January 27, 2021

ovarian torsion in second trimester

The Doppler blood flow signal disappeared in 62.5% of the patients. Once ovarian torsion is diagnosed, the patient should have nothing by mouth. Ectopic pregnancy is when a fertilized egg implants in an area outside of the uterus. The symptoms are nonspecific, and can be confused with other acute abdominal conditions such as appendicitis, ureteral or renal colic, cholecystitis and bowel obstruction. Adnexal torsion is frequently associated with ovarian hyperstimulation therapy or ovarian masses. Ovarian torsion is rare in the second and third trimester of pregnancy. 8 The safest time to perform laparoscopic surgery in pregnancy is usually the second trimester, and surgery prior to the third trimester has the least risk of premature delivery. ... CPT, MC, USA, is a second-year resident in the Tripler Army Medical Center Department of Obstetrics and Gynecology. The torsion of normal adnexa is rare during pregnancy, especially in the third trimester. RESULTS: Sixteen (48.5%) pregnancies were conceived by ovulation induction or in vitro fertilization. Adnexal torsion during pregnancy is a rare condition, more common in the second and early third trimester, and exceptional during the first trimester . Ovarian torsion occurred most commonly in the first trimester (15/33, 45.4%), whereas it may occur in the second and the third trimester (27.3% in both groups). The torsion of normal adnexa is rare during pregnancy, especially in the third trimester. Conclusion(s): Ovarian torsion in pregnancy is more common in the first trimester, and induction of ovulation is a major risk factor. The blood supply to the ovaries is disrupted, and it causes unbearable pain in pregnant women. Hum Reprod. 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.. size. Masses that persist into the second trimester are at risk for torsion, rupture, or labor obstruction. Early diagnosis and treatment are es-sential to save the adnexa and decrease maternal and fetal morbidity [8]. Hence, ovarian torsion in pregnancy occurs most commonly in the first trimester, occasionally in the second, and rarely in the third. Background factors (diameter of largest myoma, number of ovarian torsion in children treated in our medical center between 1997-2008. myomas, incision sites, and number of suture layers) of the wound Setting: The department of Gynecology at the Lis Maternity Hospital, significantly associated with adhesion were analyzed for 296 separate a tertiary referral center in Tel Aviv. 13. [4] Differential diagnosis could be other acute abdominal conditions such as appendicitis, ureteral or renal colic, cholecystitis and bowel obstruction, non preganant horn of bicornuate uterus, appendiceal abscess and ectopic pregnancy. Treatment involves surgery, and though it is not a major one, you will need anaesthesia. This study assessed the clinical characteristics, treatment and outcomes of adnexal torsion in pregnant women. 4 Most frequent complication of ovarian mass in pregnancy is torsion 6 and in our series 2 patients presented with ovarian and parovarian cyst complete torsion, one in first trimester and one in late third trimester. Adnexal torsion is frequently associated with ovarian hy-perstimulation therapy or ovarian masses. Ovarian torsion may occur at any time during pregnancy, although it has been reported to occur more frequently in the first trimester ( 13 , 15 , 16 , 22 , 23 ). Preterm labor. Eighty-two pregnant women with surgically … Generally, surgical management of ovarian masses has been recommended in the second trimester to minimize the risk of miscarriage, torsion, … Adnexal torsion is difficult to diag- It may present with nonspecific signs and symptoms, and should be considered in any female with acute abdominal pain. It is a gynecological emergency and requires urgent surgical intervention to prevent ovarian necrosis. Laparoscopic unwinding of hyperstimulated ischaemic ovaries during the second trimester of pregnancy. We aimed to evaluate the feasibility of prophylactic laparoscopic adnexal surgery during the late first trimester and second trimester for the prevention of adnexal torsion. Management Cysts less than 6 centimetres in diameter and appearing benign on ultrasound are generally treated conservatively as they may undergo spontaneous resolution. PID (first trimester) Placental abruption. Treatment options are limited to surgery, either by laparoscopy or laparotomy. 1 – 4 While recurrence of HL in subsequent pregnancies has been reported in at least 3 cases, 1 1 8 we had none in our series. Typically, the ovaries return to normal size during the first few months postpartum. MAIN OUTCOME MEASURE(S): Clinical and sonographic findings of ovarian torsion in pregnancy. Otherwise, a cystic tumour identified in the first trimester should be characterised and … A 22-year-old second gravida presented at 22+ weeks gestation with severe abdominal pain and shock. The diagnosis is based on an awareness of the relevant risk factors, the clinical presentation, and a high index of suspicion. Most functional cysts resolve by the early second trimester.9,10 In rare cases, a cyst may develop complica-tions such as torsion or rupture, causing acute pain or haemorrhage. Abstract. The median duration from admission to surgery was 6 hours (range, 1 hour to 3.7 days), being significantly shorter in the first trimester. It is an unusual complication of pregnancy and for most obstetricians it probably represents a ‘once-in-a-lifetime’ diagnosis. Ovarian torsion, therefore, occurs most frequently in the first trimester, occasionally in the second, and rarely in the third. Even pregnant women can develop ovarian torsion because of the corpus luteum cyst. 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. 31) weeks: 53 (64.6%) were in the first trimester, 21 (25.6%) were in the second trimester, and 8 (9.8%) were in the third trimester. Torsion of a large ovarian dermoid cyst in the second trimester of pregnancy and its management: a case report Author: Goli Kazemi Nia Subject: Background:The Dermoid cyst is the most common ovarian germ cell tumor in pregnant women. No differences were observed in age, surgical history, presenting symptom, time from symptom onset to gynecologic ED admission, time from admission to surgery, affected side, No. We retrospectively reviewed eight patients who underwent laparoscopic surgery for ovarian cysts during the late first trimester or second trimester (April 2012-September 2016). Ovarian Torsion. Assisted conception: the induction of ovulation during infertility tratment can lead to theca lutein cysts and expansion of the ovarian volume predisposing to torsion. Adnexal torsion during pregnancy is a gynecological emergency. So, ovarian torsion during pregnancy occurs most likely in the first trimester, and rarely in the second and third trimesters. An ovarian mass that iş 6 cm in diameter or symptomatic is usually considered signiWcant and requires surgical intervention. The most common symptoms and signs were sudden pelvic pain (100%) and adnexal or pelvic masses (97.6%), followed by nausea and vomiting (61%). ... Levy T, Dicker D, Shalev J, et al. Uterine torsion is defined as rotation of the uterus of more than 45° on its long axis. The corpus luteum regresses in the second trimester, hence the risk of torsion is greatest in the first trimester and decreases thereafter. Incidence of ovarian surgery required in pregnancy is about 1:1312 pregnancies. Management of adnexal torsion in pregnancy is controversial owing to the associated risks. Ovarian torsion is an uncommon gynecological emergency that requires prompt recognition and treatment. It can be intermittent or sustained and results in venous, arterial and lymphatic stasis. 5 Laparoscopy during pregnancy has an increased risk of injury to the uterus and possibly pregnancy loss. 3,4 The fifth most common surgical emergencies are ovarian torsions. Ovarian torsion. Delayed diagnosis and treatment can cause ovarian necrosis and fetal loss. During pregnancy diagnosis of ovarian torsion can be challenging. Early diagnosis and treatment are essential to save the adnexa and decrease maternal and fetal morbidity [ 8 ]. 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 ... produces hormones that initially help sustain the pregnancy. Adnexal torsion during pregnancy is a rare event and bilateral adnexal torsion is even rarer. Progression to ovarian torsion can cause loss of ovarian function if not treated promptly . 12. When the enlarged ovaries are detected in the second trimester, some may continue to increase in size until delivery and, less often, others may revert to normal during the pregnancy. Thus, we can conclude that first trimester torsion is usually associated with cystic or multicystic ovaries (the latter most often found in patients treated by ovulation induction), and that the gradual regression of these ovarian cysts during the second and third trimester is connected to the lower risk of torsion. Fetal mortality up to 12% and occasional maternal mortality are reported. AbstractObjectiveMaternal ovarian torsion in pregnancy is a rare complication. Diagnosis is hampered by non-specific symptoms common in pregnancy (nausea, vomiting). The corpus luteum cyst goes away on its own by the second trimester. The cyst usually goes away by the second trimester. If the fallopian tubes or the ovary gets twisted, it is referred to as ovarian torsion, and this can lead to a lot of pain. Ovarian torsion during pregnancy occurs in about 12% to 18% of cases of ovarian torsion overall (5,6), which is in agreement with our data. Ovarian torsion in second trimester of pregnancy, though is an extremely rare problem in pregnancy, adnexal torsion should be taken into consideration in the differential diagnosis of abdominal pain. Ovarian torsion can be managed conservatively if diagnosed at an earlier gestational age. 2. Hence this case is reported. A retrospective study was conducted at a tertiary center between January 2008 and January 2018. During pregnancy, the risk of complications such as torsion, rupture,and infection increases in dermoid cysts. Symptomatic ovarian cysts have an incidence of 2.3–8.8% in pregnancy, and the incidence of adnexal masses requiring surgery in pregnancy is reportedly 1–2.3% of all gestations . wounds. 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