The Journal of Minimally Invasive Gynecology

Paper: Differences between adnexal torsion in pregnant and non-pregnant women
Paper authors: Shimon Ginath, Amir Shalev, Ran Keidar, Ram Kerner, Alexander Condrea, Abraham Golan and Ron Sagiv
Paper ref: (2012) 19, 708-714

Ten to 20 percent of adnexal torsion, though an uncommon cause of abdominal pain in women, occur in pregnancy, particularly after induction of ovulation, when the loss of any ovarian function post treatment can seem even more devastating to women already having required fertility treatment.

Due to the non-specific nature of presenting symptoms, this study’s aim was to compare the clinical manifestation, management and outcome of adnexal torsion in pregnant and non-pregnant women. This is a retrospective case-control study of computerised medical records and hospital charts from 1st January 1990 through 31st December 2009, in the authors’ own unit. This give them 262 cases to review, the largest series of women from one single centre reviewed to date.

The authors state their findings are similar to those already carried out in previous studies. They report presenting complaints are similar between pregnant and non-pregnant patients, with 97 percent vs 96 percent presenting with abdominal pain but only 34 percent vs 26 percent presenting with peritoneal irritation symptoms in the pregnant vs non-pregnant groups respectively. They report occurrence at a mean gestational age of 11.5 weeks in the pregnant group, and an overall incidence of one in 932 births, as well as showing laparoscopy is the overall treatment of choice.

They show that pregnancy can be a risk factor particularly after treatment for infertility (56 percent in the pregnant group vs seven percent in the non-pregnant), as well as previous torsion in the pregnancy, with recurrent adnexal torsion more common in the pregnant group (14.3 percent vs 4.5 percent) as well as recurring in significantly shorter time (209 days vs 700 days).

They state that this is unfortunately only a convenience sample and does not address false positive or false negative rates, as they only looked at proven ovarian torsions, and only those that presented to their own unit.

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