Perioperative Outcomes in Pregnant Women Who Underwent Surgery for Adnexal Torsion

Ekici, Huseyin; Okmen, Fırat; Imamoglu, Metehan; Hortu, Ismet; Akdemir, Ali

doi:10.1055/s-0042-1742403

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Revista Brasileira de Ginecologia e Obstetrícia

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Sumário

Original Article • Rev. Bras. Ginecol. Obstet. 44 (04) • Apr 2022 • https://doi.org/10.1055/s-0042-1742403 copy

Perioperative Outcomes in Pregnant Women Who Underwent Surgery for Adnexal Torsion

Resultados perioperatórios em mulheres grávidas submetidas a cirurgia para torção anexial

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To evaluate clinical characteristics, maternal and fetal outcomes in pregnant women who underwent surgery for adnexal torsion (AT).

Methods

All patients, who underwent surgical operation due to AT during pregnancy at the Department of Obstetrics and Gynecology, School of Medicine, Ege University between 2005 and 2020 were retrospectively investigated. Main clinical and perioperative outcomes were evaluated.

Results

A total of 21 patients who underwent surgery due to AT during pregnancy were included. Of all patients, 61.9% underwent laparoscopy and the remaining 38.1% underwent laparotomy. The most common surgical procedure was adnexal detorsion in both groups (48%). Mean gestational age at the time of diagnosis, duration of surgery and hospitalization were significantly lower in the laparoscopy group, when compared with the laparotomy group (p=0.006, p=0.001, and p=0.001, respectively.) One of the patients had an infection during the postoperative period. Spontaneous abortion was only observed in one case.

Conclusion

It can be concluded that the surgical intervention implemented for the exact diagnosis and treatment of AT (laparotomy or laparoscopy) did not have an unfavorable effect on pregnancy outcomes such as abortion, preterm delivery, and fetal anomaly. However, laparoscopy may be superior to laparotomy in terms of advantages.

Keywords:
adnexal torsion; pregnancy; emergent surgery; perinatal outcomes

Parameter	Results
Maternal age (years)	30 ± 3.9
Parity, n (%)
Nulliparous	9 (42.8%)
Parous	12 (57.2%)
Surgical history, n (%)
Laparoscopy	3 (14.3%)
Laparotomy	6 (28.6%)
GA at the time of torsion (weeks)	11.9 ± 4.6
GT at the time of torsion*
First trimester	14 (66.6%)
Second trimester	7 (33.3%)
Mode of conception, n (%)
Spontaneous conception	15 (71.4%)
Assisted reproductive technology	6 (28.6%)
Twin pregnancy	1 (4.7%)
Torsion side
Right	13 (61.9%)
Left	8 (38.1%)
Preoperative WBC (cells/ µL)	12,368 ± 4,864
Preoperative CRP (mg/dL)	1.2 ± 0.8

Variable	Laparoscopy group	Laparotomy group	p-value
GA at the time of diagnosis (weeks)	9.8 ± 3.4	15.25 ± 4.6	0.006
Operation time (min)	61.6 ± 8.3(45–70)	84 ± 13.4(70–100)	0.001
Duration of hospitalization (days)	3.5 ± 1(2–5)	5.7 ± 1(4–7)	0.001
GA at birth (weeks)	38.1 ± 1.7(34–41)	37.7 ± 2(35–40)	0.549
Birthweight (g)	3,043 ± 338(2,400–3650)	3,010 ± 292(2,600–3530)	0.821
Preterm delivery n/N (%)	1/13 (7.7%)	2/8 (25%)	0.271
Cesarean section, n/N (%)	7/13 (53.8%)	4/8 (50%)	0.676
Ultrasonographic findings n/N
Normal-appearing ovary without cysts	6/13 (46.2%)	2/8 (25%)	0.4
Cystic ovary	5/13 (38.4%)	5/8 (62.5%)	0.387
Hyperstimulated ovary	2/13 (15.4%)	1/8 (12.5%)	0.54
Complications
Intraoperative n/N (%)	0/13	0/8	NA
Postoperative n/N (%)	0/13	1/8 (12.5%)	0.381

Variable	First trimester	Second trimester	p-value
Operation time (min)	63.4 ± 9.8 (45–80)	84.2 ± 15.1 (70–100)	0.020
Hospitalization (days)	3.7 ± 1.3(2–7)	5.5 ± 0.9 (4–7)	0.009
GA at delivery (weeks)	38.1 ± 1.8(34–41)	37.7 ± 1.7 (35–40)	0.601
Birthweight (g)	3,018 ± 348(2,400–3,650)	3,052 ± 259(2,600–3,420)	0.820
Preterm delivery, n/N (%)	1/14 (7.1%)	2/7 (28.6%)	0.186
Cesarean section, n/N (%)	7/14 (50%)	4/7 (57.1%)	0.761

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[1] Address for correspondence
Ismet Hortu, Department of Obstetrics and Gynecology, School of Medicine, Ege University, 35100, Bornova, Izmir, Turkey (e-mail: ismethortu@yahoo.com).