What are the outcomes for untreated pregnant intermittent ovarian torsion?

Outcomes of Untreated Pregnant Intermittent Ovarian Torsion

Untreated intermittent ovarian torsion during pregnancy can lead to serious complications including ovarian necrosis, loss of ovarian function, increased risk of miscarriage, and potential maternal sepsis if left unmanaged. 1, 2

Clinical Presentation and Diagnostic Challenges

• Intermittent ovarian torsion typically presents as severe, constant pain that may fluctuate in intensity but rarely completely resolves without intervention 2
• Diagnosis is challenging as 38-60% of pregnant patients with torsion have normal Doppler flow on ultrasound, making it a clinical diagnosis that requires high suspicion 1
• Symptoms may mimic urinary tract infection, including dysuria, due to anatomical proximity of ovaries to the bladder 2
• Pain may be sudden-onset and located in the lower abdomen, often accompanied by nausea and vomiting (61% of cases) 3

Outcomes of Untreated Intermittent Ovarian Torsion in Pregnancy

Maternal Outcomes

• Recurrent episodes of torsion occur in 4-15% of pregnant patients with prior torsion, with higher recurrence rates among those who undergo surgical detorsion alone versus cyst drainage 1
• Progressive ischemia leads to hemorrhagic and gangrenous changes in the ovary, ultimately requiring oophorectomy if intervention is delayed 4
• Serious infection may develop, potentially leading to sepsis that jeopardizes both maternal and fetal health 4
• Permanent loss of ovarian function in the affected ovary if necrosis occurs 5

Pregnancy Outcomes

• Some studies report increased risk of miscarriage and preterm delivery following ovarian torsion during pregnancy 1
• Other studies have found no adverse maternal or perinatal outcomes when properly managed 1
• Delayed diagnosis and treatment can lead to fetal loss in severe cases 3

Diagnostic Imaging for Intermittent Torsion

• Ultrasound is the first-line imaging modality with key findings including 2, 1:
  • Unilaterally enlarged ovary (>4 cm or volume >20 cm³)
  • Peripheral follicles (found in up to 74% of cases)
  • Abnormal or absent venous flow (100% sensitivity, 97% specificity)
  • Whirlpool sign (twisted vascular pedicle)
• Normal arterial blood flow does not rule out intermittent torsion, as torsion can be partial or intermittent 2
• MRI should be considered when ultrasound findings are inconclusive but clinical suspicion remains high, with 80-85% sensitivity for torsion 2

Risk Factors for Ovarian Torsion in Pregnancy

• Presence of ovarian masses increases risk, with cysts undergoing torsion having a mean size of 10 cm 1
• Ovarian hyperstimulation from fertility treatments significantly increases risk 4
• Approximately 3-12% of pregnant women with adnexal masses experience torsion 1, 5

Management Implications

• Early diagnosis and prompt surgical intervention is crucial to preserve ovarian function and maintain pregnancy 4
• Delaying surgery may lead to serious infection and compromise both maternal and fetal health 4
• Laparoscopic surgery in early pregnancy is generally safe for the fetus and should be performed once diagnosis is confirmed 4, 3
• Conservative management with detorsion and preservation of the ovary is possible with early intervention 3

Pitfalls in Diagnosis

• Misdiagnosis as urinary tract infection due to overlapping symptoms 2
• False reassurance from normal Doppler flow, which does not exclude intermittent torsion 1, 2
• Delayed diagnosis due to non-specific symptoms, particularly when pain temporarily resolves between torsion episodes 2

Prompt surgical intervention remains the only definitive treatment for ovarian torsion in pregnancy, with the best outcomes achieved through early diagnosis and management 4, 3.