had a benign convalescence and was dis-charged on the third postoperative day. Clinical characteristics, treatment and outcomes of adnexal torsion in pregnant women: a retrospective study. 2008 Aug;34(4 Pt 2):683-7. doi: 10.1111/j.1447-0756.2008.00907.x. This study assessed the clinical characteristics, treatment and outcomes of adnexal torsion in pregnant women. None of these patients had significant complications during or after surgery. Materials and methods: I'm currently about 5 and a bit weeks pregnant. Conclusion: [Adnexal torsion: a report of 135 cases]. Eighty-two pregnant women with surgically … National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Hyttel TE, Bak GS, Larsen SB, Løkkegaard EC. This can cut off blood supply to the ovary. It is a gynecological emergency and requires urgent surgical intervention to prevent ovarian necrosis. Fertil Steril 2009. Study objective: Ovarian torsion (OT) is when an ovary twists on its attachment to other structures, such that blood flow is decreased. Published by Elsevier Inc. All rights reserved. A laparoscope (an instrument with a small lighted camera at the end) is inserted. Clinical, surgical and pathologic findings of adnexal torsion in pregnant and nonpregnant women. It is possible to perform volume reduction before OPU and also possible to become pregnant by embryo transfer afterward. A total of 98 cases were confirmed as ovarian torsion, including 72 cases in group 1 and 26 cases in group 2. Because success rates after IVM are correlated to the number of antral follicles, IVM has typically been offered to patients with polycystic ovary syndrome (PCOS) (Guzman et al., 2013). Figure 1 (A) Power Doppler on presentation of patient to the emergency department shows no vascular flow to left ovary. 2. The clinical symptoms could be confused with other acute abdominal conditions. Ovarian Torsion in Pregnancy (4 Posts) Add message | Report. Epub 2017 Sep 7. doi: 10.1016/j.fertnstert.2006.05.091. 2019 Mar;299(3):625-634. doi: 10.1007/s00404-018-05039-y.  |  Clinical characteristics, treatment and outcomes of adnexal torsion in pregnant women: a retrospective study. We report a very rare case of bilateral ovarian torsion complicating SOHSS in a singleton pregnancy, which was successfully managed by laparoscopic detorsion. Maternal adnexal torsion in pregnancy, with a reported incidence of 1–10 per 10,000 spontaneous pregnancies, is very uncommon. Pregnancy after treatment for infertility is a risk factor for adnexal torsion. 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. J Gynecol Obstet Biol Reprod (Paris). Rarely, a cyst may be malignant (cancer) (see FAQ096 Ovarian Cancer). Recurrence of ovarian torsion occurs more frequently in pregnant patients, and in particular in enlarged multicystic ovaries. Approximately 20% of the cases occur during pregnancy 1. abdominal pain, emergency laparotomy was performed, which revealed ruptured ectopic pregnancy and ovarian torsion with active bleeding and a 7×6 cm cyst in the same side with two rounds of torsion. Ovarian torsion is a condition that occurs when an ovary twists around the ligaments that hold it in place. HHS The increased use of assisted reproductive technologies has led to an increase in the risk of adnexal torsion, particularly in pregnant women or women with ovarian hyperstimulation syndrome (OHSS). Other symptoms may include nausea. The mean (SD) gestational age in the pregnant group was 11.5 (7.7) weeks. 2020 Aug 24;20(1):483. doi: 10.1186/s12884-020-03173-7. However, with in vitro fertilization (IVF) treatments, ovarian hyperstimulation may increase the size of the ovaries and result in the occurrence of adnexal torsion. 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 ). J Minim Invasive Gynecol 2007; 14:270. Ovarian torsion is also a medical emergency where a large cyst causes an ovary to twist or move from its original position. Please enable it to take advantage of the complete set of features! 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. To review the literature on the available surgical options. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Ovarian torsion is usually treated with laparoscopic surgery. Ssi-Yan-Kai G, Rivain AL, Trichot C, Morcelet MC, Prevot S, Deffieux X, De Laveaucoupet J. Emerg Radiol. Clipboard, Search History, and several other advanced features are temporarily unavailable. Lo LM, Chang SD, Horng SG, Yang TY, Lee CL, Liang CC. Interventions:  |  The diagnosis depends mainly on the clinical manifestation, D-dimer level and imaging tests such as compression ultrasonography and computed tomography pulmonary angiogram. Ye P, Zhao N, Shu J, Shen H, Wang Y, Chen L, Yan X. Arch Gynecol Obstet. Successful pregnancy complicated by early and late adnexal torsion after in vitro fertilization. Djavadian D, Braendle W, Jaenicke F. Laparoscopic oophoropexy for the treatment of recurrent torsion of the adnexa in pregnancy: case report and review. Ovarian Torsion Blood flow to the ovary is reduced or cut off when the weight of a cyst causes the ovary to turn over on itself one or more times (called ovarian torsion). Hasiakos D, Papakonstantinou K, Kontoravdis A, Gogas L, Aravantinos L, Vitoratos N. J Obstet Gynaecol Res. Here, we report two cases of ovarian torsion after IVF and discuss the optimal management of this … Ovarian torsion is an acute abdomen requiring prompt intervention. Ovarian rupture and torsion . Lee JH, Roh HJ, Ahn JW, Kim JS, Choi JY, Lee SJ, Lee SH. Taiwan J Obstet Gynecol. Twenty pregnant women were identified with surgically proven OT, 10 in the first trimester, eight in the second, and two in the third. B. ackground he incidence of adnexal masses in pregnancy ranges from 1 in 81 to 1 in 8000 pregnancies. • There is a high rate of cyst recurrence after the procedure (33–40%) • Offered only to simple benign cysts • If it’s a malignant cyst then it may increase the stage of cancer, but it is uncertain if this worsens the prognosis. Because pregnant women are usually … Adnexal torsion during pregnancy is a gynecological emergency. AbstractObjectiveMaternal ovarian torsion in pregnancy is a rare complication. Adnexal torsion during pregnancy is a rare condition. Laparoscopic Detorsion of Twisted Ovary in a Nulliparous Woman with a Recurrent, Bilateral Mature Cystic Teratoma 5. Similar But Different: A Comparison of Adnexal Torsion in Pediatric, Adolescent, and Pregnant and Reproductive-Age Women. Laparoscopy versus laparotomy for surgical intervention of ovarian torsion. Ovarian torsion is a disorder with a very high patient morbidity. This article provides an overview of the symptomatology, ultrasound diagnosis and classification, as well as treatment options for ovarian torsion. It often forms during or after ovulation. It is possible to perform volume reduction before OPU and also possible to become pregnant by embryo transfer afterward. If an ovary is lost to necrosis, conception and pregnancy are still possible. Design: Ovarian torsion doesn’t affect fertility in any way. Conclusion: However, when torsion occurs during pregnancy, symptoms are … Copyright © 2012 AAGL. In the first trimester, women may have corpus luteum cysts that cause the ovary to … The pregnancy was fine, butplacenta previa was diagnosed, so the patient under … NLM While classically the pain is sudden in onset, this is not always the case. Medicine (Baltimore). Most patients in the first trimester (75%) and a minority in the second and third trimesters (37.5%) received management via laparoscopy. Ethical issues. Both hemorrhagic and ischemic necrosis were present.  |  Ovarian torsion associated with infertility treatment often occurs mainly with ovarian hyperstimulation syndrome (OHSS) after OPU, but if it seems to be caused by ovarian swelling just before OPU. Ovarian torsion associated with infertility treatment often occurs mainly with ovarian hyperstimulation syndrome (OHSS) after OPU, but if it seems to be caused by ovarian swelling just before OPU. 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. This site needs JavaScript to work properly. USA.gov. Sonographic demonstration of multicystic ovaries was more common in pregnant women with recurrent torsion than in women with a single episode of torsion (86% vs 31%; p = .009).  |  Delayed diagnosis and treatment can cause ovarian necrosis and fetal loss. USA.gov. The difficulty for the clinician lies in differentiating between ovarian torsion and other etiologies such as ectopic pregnancy, appendicitis, ovarian cysts, pelvic inflammatory disease (PID), urinary tract infection (UTI), nephrolithiasis, and endometriosis. Ovarian torsion, a major complication of OHSS, is estimated to occur in 12-25% of pregnant women. Recurrence of ovarian torsion occurs more frequently in pregnant patients, and in particular in enlarged multicystic ovaries. Ovarian torsion is most common in the first trimester of pregnancy, but can happen well into the third trimester, and torsion early in pregnancy seems to increase the risk for recurrence at a later gestational age (1). Maternal adnexal torsion in pregnancy is associated with significant risk of recurrence. A repeated episode of torsion occurred more frequently in the pregnant group (14% vs 4%; p = .03). Pregnant patients are reported to have a 1% increased risk of ovarian tor-sion compared to nonpregnant patients. 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/. Here, we report our experience managing ovarian torsion in early pregnancy after IVF treatment. Pregnant women can experience ovarian torsion as well as those who are not pregnant. Comparison of adnexal torsion between pregnant and nonpregnant women. Sorry if this comes up twice, I posted but nothing appeared so don't think it uploaded properly. Surgery to treat proved adnexal torsion.  |  Maternal ovarian torsion in pregnancy is a rare complication. VTE after ovarian torsion-detorsion in pregnancy is an infrequent event and is more likely to occur in the first and second trimester. The patient was discharged 48 hours after the operation with a good general condition Results: doi: 10.1097/MD.0000000000020627. Distinctive pattern of left-right asymmetry of ovarian benign teratomas in Chinese population: a 12-year-long cross-sectional study. Fertil Steril. 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. Setting: In our patient, right sided ovarian torsion was suspected as appendicitis. VTE after ovarian torsion-detorsion in pregnancy is an infrequent event and is more likely to occur in the first and second trimester. Objective: Acta Obstet Gynecol Scand. If a disease such as ovarian tumor is found during the work-up, attempts to become pregnant can be delayed until the disease has been treated. It is possible to perform volume reduction before OPU and also possible to become pregnant by embryo transfer afterward. 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. 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