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Dur R, Demirdag E, Yucel Celik O, Karahanoglu E, Dur G, Ozdemir CY, Yucel A, Moraloglu Tekin O. Adnexal masses and pregnancy: a single-center experience of 9 years. Arch Gynecol Obstet 2024; 310:387-394. [PMID: 38704757 DOI: 10.1007/s00404-024-07527-w] [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: 09/20/2022] [Accepted: 04/21/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE This study aims to analyze the experience of a tertiary health center about the management of adnexal masses that have been diagnosed during pregnancy or detected accidentally during cesarean delivery. METHODS This is a retrospective review of 160 women who underwent concurrent surgery for adnexal mass during cesarean section, 24 women who delivered vaginally and subsequently had surgery due to the prenatal diagnosis of adnexal mass and 10 women who underwent surgery for adnexal mass during pregnancy. Corresponding to the delivery and surgery times, 200 women who had no diagnosis of pregnancy-associated adnexal mass served as controls. RESULTS The women in the control group and study groups had statistically similar gestational age at delivery, birth weight and preterm delivery (p > 0.05 for all). Miscarriage was significantly more frequent in women undergoing surgery for adnexal mass during pregnancy (p = 0.001). The women who had surgery for adnexal mass during pregnancy, at the time of cesarean section and following delivery were statistically similar with respect to surgery type and histopathological diagnosis (p > 0.05 for both). Malignancy was detected in none of the patients who underwent surgery for adnexal mass during pregnancy. Acute abdomen was the indication for the emergency surgery in six patients (3.5%) who had surgery for adnexal mass during pregnancy. Four patients (2.4%) had surgery for adnexal mass during pregnancy due to the high index of suspicion for malignancy. CONCLUSION The risk of malignancy was relatively lower in this cohort of adnexal masses detected during pregnancy and cesarean delivery. Surgical management of adnexal masses should be postponed to postpartum period as such management leads to an increased risk of miscarriage. Unless there is a need for emergent surgery or cancer staging, vaginal delivery should be encouraged in women diagnosed with adnexal mass during pregnancy.
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Affiliation(s)
- Rıza Dur
- Department of Obstetrics and Gynecology, Afyonkarahisar Health Sciences University Hospital, Afyonkarahisar, Turkey.
- Zafer Sağlık Külliyesi Dörtyol Mahallesi, 2078 Sokak No: 3, Afyonkarahisar, Turkey.
| | - Erhan Demirdag
- Department of Obstetrics and Gynecology, Gazi University Hospital, Ankara, Turkey
| | - Ozge Yucel Celik
- Department of Perinatology, Van Training and Research Hospital, Van, Turkey
| | | | - Gamze Dur
- Department of Family Medicine, Afyonkarahisar Health Sciences University Hospital, Afyonkarahisar, Turkey
| | - Cem Yagmur Ozdemir
- Department of Obstetrics and Gynecology, Afyonkarahisar Health Sciences University Hospital, Afyonkarahisar, Turkey
| | - Aykan Yucel
- Department of Obstetrics and Gynecology Obstetrics, Ankara City Hospital, Ankara, Turkey
| | - Ozlem Moraloglu Tekin
- Department of Obstetrics and Gynecology Obstetrics, Ankara City Hospital, Ankara, Turkey
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2
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Thiyagalingam S, Petrosellini C, Mellon C. Adnexal Torsion in the Third Trimester. Cureus 2024; 16:e60836. [PMID: 38910722 PMCID: PMC11191385 DOI: 10.7759/cureus.60836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2024] [Indexed: 06/25/2024] Open
Abstract
A 41-year-old woman presented with acute, severe left-sided abdominal pain and vomiting at 37 weeks' gestation. Her symptoms were attributed to renal colic, and she was admitted for supportive treatment. During her admission, she went into spontaneous labour. Due to other obstetric indications, the team proceeded with delivery by emergency caesarean section. Intra-operatively, a necrotic left fallopian tube and ovary were identified, and a diagnosis of adnexal torsion (AT) was recognised. There was no return of tissue perfusion on de-torsion, and a left salpingo-oopherectomy was performed. AT in pregnancy is unusual, with only a minority of cases occurring in the third trimester. This is a challenging diagnosis to establish and requires a high index of suspicion. Ultrasound and magnetic resonance imaging can be helpful in establishing a diagnosis but should not delay definitive treatment. Prompt surgical intervention is paramount to prevent irreversible damage to ovarian tissue.
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Affiliation(s)
| | | | - Claire Mellon
- Obstetrics and Gynaecology, Whittington Health NHS Trust, London, GBR
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3
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Cusimano MC, Liu J, Azizi P, Zipursky J, Sajewycz K, Sussman J, Kishibe T, Wong E, Ferguson SE, D'Souza R, Baxter NN. Adverse Fetal Outcomes and Maternal Mortality Following Nonobstetric Abdominopelvic Surgery in Pregnancy: A Systematic Review and Meta-analysis. Ann Surg 2023; 278:e147-e157. [PMID: 34966066 DOI: 10.1097/sla.0000000000005362] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To quantify the absolute risks of adverse fetal outcomes and maternal mortality following nonobstetric abdominopelvic surgery in pregnancy. SUMMARY BACKGROUND DATA Surgery is often necessary in pregnancy, but absolute measures of risk required to guide perioperative management are lacking. METHODS We systematically searched MEDLINE, EMBASE, and EvidenceBased Medicine Reviews from January 1, 2000, to December 9, 2020, for observational studies and randomized trials of pregnant patients undergoing nonobstetric abdominopelvic surgery. We determined the pooled proportions of fetal loss, preterm birth, and maternal mortality using a generalized linear random/mixed effects model with a logit link. RESULTS We identified 114 observational studies (52 [46%] appendectomy, 34 [30%] adnexal, 8 [7%] cholecystectomy, 20 [17%] mixed types) reporting on 67,111 pregnant patients. Overall pooled proportions of fetal loss, preterm birth, and maternal mortality were 2.8% (95% CI 2.2-3.6), 9.7% (95% CI 8.3-11.4), and 0.04% (95% CI 0.02-0.09; 4/10,000), respectively. Rates of fetal loss and preterm birth were higher for pelvic inflammatory conditions (eg, appendectomy, adnexal torsion) than for abdominal or nonurgent conditions (eg, cholecystectomy, adnexal mass). Surgery in the second and third trimesters was associated with lower rates of fetal loss (0.1%) and higher rates of preterm birth (13.5%) than surgery in the first and second trimesters (fetal loss 2.9%, preterm birth 5.6%). CONCLUSIONS Absolute risks of adverse fetal outcomes after nonobstetric abdom- inopelvic surgery vary with gestational age, indication, and acuity. Pooled estimates derived here identify high-risk clinical scenarios, and can inform implementation of mitigation strategies and improve preoperative counselling.
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Affiliation(s)
- Maria C Cusimano
- Department of Obstetrics & Gynecology, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School ofPublic Health, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Jessica Liu
- Department of Obstetrics & Gynecology, University of Toronto, Toronto, ON, Canada
| | - Paymon Azizi
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School ofPublic Health, University of Toronto, Toronto, ON, Canada
| | - Jonathan Zipursky
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School ofPublic Health, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Katrina Sajewycz
- School of Medicine, Faculty ofHealth Sciences, Queen's University, Kingston, ON, Canada
| | - Jess Sussman
- School of Medicine, Faculty ofMedicine, University of Toronto, Toronto, ON, Canada
| | - Teruko Kishibe
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Health Sciences Library, St. Michael's Hospital, Toronto, ON, Canada
| | - Eric Wong
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School ofPublic Health, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sarah E Ferguson
- Department of Obstetrics & Gynecology, University of Toronto, Toronto, ON, Canada
- Division of Gynecologic Oncology, Princess Margaret Cancer Centre/Sinai Health Systems, Toronto, ON, Canada
| | - Rohan D'Souza
- Department of Obstetrics & Gynecology, University of Toronto, Toronto, ON, Canada
- Division of Maternal Fetal Medicine, Mount Sinai Hospital/Sinai Health Systems, Toronto, ON, Canada
| | - Nancy N Baxter
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School ofPublic Health, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne ViC, Australia
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4
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Takeda A, Hayashi S. Gasless laparoendoscopic single-site assisted extracorporeal ovarian cystectomy through the umbilicus for the management of ovarian torsion at 33 weeks of gestation: A case report with literature review. Case Rep Womens Health 2023; 38:e00517. [PMID: 37324931 PMCID: PMC10267531 DOI: 10.1016/j.crwh.2023.e00517] [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: 05/18/2023] [Revised: 05/30/2023] [Accepted: 05/30/2023] [Indexed: 06/17/2023] Open
Abstract
Ovarian torsion in the third trimester of pregnancy is a rare but potentially dangerous non-obstetric complication for both mother and fetus and presents a diagnostic and therapeutic challenge for the treating physicians. A 39-year-old woman (gravida 2, para 1) presented at 7 weeks of gestation. Asymptomatic bilateral small ovarian cysts were diagnosed at the initial presentation. Progesterone was intramuscularly administered every 2 weeks after 28 weeks of gestation because of uterine cervical length shortening. Sudden onset of right lateral abdominal pain was reported at 33 weeks and 2 days of gestation. Emergency laparoendoscopic single-site (LESS) surgery was performed through the umbilicus under strong suspicion of right adnexal torsion with ovarian cyst, as indicated by magnetic resonance imaging a day after admission. Isolated right ovarian torsion without fallopian tube involvement was identified under laparoscopic view. The contents of the right ovarian cyst were aspirated after confirming resumption of color tone of the right ovary after detorsion. Then, the right adnexal tissue was grasped through the umbilicus, followed by a successful ovarian cystectomy under direct vision. Tocolysis was postoperatively attempted by intravenous ritodorine hydrochloride and magnesium sulfate administration, which was continued through to 36 weeks and 4 days of gestation, because of increased uterine contraction frequency. The next day, spontaneous labor occurred, followed by the vaginal delivery of a healthy 2108-g female infant. The postnatal course was uneventful. Transumbilical LESS-assisted extracorporeal ovarian cystectomy is a feasible and minimally invasive option for ovarian torsion management in the third trimester of pregnancy.
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Affiliation(s)
- Akihiro Takeda
- Corresponding author at: Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, 5-161 Maebata-cho, Tajimi, Gifu 507-8522, Japan.
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Causa Andrieu PI, Wahab SA, Nougaret S, Petkovska I. Ovarian cancer during pregnancy. Abdom Radiol (NY) 2023; 48:1694-1708. [PMID: 36538079 PMCID: PMC10627077 DOI: 10.1007/s00261-022-03768-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 12/01/2022] [Accepted: 12/02/2022] [Indexed: 05/01/2023]
Abstract
Adnexal masses during pregnancy are a relatively uncommon entity. Their clinical management is challenging given the overlapping features of certain entities on imaging and histopathology, which can mimic malignancy, and the potential side effects to the mother and fetus, whether expectant management versus surgery is pursued. Ultrasonography with Doppler evaluation is the modality of choice for evaluating adnexal masses during pregnancy. Magnetic resonance imaging is the second-line modality useful when US findings are inconclusive/indeterminate. Most adnexal masses in pregnant patients are benign in origin (e.g., functional cysts, mature cystic teratoma, decidualization of endometrioma), but a few are malignant in origin (e.g., dysgerminoma, granulosa cell tumor). Most cases of adnexal masses are asymptomatic, but complications such as ovarian torsion can occur. This review aims to familiarize the radiologist with the imaging of adnexal lesions during pregnancy so that the radiologist can identify ovarian cancer. Specifically, the review will detail the most common benign and malignant adnexal masses in pregnancy, mimickers, and their corresponding imaging findings on US and MRI.
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Affiliation(s)
- Pamela I Causa Andrieu
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
| | - Shaun A Wahab
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Stephanie Nougaret
- Department of Radiology, Cancer Institute of Montpellier, Montpellier, France
| | - Iva Petkovska
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
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6
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Ashmore AA, Blackstock S, Kenny C, Ismail A. Recognition and initial management of ovarian torsion. BMJ 2023; 381:e074514. [PMID: 37116904 DOI: 10.1136/bmj-2022-074514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Affiliation(s)
- Ayisha A Ashmore
- Gynaecology Department, University Hospitals Leicester NHS Trust, Leicester, UK
| | | | - Conor Kenny
- The Old Church GP Surgery, Chingford, London, UK
| | - Aemn Ismail
- Gynaecology Department, University Hospitals Leicester NHS Trust, Leicester, UK
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7
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Lapides A, Ma W, McKinney C, Chuang L. Laparoscopically-treated ovarian torsion in a 32-week pregnancy: A case report. Case Rep Womens Health 2023; 37:e00496. [PMID: 37020693 PMCID: PMC10068008 DOI: 10.1016/j.crwh.2023.e00496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 03/17/2023] Open
Abstract
Ovarian torsion is a gynecologic emergency which, while rare during pregnancy, is associated with increased risk during pregnancy. Most torsions during pregnancy occur during the first and second trimester, with only 10.5% of cases reported during the third trimester. A 35-year-old woman at 32 weeks and 2 days of gestation presented with right lower quadrant abdominal pain. Transvaginal ultrasound demonstrated a large right ovarian cyst and decreased flow on color Doppler consistent with ovarian torsion. The diagnosis was confirmed via diagnostic laparoscopy with direct visualization of the necrotic, edematous ovarian cyst and pedicle, which had been torsed twice. The pedicle was detorsed and the necrotic cyst was resected while sparing as much of the normal ovary as possible. The patient provided written consent for publication of this case report. Data supports that laparoscopy is a safe and reasonable treatment for ovarian torsion during pregnancy. It is associated with shorter hospital stays and fewer postoperative complications without increasing the risk of obstetric or neonatal complications. Much of this data, however, is obtained from case reports of torsions during the first and second trimester. The incidence of third trimester ovarian torsion is estimated to be 5-10% of torsion cases that occur in pregnancy. This case demonstrates a successful laparoscopic treatment of a third-trimester torsion in a woman who went on to deliver a healthy baby girl by spontaneous vaginal delivery.
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8
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Muacevic A, Adler JR, Jha SV, Bankar NJ, Khatake P. A Case of Twisted Ovarian Dermoid Cyst During Pregnancy. Cureus 2023; 15:e33582. [PMID: 36779154 PMCID: PMC9909625 DOI: 10.7759/cureus.33582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 01/08/2023] [Indexed: 01/12/2023] Open
Abstract
Ovarian cysts are common during pregnancy as an outcome of routine prenatal ultrasounds. Although most cases are benign, complications, such as torsion, rupture, and malignant changes, can occur. Torsion risk increases fivefold during pregnancy. It is extremely hazardous to expectant mothers and unborn children. In a rural health tertiary center, we report the case of a 23-year-old primigravida with 14 weeks of pregnancy presented with acute abdomen and nausea, vomiting for four hours. On ultrasonography, she was diagnosed with a 14 cm × 11 cm left dermoid cyst. She underwent a laprotomy, and a twisted dermoid cyst was found; therefore, a left oophorectomy was performed with consent. Histopathological examination revealed the presence of a dermoid cyst. She is regularly followed up at our center with a healthy intrauterine fetus growing within. Although antepartum surgical intervention has been proven safe, there are some risks associated with abdominal surgery for both pregnant women and their unborn children. As a result, the management strategy must be chosen based on a risk-benefit analysis of adnexal mass characterization and gestational age.
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Affiliation(s)
| | | | - Sagar V Jha
- Obstetrics and Gynecology, Datta Meghe Medical College Nagpur, Datta Meghe Institute of Medical Sciences (DU), Wardha, IND
| | - Nandkishor J Bankar
- Microbiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (DU), Wardha, IND
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9
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Rottenstreich M, Moran I, Hirsch A, Rotem R, Armon S, Benshushan A, Grisaru-Granovsky S, Rottenstreich A. Factors Associated With Operatively Confirmed Adnexal Torsion Among Pregnant Women - A Multicenter Cohort Study. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:e98-e104. [PMID: 32823290 DOI: 10.1055/a-1232-1378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE The aim of this study was to investigate the association of clinical, laboratory, and ultrasound findings with the surgical diagnosis of adnexal torsion in a retrospective cohort of women operated for suspected torsion during pregnancy. MATERIALS AND METHODS A multicenter retrospective study of pregnant women who underwent urgent laparoscopy for suspected adnexal torsion during 2004-2019 in three tertiary medical centers. RESULTS Adnexal torsion was found in 143/208 (68.8 %) cases. Women with adnexal torsion had lower parity and lower rates of previous cesarean section, but higher rates of fertility treatments and multiple gestations, and were more likely to report right lower abdominal pain, with shorter duration of symptoms (< 24 hrs) and vomiting but not nausea. Women with adnexal torsion were found to have higher rates of sonographic findings suggestive of ovarian edema, while normal-appearing ovaries on ultrasound were more common in women without torsion. A multivariate logistic regression analysis showed that complaints of right abdominal pain were positively associated with adnexal torsion (aOR [95 % CI] 5.03 (1.45-17.49), while previous cesarean delivery and ultrasound findings of normal-appearing ovaries were negatively associated with adnexal torsion (aOR of 0.17 (0.05-0.52) and 0.10 (0.02-0.43), respectively). CONCLUSION Clinical characteristics and ultrasound findings may be incorporated into the emergency room workup of pregnant women with suspected adnexal torsion.
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Affiliation(s)
- Misgav Rottenstreich
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Ido Moran
- Faculty of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ayala Hirsch
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Reut Rotem
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Shunit Armon
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Avi Benshushan
- Faculty of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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10
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Cathcart AM, Nezhat FR, Emerson J, Pejovic T, Nezhat CH, Nezhat CR. Adnexal masses during pregnancy: diagnosis, treatment, and prognosis. Am J Obstet Gynecol 2022:S0002-9378(22)02179-2. [PMID: 36410423 DOI: 10.1016/j.ajog.2022.11.1291] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/15/2022] [Accepted: 11/15/2022] [Indexed: 11/21/2022]
Abstract
Adnexal masses are identified in pregnant patients at a rate of 2 to 20 in 1000, approximately 2 to 20 times more frequently than in the age-matched general population. The most common types of adnexal masses in pregnancy requiring surgical management are dermoid cysts (32%), endometriomas (15%), functional cysts (12%), serous cystadenomas (11%), and mucinous cystadenomas (8%). Approximately 2% of adnexal masses in pregnancy are malignant. Although most adnexal masses in pregnancy can be safely observed and approximately 70% spontaneously resolve, a minority of cases warrant surgical intervention because of symptoms, risk of torsion, or suspicion of malignancy. Ultrasound is the mainstay of evaluation of adnexal masses in pregnancy because of accuracy, safety, and availability. Several ultrasound mass scoring systems, including the Sassone, Lerner, International Ovarian Tumor Analysis Simple Rules, and International Ovarian Tumor Analysis Assessment of Different NEoplasias in the adneXa scoring systems have been validated specifically in pregnant populations. Decisions regarding expectant vs surgical management of adnexal masses in pregnancy must balance the risks of torsion or malignancy with the likelihood of spontaneous resolution and the risks of surgery. Laparoscopic surgery is preferred over open surgery when possible because of consistently demonstrated shorter hospital length of stay and less postoperative pain and some data demonstrating shorter operative time, lower blood loss, and lower risks of fetal loss, preterm birth, and low birthweight. The best practices for laparoscopic surgery during pregnancy include left lateral decubitus positioning after the first trimester of pregnancy, port placement with respect to uterine size and pathology location, insufflation pressure of less than 12 to 15 mm Hg, intraoperative maternal capnography, pre- and postoperative fetal heart rate and contraction monitoring, and appropriate mechanical and chemical thromboprophylaxes. Although planning surgery for the second trimester of pregnancy generally affords time for mass resolution while optimizing visualization with regards to uterine size and pathology location, necessary surgery should not be delayed because of gestational age. When performed at a facility with appropriate obstetrical, anesthetic, and neonatal support, adnexal surgery in pregnancy generally results in excellent outcomes for pregnant patients and fetuses.
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Affiliation(s)
- Ann M Cathcart
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR
| | - Farr R Nezhat
- Weill Cornell Medical College, Cornell University, New York, NY; New York University Long Island School of Medicine, Mineola, NY.
| | - Jenna Emerson
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR; Division of Gynecologic Oncology, Oregon Health & Science University, Portland, OR
| | - Tanja Pejovic
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR; Division of Gynecologic Oncology, Oregon Health & Science University, Portland, OR
| | - Ceana H Nezhat
- Atlanta Center for Minimally Invasive Surgery and Reproductive Medicine, Atlanta, GA
| | - Camran R Nezhat
- Center for Special Minimally Invasive and Robotic Surgery, Palo Alto, CA; University of California San Francisco, San Francisco, CA; Stanford University Medical Center, Palo Alto, CA
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11
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Adnexal torsion: a review of diagnosis and management strategies. Curr Opin Obstet Gynecol 2022; 34:196-203. [PMID: 35895961 DOI: 10.1097/gco.0000000000000787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Adnexal torsion remains a diagnostic challenge heavily reliant on high clinical suspicion, with patient presentation and imaging used as adjuncts to aid in its diagnosis. This review summarizes diagnostic and management techniques of adnexal torsion to assist providers when encountering this surgical emergency. RECENT FINDINGS Common findings of adnexal torsion include abdominal pain, nausea, vomiting, and adnexal mass or ovarian enlargement. An elevated neutrophil to lymphocyte ratio may be useful for diagnosis. A 'whirlpool' sign, 'follicular ring' sign, enlarged/edematous ovary, and absent Doppler flow to the ovary are highly suggestive of adnexal torsion. Intraoperative visual diagnosis of ovarian death is highly inaccurate, with only 18-20% of ovaries necrotic on pathological examination. Necrotic appearing ovaries have been shown to have follicular activity on ultrasound one year postoperatively. SUMMARY Pelvic ultrasound remains the first-line imaging modality. In patients of reproductive age, we recommend performing detorsion with ovarian conservation, even in cases where the tissue appears necrotic, given poor intraoperative diagnostic rates of tissue death. Retention of ovarian function is also reliant on a timely diagnosis and intervention. We emphasize that the risk of ovarian damage/loss outweigh the risk of a diagnostic laparoscopy in patients of reproductive age.
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12
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Samejima K, Takai Y, Matsunaga S, Nagai T, Kikuchi A. The safety and effectiveness of elective laparoscopic surgery for benign ovarian cysts during pregnancy-Comparison with emergency surgery. J Obstet Gynaecol Res 2022; 48:2603-2609. [PMID: 35882386 DOI: 10.1111/jog.15357] [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: 03/07/2022] [Revised: 06/25/2022] [Accepted: 06/27/2022] [Indexed: 12/01/2022]
Abstract
AIM Relatively small benign ovarian cysts are conservatively managed in early pregnancy. However, emergency surgery is required should acute abdomen occur. Our study aimed to examine and compare the outcomes of benign ovarian cysts treated with elective laparoscopic surgery or emergency surgery during pregnancy. METHODS From 2004 to 2017, we treated 135 pregnant patients (110 elective and 25 emergencies) with benign ovarian cysts at our tertiary perinatal center and compared their surgical and perinatal outcomes. RESULTS There was no significant difference in cyst diameter (7.6 ± 2.5 vs. 6.8 ± 2.1 cm), but cysts <6 cm were significantly more common in emergency (36%) than in elective (15%) cases. Mature teratomas were significantly more common in elective cases (89% vs. 52%) but corpus luteum cysts were more common in emergency cases (0% vs. 32%). The rates of laparoscopic surgery (98.2% vs. 52.0%) and ovarian conservation (99.1% vs. 80.0%) were significantly higher, and post-surgical hospitalization (4.6 ± 1.3 vs. 9.8 ± 10.5 days) was significantly shorter in elective than in emergency cases. There was no significant difference in the gestational age for delivery (38.9 ± 1.9 vs. 38.4 ± 2.7 weeks), preterm birth rate (12% vs. 20%), or birth weight (2939 ± 469 vs. 3019 ± 510 g). CONCLUSIONS We cannot state that an emergency surgery during pregnancy is rarely required for small benign ovarian cysts. However, the surgical outcomes were significantly better for elective than for emergency surgery, with no difference in perinatal outcomes. If a benign ovarian cyst is found early in pregnancy, elective laparoscopic surgery may be considered with adequate informed consent.
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Affiliation(s)
- Kouki Samejima
- Department of Obstetrics and Gynecology, Saitama Medical Center/ Saitama Medical University, Kawagoe, Saitama, Japan
| | - Yasushi Takai
- Department of Obstetrics and Gynecology, Saitama Medical Center/ Saitama Medical University, Kawagoe, Saitama, Japan
| | - Shigetaka Matsunaga
- Department of Obstetrics and Gynecology, Saitama Medical Center/ Saitama Medical University, Kawagoe, Saitama, Japan
| | - Tomonori Nagai
- Department of Obstetrics and Gynecology, Saitama Medical Center/ Saitama Medical University, Kawagoe, Saitama, Japan
| | - Akihiko Kikuchi
- Department of Obstetrics and Gynecology, Saitama Medical Center/ Saitama Medical University, Kawagoe, Saitama, Japan
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13
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Bridwell RE, Koyfman A, Long B. High risk and low prevalence diseases: Ovarian torsion. Am J Emerg Med 2022; 56:145-150. [PMID: 35397355 DOI: 10.1016/j.ajem.2022.03.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Ovarian torsion is a rare, frequently misdiagnosed condition that carries with it a high rate of morbidity. OBJECTIVE This review highlights the pearls and pitfalls of ovarian torsion, including presentation, evaluation, and management in the emergency department (ED) based on current evidence. DISCUSSION Ovarian torsion is one of the most common gynecological surgical emergencies and occurs with complete or partial rotation of the ovary along the supporting ligaments, obstructing vascular flow. Several risk factors include the presence of an ovarian mass or cyst. The most common population affected includes reproductive aged women, though cases also occur in premenarchal females, pregnant women, and postmenopausal women. Abdominal or pelvic pain is common but is not always sudden in onset or severe. Nausea and vomiting occur in 70%. Ultrasound can assist with diagnosis, but a normal ultrasound examination cannot exclude the diagnosis. Computed tomography with intravenous contrast can assist with diagnosis. Treatment includes emergent gynecologic consultation for surgical detorsion, along with symptomatic therapy in the ED. CONCLUSIONS An understanding of ovarian torsion can assist emergency clinicians in diagnosing and managing this disease.
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Affiliation(s)
- Rachel E Bridwell
- Department of Emergency Medicine, Madigan Army Medical Center, Tacoma, WA, USA
| | - Alex Koyfman
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA
| | - Brit Long
- SAUSHEC, Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
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Suzuki T, Doi H, Yamaguchi N, Hayashi T. Two cases of low-risk adnexal torsion in the third trimester of pregnancy. HYPERTENSION RESEARCH IN PREGNANCY 2022. [DOI: 10.14390/jsshp.hrp2022-007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Hiromi Doi
- Department of Obstetrics and Gynecology, Keiai Hospital
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Verma M, Bhuria V, Chauhan M, Nanda S, Dahiya P, Singhal SR. Adnexal Torsion: A Retrospective Analysis From a Tertiary Care Teaching Hospital in Northern India. Cureus 2021; 13:e17792. [PMID: 34660002 PMCID: PMC8496559 DOI: 10.7759/cureus.17792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 11/05/2022] Open
Abstract
Background Adnexal torsion is an acute gynecological emergency presenting with acute abdomen which can be missed owing to non-specific symptoms. Among reproductive-age women, conservative surgery is preferred. The present study was a retrospective analysis of adnexal torsion cases reported to a tertiary care teaching hospital in Northern India. The purpose of the study was to describe the demography, clinical features, diagnostic and treatment modalities, and prognosis of adnexal torsion cases. Methods Surgically proven adnexal torsion case records were retrieved and data were entered in an excel sheet from a period of two and half years from January 2018 to June 2020. Results There were 28 cases with an age range of 7-85 years (median age 24 years) with lower abdominal pain and nausea/vomiting symptoms. The majority were in the reproductive age group (71.4%). A Colour Doppler was done which detected 75% (12/16) of the ovarian torsion cases. The size of the adnexal torsion was 5-10 cm in 60.7% with right-sided torsion seen in 57.14%. Detorsion and salpingo-oophorectomy was done in 14 (50%) and 11 (39.2%) cases, respectively. Histopathological examination revealed hemorrhagic/necrotic infarcts (54.2%) and dermoid cysts (33.3%). Conclusions Owing to non-specific symptoms, adnexal torsion is diagnosed with strong clinical suspicion as routine ultrasonography diagnosed only 7.1% in the present study. Conservative surgery is preferred in the reproductive age group.
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Affiliation(s)
- Menka Verma
- Obstetrics and Gynaecology, Pt. B. D. Sharma Post Graduate Institute of Medical Sciences (PGIMS) Rohtak, Rohtak, IND
| | - Vandana Bhuria
- Obstetrics and Gynaecology, Pt. B. D. Sharma Post Graduate Institute of Medical Sciences (PGIMS) Rohtak, Rohtak, IND
| | - Meenakshi Chauhan
- Obstetrics and Gynaecology, Pt. B. D. Sharma Post Graduate Institute of Medical Sciences (PGIMS) Rohtak, Rohtak, IND
| | - Smiti Nanda
- Obstetrics and Gynaecology, Pt. B. D. Sharma Post Graduate Institute of Medical Sciences (PGIMS) Rohtak, Rohtak, IND
| | - Pushpa Dahiya
- Obstetrics and Gynaecology, Pt. B. D. Sharma Post Graduate Institute of Medical Sciences (PGIMS) Rohtak, Rohtak, IND
| | - Savita R Singhal
- Obstetrics and Gynaecology, Pt. B. D. Sharma Post Graduate Institute of Medical Sciences (PGIMS) Rohtak, Rohtak, IND
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Martínez Fernández GS, Zomeño Bravo G, Cañete San Pastor P, Ortiz Murillo E, Balanza Chancosa R. Adnexal Torsion: Clinical Presentation and Management of a Retrospective Series of 21 Years. J Gynecol Surg 2021. [DOI: 10.1089/gyn.2020.0204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Gema Zomeño Bravo
- Service of Obstetrics and Gynecology, University Hospital Dr. Peset, Valencia, Spain
| | | | - Ester Ortiz Murillo
- Service of Obstetrics and Gynecology, University Hospital Dr. Peset, Valencia, Spain
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17
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Abstract
Importance Adnexal masses are identified in approximately 0.05% to 2.4% of pregnancies, and more recent data note a higher incidence due to widespread use of antenatal ultrasound. Whereas most adnexal masses are benign, approximately 1% to 6% are malignant. Proper diagnosis and management of adnexal masses in pregnancy are an important skill for obstetricians. Objective The aim of this study was to review imaging modalities for evaluating adnexal masses in pregnancy and imaging characteristics that differentiate benign and malignant masses, examine various types of adnexal masses, and understand complications of and explore management options for adnexal masses in pregnancy. Evidence Acquisition This was a literature review using primarily PubMed and Google Scholar. Results Ultrasound can distinguish between simple-appearing benign ovarian cysts and masses with more complex features that can be associated with malignancy. Radiologic information can help guide physicians toward recommending conservative management with observation or surgical removal during pregnancy to facilitate diagnosis and treatment. The risks of expectant management of an adnexal mass during pregnancy include rupture, torsion, need for emergent surgery, labor obstruction, and progression of malignancy. Historically, surgical removal was performed more routinely to avoid such complications in pregnancy; however, increasing knowledge has directed management toward conservative measures for benign masses. Surgical removal of adnexal masses is increasingly performed via minimally invasive techniques including laparoscopy and robotic surgery due to a decreased risk of surgical complications compared with laparotomy. Conclusions and Relevance Adnexal masses are increasingly identified in pregnancy because of the use of antenatal ultrasound. Clear and specific guidelines exist to help differentiate between benign and malignant masses. This is important for management as benign masses can usually be conservatively managed, whereas malignant masses require excision for diagnosis and treatment. A multidisciplinary approach, including referral to gynecologic oncology, should be used for masses with complex features associated with malignancy. Proper diagnosis and management of adnexal masses in pregnancy are an important skill for obstetricians.
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Bart Y, Mohr-Sasson A, Yousefi S, Goldenberg M, Meyer R, Toussia-Cohen S, Eyal Y, Mazaki-Tovi S, Mashiach R. Adnexal torsion recurrence-is the adnexal twist degree a risk factor? A retrospective cohort study. BJOG 2021; 128:1511-1516. [PMID: 33978295 DOI: 10.1111/1471-0528.16738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate whether the adnexal twist degree is related to torsion recurrence and whether there is a dose-dependent correlation. DESIGN A retrospective cohort study. SETTING Single tertiary medical centre. POPULATION The study includes non-pregnant patients operated, for the first time, for adnexal torsion, between 2011 and 2018. METHODS Information regarding the degree of adnexal twist was collected from surgical reports. Recurrence was identified using a computerised database and ascertained via telephone with a response rate of 87.2% (253/290). MAIN OUTCOME MEASURES Adnexal torsion recurrence rate. RESULTS A total of 182 women who had undergone laparoscopic detorsion met the inclusion criteria. Twenty-two had torsion recurrence (12.1%). Adnexal twist degree in the primary event was associated with a higher recurrence risk: 4.3% of women with twist degree ≤360 (n = 3/70), 14.5% of women with twist degree of 361-720 (n = 9/62) and 20% of women with twist degree >720 (n = 10/50) (P = 0.03). The median twist degree was 540 (interquartile range [IQR] 360-855) and 720 (IQR 675-1080) degrees in the control and study groups, respectively (P = 0.005). Additional possibly associated factors for recurrence were evaluated. Age emerged as a possible risk factor, with a median age of 19 years in the recurrence group (IQR 14-27 years) versus 28.5 (IQR 19-36 years) in the non-recurrence group (P < 0.01). Logistic regression analysis revealed that together with age, adnexal twist degree remained significantly associated with torsion recurrence (odds ratio [OR] 1.98, 95% CI 1.09-3.61; P = 0.02). CONCLUSION Adnexal twist degree was found to be positively associated with the risk of torsion recurrence. TWEETABLE ABSTRACT Adnexal twist degree was found to be positively associated with the risk of torsion recurrence.
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Affiliation(s)
- Y Bart
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Mohr-Sasson
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S Yousefi
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel
| | - M Goldenberg
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel
| | - R Meyer
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S Toussia-Cohen
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Y Eyal
- Kaplan Medical Center, Rehovot, Israel
| | - S Mazaki-Tovi
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - R Mashiach
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Michalczyk K, Cymbaluk-Płoska A. Approaches to the Diagnosis and Management of Ovarian Cancer in Pregnancy. Cancer Manag Res 2021; 13:2329-2339. [PMID: 33732025 PMCID: PMC7959196 DOI: 10.2147/cmar.s290592] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 02/10/2021] [Indexed: 12/28/2022] Open
Abstract
Ovarian cancer is one of the most common gynecological cancers diagnosed in pregnancy. Its management is often very problematic due to the proximity of the adnexa to the developing fetus and chemotherapy-related toxicity risk. Tumor markers and imagining studies play important roles in diagnosis, help differentiate benign masses from malignancy and allow to plan the treatment. Due to the physiological changes that occur in pregnancy, levels of tumor markers can be altered and reduce their diagnostic value. We review current recommendations for the management and treatment of ovarian cancer in pregnant patients considering gestational age at diagnosis, tumor histology, stage of the disease, risk of obstetrical complications, and patient’s preferences.
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Affiliation(s)
- Kaja Michalczyk
- Department of Gynecological Surgery and Oncology of Adults and Adolescents, Pomeranian Medical University, Szczecin, Poland
| | - Aneta Cymbaluk-Płoska
- Department of Gynecological Surgery and Oncology of Adults and Adolescents, Pomeranian Medical University, Szczecin, Poland
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20
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Yu M, Liu Y, Jia D, Tian T, Xi Q. Adnexal torsion in pregnancy after in vitro fertilization: Case report and literature review. Medicine (Baltimore) 2021; 100:e24009. [PMID: 33545996 PMCID: PMC7837920 DOI: 10.1097/md.0000000000024009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 12/03/2020] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Torsion is the most common gynecologic emergency of the adnexal mass occurring during pregnancy. We report the clinical data of a case of twin pregnancy with adnexal torsion after in vitro fertilization (IVF) and embryo transfer, in which the patient underwent surgery for adnexal detorsion and experienced preterm delivery. One child died as a neonate, and the other child was diagnosed with hematological disease, which, to our knowledge, has not been reported previously. We also performed a systematic literature review to increase knowledge of the need for prompt surgical intervention. PATIENT CONCERNS The patient was a 32-year-old pregnant woman, who presented to our center with acute onset of stabbing and non-radiating continuous lower left abdominal pain after urination, of 6 hours duration. DIAGNOSIS Physical examination revealed that the lower abdominal tenderness was worse on the left side, and there were no signs of peritonitis. Transvaginal ultrasonographic examination indicated a multiloculated left ovary measuring 12.1 × 7.1 cm with sparse blood flow. The size of the largest cyst was 7.2 × 6.6 cm, the right ovary appeared normal, and two live fetuses were seen. INTERVENTIONS laparoscopy was performed 1.5 hours later, which revealed a cystic and multilocular left ovary with a black purplish surface and thin wall. The left ovary and left fallopian tube had undergone 720° torsion (3 rotations), and detorsion was performed laparoscopy. OUTCOMES The left adnexa recovered to near normal appearance 20 minutes postoperatively. The patient was discharged from hospital 5 days postsurgery, without complications. Unfortunately, the patient delivered two preterm babies at 30 weeks of gestation. CONCLUSIONS We should be alert to the possible risk of adnexal torsion in pregnant women after IVF. Adnexal torsion necessitates prompt surgical intervention, detorsion and preserving ovarian function are the main treatment methods. Furthermore, the possibility of recurrence, and pregnancy outcomes for the patient, as well as newborn health, should be considered.
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21
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Rottenstreich M, Rotem R, Hirsch A, Moran I, Ben-Shushan A, Armon S, Grisaru-Granovsky S, Rottenstreich A. Maternal and perinatal outcomes following laparoscopy for suspected adnexal torsion during pregnancy: a multicenter cohort study. Arch Gynecol Obstet 2020; 302:1413-1419. [PMID: 32889559 DOI: 10.1007/s00404-020-05752-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 08/15/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To investigate the association of maternal and perinatal outcomes with the surgical diagnosis of adnexal torsion in a retrospective cohort of women operated for suspected torsion during pregnancy. STUDY DESIGN This is a multicenter retrospective study and telephone questionnaire of urgent laparoscopies that occurred during pregnancy for suspected torsion between 2004 and 2019 in three tertiary medical centers. Pregnancy outcomes of women with the surgical diagnosis were compared with those whose laparoscopy was negative for adnexal torsion. Multivariable regression modeling was applied to control for possible confounders ((adjusted odds ratios (aOR) ± 95% confidence intervals (CI)]. RESULTS The study cohort included 186 women. Adnexal torsion was surgically found in 129/186 (69.4%) cases. The torsion group was characterized by higher rate of nulliparity, fertility treatments and multiple gestations as well as lower rates of previous cesarean delivery. Live birth was reported for 171 (91.9%) pregnancies, and the miscarriage rate was significantly higher in the non-torsion group. Women with torsion were more likely to be hospitalizes due to preterm labor; however, rates of preterm delivery were comparable between the groups (10.8% vs. 10.9%, p = 0.99). Logistic regression analysis had demonstrated that the performance of laparoscopy prior to 8 weeks of gestation was the only independent factor associated with miscarriage (8.23, 2.01-33.67). CONCLUSION Pregnancy outcomes following the diagnosis of adnexal torsion throughout gestation were overall favorable. Laparoscopic procedure during early stages of pregnancy was associated with higher rates of miscarriage, regardless of the surgical diagnosis of adnexal torsion.
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Affiliation(s)
- Misgav Rottenstreich
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, The Hebrew University School of Medicine, 12 Bayit Street, 91031, Jerusalem, Israel
| | - Reut Rotem
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, The Hebrew University School of Medicine, 12 Bayit Street, 91031, Jerusalem, Israel.
| | - Ayala Hirsch
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, The Hebrew University School of Medicine, 12 Bayit Street, 91031, Jerusalem, Israel
| | - Ido Moran
- Faculty of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Avi Ben-Shushan
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Shunit Armon
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, The Hebrew University School of Medicine, 12 Bayit Street, 91031, Jerusalem, Israel
| | - Sorina Grisaru-Granovsky
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, The Hebrew University School of Medicine, 12 Bayit Street, 91031, Jerusalem, Israel
| | - Amihai Rottenstreich
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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22
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Daykan Y, Bogin R, Sharvit M, Yaniv RT, Josephy D, Klein Z, Arbib N, Schonman R. Ovarian size as a risk factor for recurrent adnexal torsion: Smaller is not better. J Obstet Gynaecol Res 2020; 46:745-751. [PMID: 32077209 DOI: 10.1111/jog.14220] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/28/2020] [Accepted: 02/08/2020] [Indexed: 11/29/2022]
Abstract
AIM To investigate characteristics and risk factors for recurrent adnexal torsion (AT). METHODS Retrospective cohort study in a university-affiliated medical center included 320 Women with AT verified by laparoscopy, from January 2005 through January 2017. Demographic data, clinical symptoms, surgical findings and treatment were retrospectively reviewed from patient records. Data from primary and secondary AT of patients in the recurrent torsion group was compared to those with single torsion, to evaluate risk factors for recurrent AT. RESULTS Two hundred and sixty seven (83.4%) patients had a single event of AT and 53 (16.5%) had recurrent AT. Patients with recurrent torsion had significantly fewer previous non-gynecologic surgeries (4.3% and 9.8% of the study groups vs 32.2% of the control group, P = 0.001 for both). Ovarian size was significantly smaller in the recurrent torsion groups (47.5 mm and 48.3 mm vs 63.9 mm, P = 0.045 and P = 0.012, respectively). Polycystic ovary was significantly more common in the recurrent AT group (P = 0.028 and P = 0.005), with risk ratio 4.4 (95% confidence interval, 1.66 to 11.63). Ovaries without any specific findings were also more common among recurrent AT cases (P = 0.001 for both groups). Logistic regression analysis demonstrated that smaller ovarian size is an independent risk factor for recurrent AT. CONCLUSION Recurrent torsion correlated with fewer previous surgeries, small ovarian mass, polycystic ovaries and ovaries without specific findings, which might indicate that additional pathophysiological factors contribute to the recurrent event. Ovarian fixation might be recommended in patients with primary torsion of normal or polycystic ovaries.
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Affiliation(s)
- Yair Daykan
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel, Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rona Bogin
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel, Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Merav Sharvit
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel, Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rina Tamir Yaniv
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel, Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dana Josephy
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel, Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zvi Klein
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel, Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nissim Arbib
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel, Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Schonman
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel, Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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23
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[Borderline Ovarian Tumours: CNGOF Guidelines for Clinical Practice - Pregnancy]. ACTA ACUST UNITED AC 2020; 48:322-329. [PMID: 32004783 DOI: 10.1016/j.gofs.2020.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine the place of imaging, tumour markers, type of treatment and surgical route, follow-up, delivery mode, and re-staging in case of BOT during pregnancy, in order to provide guidelines. METHOD A systematic bibliographical analysis on BOT during pregnancy was performed through a PUDMED search on articles published from 1990 to 2019 using keywords « borderline ovarian tumour and pregnancy ». RESULTS Pelvic ultrasound is the gold standard and first-line examination for the detection and characterization of adnexal masses during pregnancy (grade C). Pelvic MRI is recommended from 12 gestational weeks in case of indeterminate adnexal masses and should be concluded by a diagnostic score (grade C). Gadolinium injection should be minimized because of proven risk to the fetus and should be discussed on a case-by-case basis after patient information (grade C). In the absence of data in the literature, it is not possible to recommend the use of any tumour marker for the diagnosis of BOT during pregnancy. In case of a surgical treatment of BOT during pregnancy, there is insufficient evidence to recommend either a cystectomy or an oophorectomy. For BOT, the laparoscopic approach should be preferred during pregnancy if it is feasible (grade C). Surgical route and type of surgery should be chosen after taking into account the tumour size, the obstetrical term, and the subsequent desire for pregnancy, following discussion in a multidisciplinary meeting. In the absence of sufficient data in the literature, it is not possible to make any recommendation on the follow-up of a BOT suspected during pregnancy. There is not enough evidence in the literature to change obstetrical management for delivery in patients with BOT. In case of incomplete staging of a BOT treated during pregnancy, restaging can be discussed as for non-pregnant patients (grade C). CONCLUSION The diagnosis of BOT occurring during pregnancy remains rare despite systematic screening of adnexal masses in the first trimester of pregnancy and an increasing maternal age. There is limited data in the literature concerning the management of BOT during pregnancy. All decisions must be taken after discussion in a multidisciplinary meeting.
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Clinical and pathological features of women with adnexal masses admitted as emergency cases to the Gynaecology Department of West Kazakhstan University. MENOPAUSE REVIEW 2019; 18:180-183. [PMID: 31975986 PMCID: PMC6970418 DOI: 10.5114/pm.2019.90377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 10/31/2019] [Indexed: 02/01/2023]
Abstract
Aim of the study To detect the clinical and pathological features of women with adnexal masses (AMs) admitted as emergency cases to the Gynaecology Department of West Kazakhstan University. Material and methods A retrospective analysis of the data of women with AMs admitted as an emergency cases to the Gynaecology Department of West Kazakhstan University. The collected data include: age, age of menarche and age of menopause, presenting symptoms, admission criteria – either self-referral or refereed from another department, ultrasound findings, associated pregnancy, associated pathology of the female genital tract, and post-operative histological results of surgically excised AMs (gold standard). Results 77.04% (245/318) of the studied AMs were found in the reproductive age group. The main causes for surgical intervention for the studied AMs was ruptured ovarian cyst in 27.1% or adnexal torsion in 9.7%. The available histological results of the surgically managed AMs showed the following: functional ovarian cyst in 36.2% (115/318), benign ovarian neoplasms (BONs) in 18.55% (59/318), and borderline malignant ovarian tumours in 0.63% (2/318). 44.34% of the studied AMs were associated with pregnancy, 49.3% with chronic tubo-ovarain diseases such as salpingo-oophoritis, 14.8% with cervical pathology and pelvic inflammatory diseases, 11.3% with uterine leiomyomas, and 4.4% with endometrial hyperplasia. Conclusions AMs were more common in the reproductive age group (77.04%), and 44.34% of the studied AMs were associated with pregnancy. The main causes of surgical intervention for the studied AMs were ruptured ovarian cyst in 27.1% or adnexal torsion in 9.7%.
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Halimeh R, Tomassian S, El Hage M, Metri N, Bersaoui M, Daou R, Anastasiadis E. Laparoscopic Adnexal Detorsion in a 20-Week Pregnant Patient: A Case Report and Literature Review. Case Rep Obstet Gynecol 2019; 2019:1093626. [PMID: 31815026 PMCID: PMC6877964 DOI: 10.1155/2019/1093626] [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] [Received: 06/29/2019] [Revised: 08/28/2019] [Accepted: 09/21/2019] [Indexed: 11/17/2022] Open
Abstract
Adnexal torsion is a cause of severe pelvic pain in reproductive aged women and during pregnancy. Adnexal torsion occurs when there is a complete turn of the ovary, tube, or both resulting in impaired blood flow to the ovary. The diagnosis of adnexal torsion is sometimes challenging due to the enlarged effect of the uterus, the displacement of abdominal and pelvic structures and the nonspecific symptoms in pregnancy. Therefore, prompt diagnosis is essential for better maternal and neonatal outcomes. The gold standard for confirmation and treatment of ovarian torsion is surgery. Laparoscopy and Laparotomy are surgical options with defined risks and benefits. Therefore, choosing the best surgical technique and surgical procedure are of utmost importance to decrease the chances of adverse events intra and postoperatively. Little literature exists regarding the laparoscopic approach of an ovarian torsion during the second trimester. Our case is a 20-week pregnant patient who had a 1080 degree rotation of the left adnexa. She required laparoscopy for adnexal detorsion and had good intraoperative, postoperative, maternal, and neonatal outcomes following management.
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Affiliation(s)
- Rawad Halimeh
- Obstetrics and Gynecology Department, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Serge Tomassian
- Faculty of Medicine and Medical Sciences, University of Balamand, El-Koura, Lebanon
| | - Maria El Hage
- Faculty of Medicine and Medical Sciences, University of Balamand, El-Koura, Lebanon
| | - Nicole Metri
- Faculty of Medicine and Medical Sciences, University of Balamand, El-Koura, Lebanon
| | - Marianne Bersaoui
- Obstetrics and Gynecology Department, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Rafi Daou
- Faculty of Medicine, University of London, St. Georges, Nicosia, Cyprus
| | - Elie Anastasiadis
- Obstetrics and Gynecology Department, Saint George Hospital University Medical Center, Beirut, Lebanon
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26
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Chattri H, Kouara M, Chetouani K. [Ovarian torsion during the postpartum period: about a case]. Pan Afr Med J 2019; 33:240. [PMID: 31692748 PMCID: PMC6814902 DOI: 10.11604/pamj.2019.33.240.19309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 06/17/2019] [Indexed: 11/28/2022] Open
Abstract
La torsion d'ovaire est une étiologie rare de douleurs pelviennes en postpartum. L'absence de signes cliniques et radiologiques spécifiques rend la suspicion et le diagnostic préopératoire difficiles. Le retard de prise en charge peut mettre en jeu la viabilité de l'ovaire. Nous présentons le cas d'une patiente de 24 ans à J5 du postpartum qui s'est présentée aux urgences pour des douleurs pelviennes aiguës, chez qui le diagnostic de torsion ovarienne sur masse kystique a été fait sur la base des signes échographiques, permettant à la patiente de bénéficier d'une kystectomie et d'un traitement conservateur.
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Affiliation(s)
- Houda Chattri
- Service de Radiologie, Centre Hospitalier Provincial de Guercif, Maroc
| | - Meryem Kouara
- Service de Gynéco-obstétrique, Centre Hospitalier Provincial de Guercif, Maroc
| | - Khadija Chetouani
- Service de Réanimation, Centre Hospitalier Provincial de Guercif, Maroc
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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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28
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Ziruma A, Hukuimwe M, Nyakura M, Majangara R, Venge M. A rare case of Meigs syndrome in pregnancy. Pan Afr Med J 2019; 33:36. [PMID: 31384351 PMCID: PMC6658162 DOI: 10.11604/pamj.2019.33.36.18653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 03/30/2019] [Indexed: 11/11/2022] Open
Abstract
We present a case of Meigs syndrome in a 19 year old woman. We suspected metastatic ovarian cancer after she had presented in her first pregnancy at 12 weeks gestation. Ultrasound scan had confirmed a complex solid mass in the left adnexa, measuring 7cm x 8cm, a viable 12 weeks pregnancy and gross ascites. She had elevated Ca 125 and serum beta - HCG. She went on to have a spontaneous miscarriage while being worked up for exploratory laparotomy. At laparotomy, a left sided solid ovarian mass 8cm x 10cm with a smooth surface and intact capsule was found. This was later confirmed to be a fibrothecoma at histology. The patient went on to recover without any further reaccumulation of ascites.
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Affiliation(s)
- Asaph Ziruma
- Department of Obstetrics and Gynaecology, University of Zimbabwe, College of Health Sciences, Harare, Zimbabwe
| | - Misai Hukuimwe
- Department of Obstetrics and Gynaecology, University of Zimbabwe, College of Health Sciences, Harare, Zimbabwe
| | - Michael Nyakura
- Department of Obstetrics and Gynaecology, University of Zimbabwe, College of Health Sciences, Harare, Zimbabwe
| | - Rumbidzai Majangara
- Department of Obstetrics and Gynaecology, University of Zimbabwe, College of Health Sciences, Harare, Zimbabwe
| | - Mervyn Venge
- Department of Obstetrics and Gynaecology, University of Zimbabwe, College of Health Sciences, Harare, Zimbabwe
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Brown BP, Holt R. Palliative Care and the Pregnant Surgical Patient: Epidemiology, Ethics, and Clinical Guidance. Surg Clin North Am 2019; 99:941-953. [PMID: 31446919 DOI: 10.1016/j.suc.2019.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Obstetricians and general surgeons frequently navigate the challenges of providing surgical care that is mindful of the unique circumstances of pregnancy. Ensuring pregnant patients have high-quality surgical care is an ethical imperative. Providers should maintain a high index of suspicion for surgical disease to ensure that surgical diagnoses are not missed or inadequately treated. A variety of imaging modalities are used in pregnancy. Surgical management includes laparoscopic and open approaches. Perioperative fetal monitoring should be the subject of multidisciplinary discussion. Symptomatic control in pregnancy should have the same goals as for nonpregnant patients. Enhanced recovery after surgery pathways frequently are appropriate.
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Affiliation(s)
- Benjamin P Brown
- Division of Emergency Obstetrics and Gynecology, Alpert Medical School of Brown University, Women and Infants Hospital of Rhode Island, 101 Dudley Street, Providence, RI 02905, USA.
| | - Roxane Holt
- Section of Maternal-Fetal Medicine, University of Chicago, University of Chicago Medicine, 5841 South Maryland Avenue, Chicago, IL 60637, USA
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Seo SK, Lee JB, Lee I, Yun J, Yun BH, Jung YS, Chon SJ. Clinical and pathological comparisons of adnexal torsion between pregnant and non‐pregnant women. J Obstet Gynaecol Res 2019; 45:1899-1905. [DOI: 10.1111/jog.14057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 06/22/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Seok K. Seo
- Department of Obstetrics and Gynecology, Severance HospitalYonsei University College of Medicine Seoul Republic of Korea
- Institute of Women's Life Medical Science Seoul Korea
| | - Jun B. Lee
- Department of Emergency MedicineYongin Severance Hospital, Yonsei University College of Medicine Yongin Korea
| | - Inha Lee
- Department of Obstetrics and Gynecology, Severance HospitalYonsei University College of Medicine Seoul Republic of Korea
- Institute of Women's Life Medical Science Seoul Korea
| | - Jisun Yun
- Department of Obstetrics and Gynecology, Severance HospitalYonsei University College of Medicine Seoul Republic of Korea
- Institute of Women's Life Medical Science Seoul Korea
| | - Bo H. Yun
- Department of Obstetrics and Gynecology, Severance HospitalYonsei University College of Medicine Seoul Republic of Korea
- Institute of Women's Life Medical Science Seoul Korea
| | - Yeon S. Jung
- Department of Obstetrics and Gynecology, Wonju Severance Christian HospitalYonsei University College of Medicine Wonju Korea
| | - Seung J. Chon
- Department of Obstetrics and Gynecology, Gil HospitalGachon University College of Medicine Incheon Korea
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Hua D, Zhao P, Jiang L. Torsion of ovarian endometrioma in pregnancy: a case report and review of the literature. Trop Doct 2019; 49:221-223. [PMID: 31067205 DOI: 10.1177/0049475519847327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Adnexal torsion induced by an endometrioma has seldom been reported. Because of its rarity and its complexity in respect of fetal health during pregnancy, the diagnosis and treatment is challenging. We report a 25-year-old primigravida in the eighth week of gestation presenting with acute onset lower abdominal pain. A pelvic ultrasonography showed an intrauterine single viable embryo with a right ovarian cyst measuring 6 × 6 cm in diameter. Exploratory laparotomy revealed torsion of the right adnexa by 360°. After a right adnexectomy was performed, the patient proceeded to full-term pregnancy. Adnexal torsion is defined as rotation of > 45° in the long axis of the adnexae. Its occurrence during gestation is reported as 2%, accounting for 2.7% of surgical emergencies in pregnant women. Most cases are caused by dermoid and functional ovarian cysts. Because of the rarity of torsion induced by an endometrioma, the diagnosis and treatment are challenging. In poor-resource conditions, a diagnostic laparoscopy (or laparotomy) remains a logical method of diagnosis, offering simultaneous therapeutic options.
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Affiliation(s)
- Dingchao Hua
- Department of Obstetrics and Gynaecology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, PR China
| | - Peng Zhao
- Department of Obstetrics and Gynaecology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, PR China
| | - Lianyun Jiang
- Department of Obstetrics and Gynaecology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, PR China
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Wyckoff ET, Bruggeman BJ, Patrick KE. Juvenile Granulosa Cell Tumor as a Cause of Ovarian Torsion Complicating Pregnancy. J Gynecol Surg 2019. [DOI: 10.1089/gyn.2016.0073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Erich T. Wyckoff
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, and University of Florida Health Shands Hospital, Gainesville, FL
| | - Bradley J. Bruggeman
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, and University of Florida Health Shands Hospital, Gainesville, FL
| | - Kathryn E. Patrick
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, and University of Florida Health Shands Hospital, Gainesville, FL
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Tanaka Y, Tsuboyama T, Yamamoto K, Terai Y, Ohmichi M, Narumi Y. A case of torsion of a normal ovary in the third trimester of pregnancy: MRI findings with emphasis on asymmetry in the diameter of the ovarian veins. Radiol Case Rep 2018; 14:324-327. [PMID: 30581517 PMCID: PMC6293029 DOI: 10.1016/j.radcr.2018.11.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 11/28/2018] [Accepted: 11/30/2018] [Indexed: 11/18/2022] Open
Abstract
A 33-year-old woman, gravida two para one, at 31 weeks of gestational age experienced sudden onset of left lower quadrant pain and underwent unenhanced pelvic MRI. On fast imaging employing steady state precession (FIESTA) sequence images, a marked difference was observed in the diameters of the right and left ovarian veins. The right ovarian vein was torturous and dilated, measuring 35 mm in diameter, while the left ovarian vein was thin and linear, measuring 7 mm in diameter. The left ovary showed no apparent swelling or hemorrhage, but was suspected to have been shifted anteriorly. The patient underwent explorative laparotomy and was found to have left ovarian torsion. A difference in diameter of the ovarian veins, with thinning of the twisted side and compensatory dilatation of the contralateral side for drainage of increased uterine blood flow, may be a useful imaging sign for the diagnosis of ovarian torsion during pregnancy.
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Affiliation(s)
- Yoshikazu Tanaka
- Department of Radiology, Osaka Medical College, Osaka Prefecture, Takatsuki, Japan
- Corresponding author.
| | - Takahiro Tsuboyama
- Department of Radiology, Osaka National Hospital, Osaka, Osaka Prefecture, Japan
| | - Kazuhiro Yamamoto
- Department of Radiology, Osaka Medical College, Osaka Prefecture, Takatsuki, Japan
| | - Yoshito Terai
- Department of Obstetrics and Gynecology, Osaka Medical College, Osaka Prefecture, Takatsuki, Japan
| | - Masahide Ohmichi
- Department of Obstetrics and Gynecology, Osaka Medical College, Osaka Prefecture, Takatsuki, Japan
| | - Yoshifumi Narumi
- Department of Radiology, Osaka Medical College, Osaka Prefecture, Takatsuki, Japan
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34
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Li C, Wang S, Tao X, Hu Y, Li X, Xiao X. Torsion of normal-sized ovary during late pregnancy: A case report and review of the literature. J Obstet Gynaecol Res 2018; 44:2110-2114. [PMID: 30019803 DOI: 10.1111/jog.13758] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 06/23/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Chunbo Li
- Department of Obstetrics and Gynecology; Obstetrics and Gynecology Hospital of Fudan University; Shanghai China
| | - Shijia Wang
- Department of Radiology; Obstetrics and Gynecology Hospital of Fudan University; Shanghai China
| | - Xiang Tao
- Department of Pathology; Obstetrics and Gynecology Hospital of Fudan University; Shanghai China
| | - Yanlai Hu
- Department of Ultrasound; Obstetrics and Gynecology Hospital of Fudan University; Shanghai China
| | - Xiaotian Li
- Department of Obstetrics and Gynecology; Obstetrics and Gynecology Hospital of Fudan University; Shanghai China
| | - Xirong Xiao
- Department of Obstetrics and Gynecology; Obstetrics and Gynecology Hospital of Fudan University; Shanghai China
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Chen LH, Chang SD, Huang HY, Wang HS, Soong YK, Wu HM. Repeated pregnancy with concomitant presence of ovarian teratoma: A case report and literature review. Taiwan J Obstet Gynecol 2018; 56:694-696. [PMID: 29037561 DOI: 10.1016/j.tjog.2017.08.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2017] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE Benign mature teratoma during pregnancy is common, mostly discovered incidentally by antenatal sonography. However, repeated pregnancy coincident with ovarian mature teratoma is rarely reported. The cases of teratoma with rapid growing characteristics are even more unique. CASE REPORT A 17-year-old woman was pregnant at 6 weeks of gestation with a left ovarian teratoma. She underwent artificial abortion followed by surgical removal of the teratoma. However, eleven years after the surgery, a right ovarian teratoma was found incidentally by antepartum sonography at 21 weeks of gestation. The right ovarian teratoma developed uneventfully, with rapid growth during pregnancy. Abdominal delivery at term was accomplished without any complication. CONCLUSION Younger patients and patients with bilateral or large size dermoid cysts should be followed up closely. Further studies are needed for better understanding of its natural clinical course and the mechanism of progression. The treatment options should be made individually, weighing the risks of torsion, rupture, or obstruction of labor versus the potential for unnecessary surgical risk to mother and fetus.
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Affiliation(s)
- Liang-Hsuan Chen
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Shuenn-Dhy Chang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Hong-Yuan Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Hsin-Shih Wang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Yung-Kuei Soong
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Hsien-Ming Wu
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan.
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36
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Affiliation(s)
- Aderemi O Alalade
- Department of Obstetrics and Gynaecology; Wrexham Maelor Hospital; Wrexham LL13 7TD UK
| | - Hemant Maraj
- Department of Obstetrics and Gynaecology; Wrexham Maelor Hospital; Wrexham LL13 7TD UK
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37
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Matsuoka S, Kobayashi T, Kusunoki S, Ogishima D. Polycystic ovary syndrome with asynchronous bilateral adnexal torsion in a natural cycle. BMJ Case Rep 2017; 2017:bcr-2016-218880. [PMID: 28835425 DOI: 10.1136/bcr-2016-218880] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Cases involving polycystic ovaries (PCOs) with adnexal torsion in a natural cycle without ovulation induction are rare, and no reports of such cases have described asynchronous bilateral adnexal torsion. Here, we report a case of PCO syndrome (PCOS) with asynchronous bilateral adnexal torsion in a natural cycle. The patient was a 37-year-old woman with a history of 2 gravidas 1 para. Her primary complaint was left lower abdominal pain. Ultrasonography and MRI identified multiple uterine myomas occupying the pelvis and the left ovary, with oedematous swelling that had moved ventrally to the uterus. She was diagnosed with adnexal torsion and underwent emergency laparoscopic adnexectomy. Nine months after surgery, she experienced right lower abdominal pain. Ultrasonography revealed suspected right adnexal torsion and she underwent emergency surgery. The right ovary was twisted 540° counterclockwise and swollen to 7 cm in size, with partial polycystic changes. She was histopathologically diagnosed with a PCO, and the final diagnosis, which also considered the endocrine test results, was PCOS. In PCOS, adnexal torsion may occur if the swollen ovary moves because of a hysteromyoma or other cause. Accordingly, torsion should be considered during the follow-up of patients with PCOS.
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Affiliation(s)
- Shozo Matsuoka
- Department of Obstetric and Gynecology, Juntendo Nerima Hospital, Tokyo, Japan
| | - Toru Kobayashi
- Department of Obstetric and Gynecology, Juntendo Nerima Hospital, Tokyo, Japan
| | - Soshi Kusunoki
- Department of Obstetric and Gynecology, Juntendo Nerima Hospital, Tokyo, Japan
| | - Daiki Ogishima
- Department of Obstetric and Gynecology, Juntendo Nerima Hospital, Tokyo, Japan
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Gynecologic Malignancies in Pregnancy: Balancing Fetal Risks With Oncologic Safety. Obstet Gynecol Surv 2017; 72:184-193. [PMID: 28304416 DOI: 10.1097/ogx.0000000000000407] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance Cancer occurs in 0.05% to 0.1% of all pregnancies. Despite literature reporting good oncologic and fetal outcomes in women treated for cancer during pregnancy, as many as 44% of gynecologists would offer termination, and 37% would not administer chemotherapy or radiotherapy in pregnancy. Objectives The aims of this study were to summarize current recommendations for the treatment of cervical and ovarian cancers in pregnancy and to review updates on existing knowledge regarding the safety of surgical and chemotherapeutic treatments in pregnancy, including both oncologic and fetal outcomes. Evidence Acquisition A detailed literature review was performed on PubMed. Results The treatment of gynecologic malignancies during pregnancy mirrors that outside pregnancy, with a balance between maternal versus fetal health. Fertility-sparing surgery can be offered to stage IA2 and low-risk IB1 cervical, stage I epithelial ovarian, germ cell ovarian, or sex-cord stromal ovarian tumors. Delayed treatment can be offered for stage IB1 cervical cancer. Neoadjuvant and/or adjuvant chemotherapy can be given for advanced gynecologic cancers with good disease-free survival without significant adverse neonatal outcomes. Conclusions A multidisciplinary approach and improved education of providers regarding the surgical and chemotherapeutic treatments in pregnancy are needed in order to fully inform patients regarding treatment options. Further research in women who are pregnant is needed to determine the safety of diagnostic and therapeutic procedures used in the nonpregnant woman. Relevance This article reviews and supports treatment of gynecologic cancer during pregnancy, calls for additional study and long-term follow-up, and justifies improved education of patients and providers regarding treatment options. Target Audience Obstetricians and gynecologists, family physicians. Learning Objectives After completing this activity, the learner should be better able to (1) review general principles in the management and treatment of gynecologic cancers in pregnancy, (2) review the diagnosis and treatment of cervical cancer in pregnancy, and (3) review the diagnosis and treatment of ovarian cancer in pregnancy.
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Abstract
Ovarian torsion is a rare but emergency condition in women. Early diagnosis is necessary to preserve the function of the ovaries and tubes and prevent severe morbidity. Ovarian torsion refers to complete or partial rotation of the adnexal supporting organ with ischemia. It can affect females of all ages. Ovarian torsion occurs in around 2%-15% of patients who have surgical treatment of adnexal masses. The main risk in ovarian torsion is an ovarian mass. The most common symptom of ovarian torsion is acute onset of pelvic pain, followed by nausea and vomiting. Pelvic ultrasonography can provide information on ovarian cysts. Once ovarian torsion is suspected, surgery or detorsion is the mainstay of diagnosis and treatment.
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Affiliation(s)
- Ci Huang
- Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Mun-Kun Hong
- Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan.,Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
| | - Dah-Ching Ding
- Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan.,Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
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Yuk JS, Shin JY, Park WI, Kim DW, Shin JW, Lee JH. Association between pregnancy and adnexal torsion: A population-based, matched case-control study. Medicine (Baltimore) 2016; 95:e3861. [PMID: 27310967 PMCID: PMC4998453 DOI: 10.1097/md.0000000000003861] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The purpose of this study was to determine the effect of pregnancy on adnexal torsion (AT). We conducted a matched case-control study using the Korean Health Insurance Review and Assessment Service-National Inpatients Sample (HIRA-NIS) from 2009 to 2011. AT patients were defined as women with both a diagnostic code (N835) and a surgical code for AT. The AT patients were randomly matched 1:4 with women without AT by age and year of claim. In total, 545 AT cases and 2180 controls were enrolled from a total of 1,843,451 women. After adjustment for such covariates as age, pregnancy was found to be associated with a lower rate of AT (adjusted odds ratio 0.314, 95% confidence interval [CI] 0.237-0.416, P value <0.01) and ovarian hyperstimulation syndrome was associated with a higher rate of AT (adjusted odds ratio 20.091, 95% CI 3.607-111.908, P value <0.01). We found that pregnancy is a negative risk factor for AT. However, a further study is needed to elucidate the mechanisms underlying these results.
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Affiliation(s)
- Jin-Sung Yuk
- Department of Obstetrics and Gynaecology, School of Medicine, Eulji University, Daejeon
- Department of Obstetrics and Gynaecology, MizMedi Hospital, Seoul
| | - Ji-Yeon Shin
- Department of Preventive Medicine, School of Medicine, Eulji University, Daejeon, Korea
| | - Won I. Park
- Department of Obstetrics and Gynecology, Hankang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Dae Woon Kim
- Department of Obstetrics and Gynaecology, School of Medicine, Eulji University, Daejeon
| | - Jung Whan Shin
- Department of Obstetrics and Gynaecology, School of Medicine, Eulji University, Daejeon
| | - Jung Hun Lee
- Department of Obstetrics and Gynecology, Gyeongsang National University Changwon Hospital, Gyeongsang National University, School of Medicine, Changwon, Republic of Korea
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41
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Iftikhar H, Idu S, Omer A. Teratodermoid mimicking cholecystitis. Clin Case Rep 2016; 4:494-8. [PMID: 27190615 PMCID: PMC4856244 DOI: 10.1002/ccr3.554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 06/01/2015] [Accepted: 08/13/2015] [Indexed: 11/16/2022] Open
Abstract
An acute abdomen assessment in pregnancy is complicated. Pain can have obstetric and nonobstetric causes. Cholecystitis is a common cause of pain in pregnancy with significant morbidity if not managed promptly. We report a case of a ruptured, torted, right ovarian teratodermoid erroneously diagnosed as cholecystitis in pregnancy.
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Affiliation(s)
- Hina Iftikhar
- Surgery Ipswich Hospital NHS trust Ipswich Suffolk UK
| | - Shareen Idu
- Surgery Ipswich Hospital NHS trust Ipswich Suffolk UK
| | - Abdel Omer
- Surgery Ipswich Hospital NHS trust Ipswich Suffolk UK
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42
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Saghafi N, Roodsary ZY, Kadkhodaeian S, Mofrad MH, Farahabadi EH, Hoseinyfarahabady M. Comparison of Adnexal Mass in Women Undergoing Mass Excision During the Antepartum Period and Cesarean Section. Oman Med J 2016; 31:217-22. [PMID: 27162593 DOI: 10.5001/omj.2016.41] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The frequency of adnexal masses in pregnant women ranges from 0.1% to 4%. Selecting the right approach to manage the subsequent intervention remains one of the most controversial challenges among gynecologists. Our aim in this cross-sectional study was to clarify the clinical-pathological differences among the adnexal masses that are excised during either the antepartum period or cesarean section (CS). METHODS In this study, we assessed 11,000 pregnancy cases referred to the Qaem Hospital in the Mashhad University of Medical Sciences, Iran, between 2010 and 2014. In total, 53 pregnant women with adnexal masses (other than non-gynecological mass and ectopic pregnancy) were selected for further investigation. We divided patients into two groups (group A and group B). Patients of group A had a diagnosed tumor that was excised antepartum while patients in group B had a mass taken out during CS. We then assembled data based on maternal age, parity, gestational age, surgery type, delivery mode, size and location of the tumor, complications, presentations, histopathological diagnosis, and ultrasonography findings for further analysis. RESULTS The major proportion of masses (62.3%) were excised during CS whereas the remainder (37.7%) were removed antepartum. The mean size of the detected tumor for benign and malignant cases was 10.0 cm and 13.8 cm in group A, and 8.0 cm and 9.3 cm in group B, respectively. There was a statistically significant difference observed between patients in the two groups regarding the benign/malignant status of the mass (p = 0.008), its size (p = 0.019) and simplicity/complexity (p = 0.004). CONCLUSIONS The rate of malignant tumors was considerably higher in women who had antepartum mass excision compared to those with mass resection during CS. Also, tumors were larger (and more complex) in patients in group A compared to group B.
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Affiliation(s)
- Nafiseh Saghafi
- Department of Obstetrics and Gynecology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zohreh Yousefi Roodsary
- Department of Obstetrics and Gynecology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sima Kadkhodaeian
- Department of Obstetrics and Gynecology, Mashhad University of Medical Sciences, Mashhad, Iran
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Mukhopadhyay A, Shinde A, Naik R. Ovarian cysts and cancer in pregnancy. Best Pract Res Clin Obstet Gynaecol 2016; 33:58-72. [DOI: 10.1016/j.bpobgyn.2015.10.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 10/22/2015] [Indexed: 12/27/2022]
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Cavaco-Gomes J, Jorge Moreira C, Rocha A, Mota R, Paiva V, Costa A. Investigation and Management of Adnexal Masses in Pregnancy. SCIENTIFICA 2016; 2016:3012802. [PMID: 27119043 PMCID: PMC4826943 DOI: 10.1155/2016/3012802] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 03/16/2016] [Indexed: 06/05/2023]
Abstract
Adnexal masses can be found in 0.19 to 8.8% of all pregnancies. Most masses are functional and asymptomatic and up to 70% resolve spontaneously in the second trimester. The main predictors of persistence are the size (>5 cm) and the imagiological morphocomplexity. Those that persist carry a low risk of malignancy (0 to 10%). Most malignant masses are diagnosed at early stages and more than 50% are borderline epithelial neoplasms. Ultrasound is the preferred method to stratify the risk of complications and malignancy, allowing medical approach planning. Pregnancy and some gestational disorders may modify the levels of tumor markers, whereby their interpretation during pregnancy should be cautious. Large masses are at increased risk of torsion, rupture, and dystocia. When surgery is indicated, laparoscopy is a safe technique and should ideally be carried out in the second trimester of pregnancy.
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Affiliation(s)
- João Cavaco-Gomes
- Department of Obstetrics and Gynecology, São João Hospital Centre, 4200-319 Porto, Portugal
| | - Cátia Jorge Moreira
- Department of Obstetrics and Gynecology, São João Hospital Centre, 4200-319 Porto, Portugal
| | - Anabela Rocha
- Department of Obstetrics and Gynecology, São João Hospital Centre, 4200-319 Porto, Portugal
| | - Raquel Mota
- Department of Obstetrics and Gynecology, São João Hospital Centre, 4200-319 Porto, Portugal
| | - Vera Paiva
- Department of Obstetrics and Gynecology, São João Hospital Centre, 4200-319 Porto, Portugal
| | - Antónia Costa
- Department of Obstetrics and Gynecology, São João Hospital Centre, 4200-319 Porto, Portugal
- Porto Medical Faculty, 4200-319 Porto, Portugal
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Abstract
With the advent of routine obstetrical ultrasound, the diagnosis of an adnexal mass in pregnancy has become increasingly common. Although the reported incidence and expected clinical course varies based on the gestational age at the time of diagnosis and the criteria used to define an adnexal mass, the majority of adnexal masses diagnosed in pregnancy are benign and are likely to resolve without complication or intervention. This review will discuss the epidemiology of adnexal masses in pregnancy, diagnostic tools, potential complications, and management options during pregnancy.
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Chen L, Ding J, Hua K. Comparative analysis of laparoscopy versus laparotomy in the management of ovarian cyst during pregnancy. J Obstet Gynaecol Res 2015; 40:763-9. [PMID: 24738121 DOI: 10.1111/jog.12228] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The aim of the present study was to evaluate the surgical and obstetric results of laparoscopy versus laparotomy in the management of ovarian cyst during pregnancy. MATERIAL AND METHODS Sixty-nine eligible patients who met our criteria were randomly divided into the laparoscopy group (n = 33) and the laparotomy group (n = 36). The two groups were compared for their surgical and obstetric outcomes and the extent of pelvic adhesion discovered in later cesarean section (CS). RESULTS The laparoscopy group had less blood loss (43 ± 15 vs 51 ± 13 mL, P = 0.02), shorter postoperative hospital stay (2.9 ± 0.5 vs 5.8 ± 0.6 days, P < 0.001), and lower postoperative pain score (2.7 ± 1.2 vs 5.9 ± 1.5, P < 0.001) compared with the laparotomy group. The operative time, neonates' Apgar scores and birthweights between the two groups showed no significant differences (P > 0.05). Sixteen patients in the laparoscopy group, and 15 patients in the laparotomy group underwent cesarean section. The filmy and dense type adhesion rate was significantly different between the laparoscopy group and the laparotomy group (6.25% vs 53.3%, and 0% vs 20%, respectively). CONCLUSIONS The present results suggest that laparoscopy is a better choice than laparotomy for ovarian cyst during pregnancy, with less blood loss, less postoperative pain and less postoperative hospital stay. It offers a faster recovery, results in less pelvic adhesion and does not affect the fetus; however, studies encompassing larger numbers of cases are needed.
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Topçu HO, İskender CT, Ceran U, Kaymak O, Timur H, Uygur D, Danışman N. Evaluation of the Diagnostic Accuracy of Serum D-Dimer Levels in Pregnant Women with Adnexal Torsion. Diagnostics (Basel) 2015; 5:1-9. [PMID: 26854140 PMCID: PMC4665548 DOI: 10.3390/diagnostics5010001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 11/20/2014] [Indexed: 11/25/2022] Open
Abstract
We aimed to evaluate the diagnostic accuracy of serum D-dimer levels in pregnant women with adnexal torsion (AT). The pregnant women with ovarian cysts who suffered from pelvic pain were divided into two groups; the first group consisted of the cases with surgically proven as AT (n = 17) and the second group consisted of the cases whose pain were resolved in the course of follow-up period without required surgery (n = 34). The clinical characteristics and serum D-dimer levels were compared between the groups. Patients with AT had a higher rate of elevated serum white blood cell (WBC) count (57% vs. 16%, p = 0.04) and serum D-dimer levels (77% vs. 21%, p < 0.01) on admission in the study group than in the control group. Elevated D-dimer and cyst diameter larger than 5 cm yielded highest sensitivity (82% for each); whereas the presence of nausea and vomiting and elevated CRP had the highest specificity (85% and 88%, respectively). This is the first study that evaluates the serum D-dimer levels in humans in the diagnosis of AT, and our findings supported the use of D-dimer for the early diagnosis of AT in pregnant women.
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Affiliation(s)
- Hasan Onur Topçu
- Zekai Tahir Burak Women's Health Education and Research Hospital, 1549 Cadde, Hardem Apartmanı, B Blok, Daire 12 Çiğdem-Çankaya, Ankara 06300, Turkey.
| | - Can Tekin İskender
- Zekai Tahir Burak Women's Health Education and Research Hospital, 1549 Cadde, Hardem Apartmanı, B Blok, Daire 12 Çiğdem-Çankaya, Ankara 06300, Turkey.
| | - Ufuk Ceran
- Zekai Tahir Burak Women's Health Education and Research Hospital, 1549 Cadde, Hardem Apartmanı, B Blok, Daire 12 Çiğdem-Çankaya, Ankara 06300, Turkey.
| | - Oktay Kaymak
- Zekai Tahir Burak Women's Health Education and Research Hospital, 1549 Cadde, Hardem Apartmanı, B Blok, Daire 12 Çiğdem-Çankaya, Ankara 06300, Turkey.
| | - Hakan Timur
- Zekai Tahir Burak Women's Health Education and Research Hospital, 1549 Cadde, Hardem Apartmanı, B Blok, Daire 12 Çiğdem-Çankaya, Ankara 06300, Turkey.
| | - Dilek Uygur
- Zekai Tahir Burak Women's Health Education and Research Hospital, 1549 Cadde, Hardem Apartmanı, B Blok, Daire 12 Çiğdem-Çankaya, Ankara 06300, Turkey.
| | - Nuri Danışman
- Zekai Tahir Burak Women's Health Education and Research Hospital, 1549 Cadde, Hardem Apartmanı, B Blok, Daire 12 Çiğdem-Çankaya, Ankara 06300, Turkey.
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Patil AR, Nandikoor S, Rao A, M Janardan G, Kheda A, Hari M, Basappa S. Multimodality imaging in adnexal torsion. J Med Imaging Radiat Oncol 2014; 59:7-19. [DOI: 10.1111/1754-9485.12266] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 10/31/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Aruna R Patil
- Department of Radiodiagnosis; Apollo Hospitals; Bangalore India
| | | | - Anuradha Rao
- Department of Radiodiagnosis; Apollo Hospitals; Bangalore India
| | | | | | - Mahesh Hari
- Department of Radiodiagnosis; Apollo Hospitals; Bangalore India
| | - Sharana Basappa
- Department of Radiodiagnosis; Apollo Hospitals; Bangalore India
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Hyttel TEW, Bak GS, Larsen SB, Løkkegaard ECL. Re-torsion of the ovaries. Acta Obstet Gynecol Scand 2014; 94:236-44. [PMID: 25412114 DOI: 10.1111/aogs.12542] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 11/12/2014] [Indexed: 12/01/2022]
Abstract
The increasing use of de-torsion of the ovaries may result in re-torsion. This review addresses risk of re-torsion and describes preventive strategies to avoid re-torsion in pre-menarcheal girls, and fertile and pregnant women. We clinically reviewed PubMed, Embase, Trip and Cochrane databases. The main outcome measures were re-torsion and viability of ovary with fixation measures. A total of 38 publications including 71 girls, 363 fertile women, and 69 pregnant women were found to be relevant. All studies were case reports or case series, sometimes with non-randomized controls. The studies show considerable heterogeneity in design, population, management and outcome. Only four studies included more than 50 cases. In pregnancy the risk of re-torsion was as high as 19.5-37.5%; among fertile women it was 28.6%. Most articles concluded that fixation of the ovaries to the pelvic sidewall or plication of the ovarian ligament after torsion may prevent re-torsion. In one case a girl experienced re-torsion after ovariopexy. Based on observational studies it seems that de-torsion and fixation of the ovary is a safe procedure that usually ensures maintenance of ovarian function and reduces the risk of recurrence, especially when there are no ovarian cysts or adnexal masses.
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Affiliation(s)
- Trine E W Hyttel
- Department of Anesthesiology, Vendsyssel Hospital, Hjørring, Denmark
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