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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Data availability
Our data is confidential and hence not available.
References
Adeyemi-Fowode O, McCracken KA, Todd NJ (2018) Adnexal torsion. J Pediatr Adolesc Gynecol 31:333–338. https://doi.org/10.1016/j.jpag.2018.03.010
Houry D, Abbott JT (2001) Ovarian torsion: a fifteen-year review. Ann Emerg Med 38:156–159. https://doi.org/10.1067/mem.2001.114303
Melcer Y, Maymon R, Pekar-Zlotin M, Vaknin Z, Pansky M, Smorgick N (2018) Does she have adnexal torsion? Prediction of adnexal torsion in reproductive age women. Arch Gynecol Obstet 297:685–690. https://doi.org/10.1007/s00404-017-4628-x
Condous G, Khalid A, Okaro E, Bourne T (2004) Should we be examining the ovaries in pregnancy? Prevalence and natural history of adnexal pathology detected at first-trimester sonography. Ultrasound Obstet Gynecol 24:62–66. https://doi.org/10.1002/uog.1083
Asfour V, Varma R, Menon P (2015) Clinical risk factors for ovarian torsion. J Obstet Gynaecol 35:721–725. https://doi.org/10.3109/01443615.2015.1004524
Hasson J, Tsafrir Z, Azem F, Bar-On S, Almog B, Mashiach R et al (2010) Comparison of adnexal torsion between pregnant and nonpregnant women. Am J Obstet Gynecol 202:536.e1–536.e6. https://doi.org/10.1016/j.ajog.2009.11.028
Ginath S, Shalev A, Keidar R, Kerner R, Condrea A, Golan A et al (2012) Differences between adnexal torsion in pregnant and nonpregnant women. J Minim Invasive Gynecol 19:708–714. https://doi.org/10.1016/j.jmig.2012.07.007
Pansky M, Feingold M, Maymon R, Ben AI, Halperin R, Smorgick N (2009) Maternal adnexal torsion in pregnancy is associated with significant risk of recurrence. J Minim Invasive Gynecol 16:551–553. https://doi.org/10.1016/j.jmig.2009.05.003
Bider D, Mashiach S, Dulitzky M, Kokia E, Lipitz S, Ben-Rafael Z (1991) Clinical, surgical and pathologic findings of adnexal torsion in pregnant and nonpregnant women. Surg Gynecol Obstet 173:363–366
Hibbard LT (1985) Adnexal torsion. Am J Obstet Gynecol 152:456–461. https://doi.org/10.1016/S0002-9378(85)80157-5
Smorgick N, Pansky M, Feingold M, Herman A, Halperin R, Maymon R (2009) The clinical characteristics and sonographic findings of maternal ovarian torsion in pregnancy. Fertil Steril 92:1983–1987. https://doi.org/10.1016/j.fertnstert.2008.09.028
Daykan Y, Bogin R, Sharvit M, Klein Z, Josephy D, Pomeranz M et al (2019) Adnexal torsion during pregnancy: outcomes after surgical intervention-a retrospective case-control study. J Minim Invasive Gynecol 26:117–121. https://doi.org/10.1016/j.jmig.2018.04.015
Amos JD, Schorr SJ, Norman PF, Poole GV, Thomae KR, Mancino AT et al (1996) Laparoscopic surgery during pregnancy. Am J Surg 171:435–437. https://doi.org/10.1016/s0002-9610(97)89626-2
Yumi H, Guidelines for diagnosis, treatment, and use of laparoscopy for surgical problems during pregnancy: this statement was reviewed and approved by the Board of Governors of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) (2007) It was prepared by the SAGES guidelines committee. Surg Endosc 2008(22):849–861. https://doi.org/10.1007/s00464-008-9758-6
Wilasrusmee C, Sukrat B, McEvoy M, Attia J, Thakkinstian A (2012) Systematic review and meta-analysis of safety of laparoscopic versus open appendicectomy for suspected appendicitis in pregnancy. Br J Surg 99:1470–1478. https://doi.org/10.1002/bjs.8889
Prodromidou A, Machairas N, Kostakis ID, Molmenti E, Spartalis E, Kakkos A et al (2018) Outcomes after open and laparoscopic appendectomy during pregnancy: a meta-analysis. Eur J Obstet Gynecol Reprod Biol 225:40–50. https://doi.org/10.1016/j.ejogrb.2018.04.010
Dvash S, Pekar M, Melcer Y, Weiner Y, Vaknin Z, Smorgick N (2019) Adnexal torsion in pregnancy managed by laparoscopy is associated with favorable obstetric outcomes. J Minim Invasive Gynecol. https://doi.org/10.1016/j.jmig.2019.09.783
Haenggi D, Uehlinger U, Heinzl S (2003) Adnexal torsion during pregnancy - management and literature overview. Gynakol Geburtshilfliche Rundsch 43:39–42. https://doi.org/10.1159/000067165
Mashiach S, Bider D, Moran O, Goldenberg M, Ben-Rafael Z (1990) Adnexal torsion of hyperstimulated ovaries in pregnancies after gonadotropin therapy. Fertil Steril 53:76–80. https://doi.org/10.1016/S0015-0282(16)53219-1
Yen CF, Lin SL, Murk W, Wang CJ, Lee CL, Soong YK et al (2009) Risk analysis of torsion and malignancy for adnexal masses during pregnancy. Fertil Steril 91:1895–1902. https://doi.org/10.1016/j.fertnstert.2008.02.014
Funding
None.
Author information
Authors and Affiliations
Contributions
MR: protocol development, data collection and management, data analysis, manuscript writing/editing. RR: protocol development, data collection and management, data analysis, manuscript writing/editing. AH: data collection and management, manuscript writing/editing. IM: data collection and management, manuscript writing/editing. ABS: protocol development, manuscript writing/editing. SA: protocol development, manuscript writing/editing. SGG: protocol development, manuscript writing/editing. AR: protocol development, data collection and management, data analysis, manuscript writing/editing.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interests.
Ethical approval
In accordance with Ministry of Health regulations, the institutional ethics committee did not require written informed consent because the data were obtained anonymously from medical records, with no direct participation of patients.
Consent for publication
All authors have reviewed the manuscript and consented to publication.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Rottenstreich, M., Rotem, R., Hirsch, A. et al. Maternal and perinatal outcomes following laparoscopy for suspected adnexal torsion during pregnancy: a multicenter cohort study. Arch Gynecol Obstet 302, 1413–1419 (2020). https://doi.org/10.1007/s00404-020-05752-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00404-020-05752-7