Does pregnancy affect decisions regarding management of suspected adnexal torsion?

Decision regarding surgery in cases of suspected adnexal torsion are usually more complex when the patient is pregnant, balancing the risks of surgery to the mother and the fetus with risks of permanent ovarian damage. The aim of this study was to examine whether pregnancy affects decisions regarding management of suspected adnexal torsion cases.

This was a retrospective study conducted at a single medical center. A total of 174 women underwent a laparoscopic surgery due to suspected adnexal torsion during the study's period. All ultrasound examinations were performed by certified ultrasound technicians or physicians. The pregnant women group was compared to non pregnant group.

A total of 37 women were pregnant and 137 were not pregnant. We found that pregnant women presented more commonly with a maximal pain level (VAS 10), vomiting and peritoneal signs compared to non-pregnant women. Women in the pregnancy group were operated on significantly faster than women in the non-pregnant group (5.1 h, IQR 3-7.7, vs 9.6 h, IQR 4.6-20.6, respectively, p = 0.001). However, using a Cox regression model accounting also for extreme pain (VAS = 10), vomiting and peritoneal signs, pregnancy was not found to be a significant independent factor that reduced time to surgery. Furthermore, we showed an ovarian torsion incidence of 81.1 % among pregnant women that underwent surgery compared to only a 39.7 % in the non-pregnant group (p < 0.001).

Pregnant women with suspected adnexal torsion that are referred for surgery are more likely to be found with adnexal torsion and to be operated on earlier than non-pregnant women.