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Shrateh ON, Jobran AWM, Alwahsh MJ, Naasan M. Successful pregnancy-preserving laparoscopic adnexectomy for complicated ovarian torsion during late pregnancy: A case report and review of the literature. Int J Surg Case Rep 2023; 106:108287. [PMID: 37148729 DOI: 10.1016/j.ijscr.2023.108287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 04/26/2023] [Accepted: 04/28/2023] [Indexed: 05/08/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE A rare disorder called ovarian torsion (OT) during pregnancy can harm both the mother and the fetus. Predisposing variables for the condition include enlarged ovaries, free mobility, and a long pedicle, despite the fact that its genesis is not entirely understood. When ovarian stimulation is used to treat infertility, the disease's incidence rises. Magnetic resonance imaging and ultrasound are examples of diagnostic imaging modalities (MRI). CASE PRESENTATION A 26-year-old woman with a 33-week pregnancy presented to our emergency department with acute, severe left groin pain. Laboratory evaluation was unremarkable except for leukocytosis (18.800/μL) with neutrophil shift. A radiologist used ultrasound to examine the abdomen and pelvis, and the results revealed a bulk enlargement of the left adnexa. The patient underwent a non-enhanced MRI in order to obtain a conclusive diagnosis, which revealed a massive enlargement and torsion of the left ovary with large areas of necrosis. The patient underwent a successful laparoscopic adnexectomy with preservation of the pregnancy. She delivered a healthy baby and had an uneventful follow up period. DISCUSSION The etiology of OT is largely unknown. Any tendency to rotate the infundibulopelvic and utero-ovarian ligaments should be considered as a possible etiology. The prevalence of OT among pregnant women is underreported and determined by small limited studies. CONCLUSION Ovarian torsion should be included in the differential diagnosis of patients with suspected acute abdomen in advanced stages of pregnancy. In addition, MRI should be used as an alternative diagnostic modality in patients with normal sonographic findings.
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Affiliation(s)
- Oadi N Shrateh
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine.
| | | | - Mohammad J Alwahsh
- Department of Obstetrics and Gynecology, Al-Istishari Arab Hospital, Ramallah, Palestine
| | - Mashhour Naasan
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine; Department of Obstetrics and Gynecology, Al-Istishari Arab Hospital, Ramallah, Palestine
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Youngster M, Kedem A, Avraham S, Yerushalmi G, Baum M, Maman E, Hourvitz A, Gat I. Treatment safety of ART cycles with extremely high oestradiol concentrations using GnRH agonist trigger. Reprod Biomed Online 2023; 46:519-526. [PMID: 36566147 DOI: 10.1016/j.rbmo.2022.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/26/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022]
Abstract
RESEARCH QUESTION Are IVF treatments with extremely high peak oestradiol levels and gonadotrophin releasing hormone (GnRH) agonist trigger associated with higher complication rates? DESIGN A retrospective cohort study including patients from two large medical centres treated between 2019 and 2021. A study group with extremely high peak oestradiol levels (≥20,000 pmol/l on the day of ovarian stimulation, or ≥15,000 pmol/l on the previous day) and a control group with normal range oestradiol levels (3000-12000 pmol/l) that received GnRH agonist triggering. Patients were surveyed about complaints and medical care related to ovum retrieval and medical files were reviewed. Major complication rates and the need for medical assistance were compared. RESULTS Several differences between the study and control group were observed because of the study design: mean age was 33.01 ± 5.14 versus 34.57 ± 4.52 (P < 0.001), mean peak oestradiol levels was 26645.34 ± 8592.57 pmol/l versus 7229.75 ± 2329.20 pmol/l (P < 0.001), and mean number of oocytes were 27.55 ± 13.46 versus 11.67 ± 5.76 (P < 0.001) for the study and control group, respectively. Major complications and hospitalization rates were similar between the study and control groups (three [1.25%] versus one [0.48%]; P = 0.62 and three [1.25%] versus two [0.96%]; P = 1.0, respectively). Thirty-six patients (15.1%) in the study group and 11 (5.3%) in the control group sought medical care after retrieval, mostly due to abdominal pain, without the need for further workup or hospitalization (P < 0.001). CONCLUSIONS Extremely high oestradiol levels were not associated with thromboembolic events, higher major complication or hospitalization rates, and therefore may be considered safe. Nevertheless, patients may be informed of possible higher rates of discomfort, mostly abdominal pain. Larger studies are warranted to confirm our results.
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Affiliation(s)
- Michal Youngster
- IVF Unit, Department of Obstetrics and Gynecology, Shamir Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; IVF Unit, Herzliya Medical Centre, Herzliya, Israel.
| | - Alon Kedem
- IVF Unit, Department of Obstetrics and Gynecology, Shamir Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; IVF Unit, Herzliya Medical Centre, Herzliya, Israel
| | - Sarit Avraham
- IVF Unit, Department of Obstetrics and Gynecology, Shamir Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; IVF Unit, Herzliya Medical Centre, Herzliya, Israel
| | - Gil Yerushalmi
- IVF Unit, Department of Obstetrics and Gynecology, Shamir Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Micha Baum
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; IVF Unit, Herzliya Medical Centre, Herzliya, Israel; IVF Unit, Department of Obstetrics and Gynecology, Sheba Medical Centre, Ramat-Gan, Israel
| | - Ettie Maman
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; IVF Unit, Herzliya Medical Centre, Herzliya, Israel; IVF Unit, Department of Obstetrics and Gynecology, Sheba Medical Centre, Ramat-Gan, Israel
| | - Ariel Hourvitz
- IVF Unit, Department of Obstetrics and Gynecology, Shamir Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; IVF Unit, Herzliya Medical Centre, Herzliya, Israel
| | - Itai Gat
- IVF Unit, Department of Obstetrics and Gynecology, Shamir Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Inoue D, Asada Y. Successful Oocyte Retrieval After Follicular Fluid Aspiration in Suspicious of Ovarian Torsion. Cureus 2020; 12:e12192. [PMID: 33489602 PMCID: PMC7816545 DOI: 10.7759/cureus.12192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
During controlled ovarian stimulation, a 34-year-old woman complained of right lower abdominal pain after the decision to retrieve oocytes. Ovarian torsion was suspected and confirmed, so aspiration of follicular fluid was performed prior to oocyte retrieval for volume reduction of the affected ovary. Two days after that, oocytes were successfully collected. Four months later, the frozen embryo was transferred and got pregnant. In conclusion, it is possible to perform volume reduction before ovum pick up (OPU), and also possible to become pregnant by embryo transfer afterward. This is the rare case report of follicular aspiration prior to oocyte retrieval.
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Yildirim H, Ozdinc S. A rare condition in the third trimester of pregnancy: Ovarian torsion. Turk J Emerg Med 2020; 20:42-45. [PMID: 32355901 PMCID: PMC7189823 DOI: 10.4103/2452-2473.276385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 11/02/2019] [Indexed: 11/04/2022] Open
Abstract
Ovarian torsion (OT) during pregnancy is a rare condition that can cause maternal and fetal morbidity. Although the etiology of the disease is not fully understood, predisposing factors include increased ovarian size, free mobility, and long pedicle. The incidence of the disease increases after ovarian stimulation for the treatment of fertility. Diagnostic imaging modalities include ultrasonography and magnetic resonance imaging (MRI). A 28-year-old woman with a 33-week pregnancy presented to our emergency department with acute, severe left groin pain. According to the patient's declaration, she had her first pregnancy, which was acquired by intrauterine insemination in another center. Her vital signs were unremarkable except for tachycardia. Physical examination revealed guarding (défense musculaire) and rebound tenderness on the left lower quadrant of the abdomen. Laboratory and imaging studies were performed for the preliminary diagnosis of acute abdomen. She was diagnosed with OT and admitted to the department of obstetrics and gynecology. OT should be included in the differential diagnosis of patients with suspected acute abdomen in advanced stages of pregnancy. In addition, MRI should be used as an alternative diagnostic modality in patients with normal sonographic findings.
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Affiliation(s)
- Halil Yildirim
- Department of Emergency Medicine, School of Medicine, Afyonkarahisar University of Health Sciences, Afyonkarahisar, Turkey
| | - Serife Ozdinc
- Department of Emergency Medicine, School of Medicine, Afyonkarahisar University of Health Sciences, Afyonkarahisar, Turkey
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Abstract
The emergency medicine provider sees a broad range of pathology involving the female genitourinary system on a daily basis. Must-not-miss diagnoses include pelvic inflammatory disease and ovarian torsion, because these diagnoses can have severe complications and affect future fertility. Although most patients with abnormal uterine bleeding are hemodynamically stable, it can present as a life-threatening emergency and providers should be adept managing severe hemorrhage. Bartholin gland cysts are common complaints that often require procedural intervention. This article discusses these diagnoses and appropriate evaluation and management in the emergency department.
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Affiliation(s)
- Sarah Mahonski
- Heritage Valley Health System, 1000 Dutch Ridge Road, Beaver, PA 15009, USA
| | - Kami M Hu
- Emergency/Internal/Critical Care Medicine, University of Maryland, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA.
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Santos-Ribeiro S, Mackens S, Racca A, Blockeel C. Towards complication-free assisted reproduction technology. Best Pract Res Clin Endocrinol Metab 2019; 33:9-19. [PMID: 30473208 DOI: 10.1016/j.beem.2018.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Assisted reproductive technology (ART) has vastly improved over the last 40 years, from a frequently unsuccessful and complicated procedure requiring hospital admission and routine laparoscopy to a fairly simple outpatient technique with relatively high success rates. However, it is important to stress that ART is not without risk and medical complications may still occur. The incidence of most of these ART-related complications is associated with how women undergo ovarian stimulation. For this reason, physicians should be aware that a carefully thought-out ovarian stimulation protocol and cycle monitoring are of paramount importance to maximise the success of the treatment while avoiding potentially life-threating complications to occur in this frequently otherwise healthy patient population. This review discusses the rationale and evolution of ovarian stimulation strategies over the years and the current developments towards finding a balance between the retrieval of a sufficient number of oocytes and ART-related complication prevention.
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Affiliation(s)
| | - Shari Mackens
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, Brussels 1090, Belgium.
| | - Annalisa Racca
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, Brussels 1090, Belgium; Academic Unit of Obstetrics and Gynaecology, IRCCS AOU San Martino-IST, University of Genoa, Largo Rosanna Benzi 10, Genova 16132, Italy.
| | - Christophe Blockeel
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, Brussels 1090, Belgium; Department of Obstetrics and Gynaecology, School of Medicine, University of Zagreb, Šalata 3, Zagreb 10000, Croatia.
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