Factors Associated with Oophorectomy in Patients with Suspected Ovarian Torsion

Laparoscopic salvage procedures for adnexal torsion in pediatric and adolescent patients during the COVID-19 pandemic: a retrospective cohort study

BACKGROUND

Early management for adnexal torsion increases likelihood of ovarian/tubal salvage. The Coronavirus disease of 2019 (COVID-19) pandemic poses delays from symptom-onset to intervention. The primary objective was to evaluate rates of ovarian salvage and tubal salvage following ovarian torsion and adnexal torsion during the COVID-19 pandemic in a pediatric and adolescent gynecology population.

METHODS

This was a retrospective quality improvement cohort study of pediatric and adolescent gynecology patients at a single children's hospital who underwent laparoscopy for suspected ovarian torsion/adnexal torsion between March 2020 to March 2021. Descriptive statistics and t-tests were utilized.

RESULTS

There were 50 suspected adnexal cases in 47 patients. All underwent laparoscopy, revealing 39 adnexal torsion occurrences in 36 patients and 1 patient with recurrent adnexal torsion three times. All underwent pre-operative COVID-19 testing. Mean age was 13.9 ± 2.6 years for adnexal torsion cohort. Menarche was achieved in 88% (n = 44) and 12% (n = 6) were pre-menarchal. The primary outcome was ovarian salvage and tubal salvage rates, which were 97.4% (n = 38) and 89.7% (n = 35), respectively. Secondary outcomes assessed factors contributing to the primary outcome or operative delays. The mean age of menarche was 11.2 years (salvaged) and 12.5 years (non-salvaged) (p = 0.04). There were no differences in mean pain duration or mean COVID-19 testing time between groups. Left, right and bilateral adnexal torsion occurred in 42% (n = 21), 32% (n = 16), and 4% (n = 2) respectively. The most common pathologies were paratubal cyst (n = 17, 34%) and benign ovarian cyst (n = 16, 32%).

CONCLUSIONS

Ovarian salvage and tubal salvage rates were 97.4% and 89.7%, respectively during the time frame studied. These salvage rates during the study period are comparable to previous rates in a pre-COVID cohort at our institution. Institutional and departmental quality and safety initiatives likely contributed to this outcome.

Adnexal torsion: a review of diagnosis and management strategies

PURPOSE OF REVIEW

Adnexal torsion remains a diagnostic challenge heavily reliant on high clinical suspicion, with patient presentation and imaging used as adjuncts to aid in its diagnosis. This review summarizes diagnostic and management techniques of adnexal torsion to assist providers when encountering this surgical emergency.

RECENT FINDINGS

Common findings of adnexal torsion include abdominal pain, nausea, vomiting, and adnexal mass or ovarian enlargement. An elevated neutrophil to lymphocyte ratio may be useful for diagnosis. A 'whirlpool' sign, 'follicular ring' sign, enlarged/edematous ovary, and absent Doppler flow to the ovary are highly suggestive of adnexal torsion. Intraoperative visual diagnosis of ovarian death is highly inaccurate, with only 18-20% of ovaries necrotic on pathological examination. Necrotic appearing ovaries have been shown to have follicular activity on ultrasound one year postoperatively.

SUMMARY

Pelvic ultrasound remains the first-line imaging modality. In patients of reproductive age, we recommend performing detorsion with ovarian conservation, even in cases where the tissue appears necrotic, given poor intraoperative diagnostic rates of tissue death. Retention of ovarian function is also reliant on a timely diagnosis and intervention. We emphasize that the risk of ovarian damage/loss outweigh the risk of a diagnostic laparoscopy in patients of reproductive age.

Ectopic Pregnancy in Tigray, Ethiopia: A Cross-Sectional Survey of Prevalence, Management Outcomes, and Associated Factors

Background

Ectopic pregnancy is a neglected and challenging gynecologic problem in developing countries including Ethiopia.

Objective

The present study is aimed at assessing the prevalence of ectopic pregnancy, its management outcomes, and factors associated with management outcomes in Tigray, North Ethiopia.

Methods

We employed a four-year retrospective cross-sectional study from September 2015 to August 2019. We extracted data about all pregnant mothers who were admitted and managed for EPs in Axum, Tigray. Ectopic pregnancy and its outcomes (favorable and unfavorable) were the dependent variables, and age, residence, ethnicity, religion, parity, history of abortion, history of EP, pelvic infections, history of surgical procedures, and use contraceptives were the independent variables. We employed descriptive statistics and bivariate and multivariate logistic regression analyses using SPSS. Ethical clearance was obtained from Axum University, Tigray, Ethiopia.

Results

The overall prevalence of ectopic pregnancy was 0.52% of total deliveries, which equates to 1 : 193 deliveries. Surgery for ectopic pregnancy accounts for 7.6% of all gynecological surgeries. Most participants were in the age group 26-30 years and lived in rural areas. Among the different EP implantation sites, most cases (92.4%) occurred in the fallopian tube, followed by 5.1% in the ovary and 2.5% in abdominal EPs. Surgical management (laparotomy) was undertaken for all the 79 women diagnosed with EPs, including laparotomy (100%), salpingo-oophorectomy (17.7%), salpingectomy (73.9%), oophorectomy (3.4%), cornual resection (2.5%), and removal of concepts tissue 2.5. The record reports that intraoperative procedure was correctly managed for 47 (59.5%) women but the condition of EP procedure was ruptured for about two-thirds (63.3%) of the women. Thirty (38%) patients had developed some complications after surgery including anemia (hemoglobin < 10.5) (n = 12), fever (n = 10), wound infection (n = 2), and pneumonia (n = 2). Women who were from urban (AOR = 11.2, 95% CI: 2.65-47.2) and who had normal hemoglobin at presentation (AOR = 9.94, 95% CI: 2.03-48.7) were associated with favorable maternal outcomes.

Conclusions

More than one-third of women with ectopic pregnancies had an unfavorable maternal outcome, which was higher among rural residents and anemic mothers. Women living in rural areas and anemia during pregnancy should seek special attention in the management of EPs. We also recommend improving the data management of hospitals in Ethiopia.