Maternal and perinatal outcomes following laparoscopy for suspected adnexal torsion during pregnancy: a multicenter coho
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GENERAL GYNECOLOGY
Maternal and perinatal outcomes following laparoscopy for suspected adnexal torsion during pregnancy: a multicenter cohort study Misgav Rottenstreich1 · Reut Rotem1 · Ayala Hirsch1 · Ido Moran2 · Avi Ben‑Shushan3 · Shunit Armon1 · Sorina Grisaru‑Granovsky1 · Amihai Rottenstreich3 Received: 9 February 2020 / Accepted: 15 August 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To investigate the association of maternal and perinatal outcomes with the surgical diagnosis of adnexal torsion in a retrospective cohort of women operated for suspected torsion during pregnancy. Study design This is a multicenter retrospective study and telephone questionnaire of urgent laparoscopies that occurred during pregnancy for suspected torsion between 2004 and 2019 in three tertiary medical centers. Pregnancy outcomes of women with the surgical diagnosis were compared with those whose laparoscopy was negative for adnexal torsion. Multivariable regression modeling was applied to control for possible confounders ((adjusted odds ratios (aOR) ± 95% confidence intervals (CI)]. Results The study cohort included 186 women. Adnexal torsion was surgically found in 129/186 (69.4%) cases. The torsion group was characterized by higher rate of nulliparity, fertility treatments and multiple gestations as well as lower rates of previous cesarean delivery. Live birth was reported for 171 (91.9%) pregnancies, and the miscarriage rate was significantly higher in the non-torsion group. Women with torsion were more likely to be hospitalizes due to preterm labor; however, rates of preterm delivery were comparable between the groups (10.8% vs. 10.9%, p = 0.99). Logistic regression analysis had demonstrated that the performance of laparoscopy prior to 8 weeks of gestation was the only independent factor associated with miscarriage (8.23, 2.01–33.67). Conclusion Pregnancy outcomes following the diagnosis of adnexal torsion throughout gestation were overall favorable. Laparoscopic procedure during early stages of pregnancy was associated with higher rates of miscarriage, regardless of the surgical diagnosis of adnexal torsion. Keywords Adnexal torsion · Laparoscopy · Pregnancy outcome · Reproductive age women
Introduction Adnexal torsion (AT) is an emergent condition defined as a rotation of the ovarian peduncle around its own axis which might lead to ischemia and eventually to ovarian necrosis.
* Reut Rotem [email protected] 1
Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, The Hebrew University School of Medicine, 12 Bayit Street, 91031 Jerusalem, Israel
2
Faculty of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
3
Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
Adnexal torsion most commonly occurs among reproductive-aged women [1–3]. Pregnancy is a risk factor for AT with an estimated incidence of 1–5:10,000 of all pregnancies [4] and a prevalence of 8–27% among all cases of AT
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