Adnexal torsion in pregnancy after in vitro fertilization

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.

Acute Mesenteric Vein Thrombosis in a Pregnant Patient at 10 Weeks Gestation: A Case Report

“…Some etiologies require immediate treatment, as they can be life-threatening to both the mother and the fetus. Some of these conditions include acute appendicitis, cholecystitis, ectopic pregnancy [2,3], ovarian torsion [4], and deep vein thrombosis [5]. Evaluation of abdominal pain can prove a diagnostic challenge during pregnancy.…”

Ovarian torsion in a twin pregnancy at 32 weeks and 6 days: A case-report

“…Except for obstetrical causes, the prevalence of all abdominal emergency surgeries during pregnancy is between 0.2 and 2% 4 . In the literature, several cases of ovarian torsion are described during the third trimester of singleton pregnancy 5 and only a few studies report an ovarian torsion in twin pregnancy [6][7][8][9][10][11][12][13][14][15][16][17][18] (table 1). Only one case reports an ovarian torsion in a triplet pregnancy during the third trimester resulting in a preterm delivery by C-section 19 .…”