Clinical characteristics, treatment and outcomes of adnexal torsion in pregnant women: a retrospective study

Wang, Yongxue; Deng, Shan

doi:10.1186/s12884-020-03173-7

Cited by 19 publications

(13 citation statements)

References 24 publications

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“…Secondly, they may have been more likely to perform oophorectomy based on what the ovary looked like and the patient's symptoms. This would be consistent with another study that identi ed that surgeons preferred to perform oophorectomies if the color of the adnexa was still blue-black at 10 minutes after detorsion [12]. However, as previously mentioned, there is strong evidence for good recovery of ovarian function despite how they may appear at the time of surgery.…”

Section: Discussionsupporting

confidence: 89%

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Clinical factors and surgical decision-making when managing premenopausal women with adnexal torsion

Goh

2022

Arch Gynecol Obstet

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PurposeThe primary objective of this study is to identify if and which clinical factors may in uence surgical decision-making when managing premenopausal women who present emergently with adnexal torsion (AT). MethodsThis retrospective cohort study was conducted at a single tertiary hospital. Medical records for all admissions for AT between 1 January 2010 and 30 June 2020 were reviewed and data regarding patient demographics, history of torsion, and the index admission were collected. Conservative surgery was de ned as detorsion only or detorsion with cyst decompression. Interventional surgery was de ned as ovarian cystectomy, salpingectomy, oophorectomy or salpingo-oopherectomy. Results126 women were included for nal analysis. Of the 109 women diagnosed with AT at emergency surgery, 12 were postmenopausal (all had interventional surgery). In the 97 premenopausal women, 50 (52%) underwent conservative surgery. Pregnant women were more likely to undergo conservative surgery than non-pregnant women (Relative Risk [RR] 0.20, 95% con dence interval [CI] 0.5, 0.75, p=0.001). Women having laparoscopies were also more likely to undergo conservative surgery (RR 0.08, 95% CI 0.01, 0.53, p=0.001) than if they had laparotomies. Although not reaching statistical signi cance, women were more likely to undergo laparotomy if they were febrile or if a senior gynecology consultant was involved in their care. History of torsion, age, parity and ovarian size did not alter the risk of interventional surgery. ConclusionThis study identi ed that premenopausal women who presented emergently with AT were signi cantly more likely to have conservative surgery if they were pregnant or if they underwent laparoscopic surgery.

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Section: Discussionsupporting

confidence: 89%

“…In our study, 52% of premenopausal women were conservatively managed at the time of emergency surgery for AT which is comparable to published rates of 20.6-65.4% [6, [10][11][12][13][14][15]. This is despite a difference in the de nition of "conservative surgery".…”

Section: Discussionsupporting

confidence: 79%

Clinical factors and surgical decision-making when managing premenopausal women with adnexal torsion

Goh

2022

Arch Gynecol Obstet

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“…1). After title/abstract and full-text screening, 114 articles 24–137 were included in the systematic review and 100 articles 24–47,49–51,53–58,60–66,68–72,74–89,91–105,108–118,121,123–127,129–134,136,137 were included in the meta-analysis for either fetal loss, preterm birth, or maternal mortality.…”

Section: Resultsmentioning

confidence: 99%

Adverse Fetal Outcomes and Maternal Mortality Following Nonobstetric Abdominopelvic Surgery in Pregnancy

et al. 2021

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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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“…In a study of 82 patients with surgically confirmed pathology, ovarian torsion was more commonly diagnosed in the first trimester, with a median gestational age of 11 weeks (range 6-31 weeks) 32. Although presenting symptoms are similar to those of non-pregnant women, diagnosis can be more challenging because of the gravid uterus obscuring views of the ovaries on imaging.…”

Section: Are There Any Special Considerations?mentioning

confidence: 99%

Recognition and initial management of ovarian torsion

Ashmore

Blackstock

Kenny

et al. 2023

BMJ

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Clinical characteristics, treatment and outcomes of adnexal torsion in pregnant women: a retrospective study

Cited by 19 publications

References 24 publications

Clinical factors and surgical decision-making when managing premenopausal women with adnexal torsion

Clinical factors and surgical decision-making when managing premenopausal women with adnexal torsion

Adverse Fetal Outcomes and Maternal Mortality Following Nonobstetric Abdominopelvic Surgery in Pregnancy

Recognition and initial management of ovarian torsion

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