Comparison of Adnexal Torsion between Pregnant and Nonpregnant Women

An estimated 12–25% of adnexal torsion is found in pregnant women; the authors sought to characterize this rare and dangerous condition as the published data on this population currently comprise only small case series and anecdotal case reports. This case-control study compared the manifestations, treatment, and outcomes of adnexal torsion in pregnant vs. non-pregnant women. The study population included a total of 118 women with surgically confirmed adnexal torsion, 41 of whom were pregnant, in two institutions in Tel Aviv over a period of 9 years. Seventy-seven non-pregnant women who presented during the same time period were considered the control group. Pregnant women with torsion presented very similarly to non-pregnant women, with acute abdominal and pelvic pain, nausea, and vomiting. They were more likely to have peritoneal signs (42.8% compared with 19%) and also more likely to have a false-negative Doppler ultrasound (61.1% compared with 45.1%), although this latter difference was not significant. Assisted reproductive technology (ART) was strongly correlated with an increased risk of torsion, both in pregnant and non-pregnant women. Seventy-three percent of the pregnant women with confirmed torsion had undergone ART treatment and 20% of non-pregnant women had previously undergone ART. Pregnant women with torsion were likely to have torsion recur during the same pregnancy, at a rate of 19.5%. These women generally did very well with operative intervention, with uncomplicated pregnancies reported in all but three women.