O&G Cases · Gynaecological health — adnexal pathology
Ovarian torsion at 10 weeks — emergency management station
Emergency station: suspected ovarian torsion at 10 weeks in an IVF pregnancy with a known adnexal mass. Tests recognition of the torsion clock, refusal to delay for imaging, the surgical decision and pregnant-patient laparoscopy technique, ovarian conservation versus oophorectomy counselling, the quantified obstetric outcomes, and structured communication with the woman and the theatre team. Includes assessor key and marking domains.
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Station brief
Format. Emergency management station, approximately 12 minutes. You are the O&G registrar on call. The emergency department registrar has clerked her; the anaesthetist and theatre team are contactable. The assessor runs the clock and feeds you new findings. [1]
Candidate instruction. Recognise and manage suspected ovarian torsion in pregnancy. Verbalise the time-critical decision, your refusal to delay for imaging, the surgical approach, the ovarian conservation decision, and your communication with the woman and the team. [1][2]
References7ShowHide
- [1]Dvash S, Pekar M, Melcer Y, et al. Adnexal Torsion in Pregnancy Managed by Laparoscopy Is Associated with Favorable Obstetric Outcomes. J Minim Invasive Gynecol, 2020.PMID 31563614
- [2]Rottenstreich M, Rotem R, Hirsch A, et al. Maternal and perinatal outcomes following laparoscopy for suspected adnexal torsion during pregnancy: a multicenter cohort study. Arch Gynecol Obstet, 2020.PMID 32889559
- [3]Cagino K, Li X, Thomas C, et al. Surgical Management of Adnexal Masses in Pregnancy: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol, 2021.PMID 33515746
- [4]Balinskaite V, Bottle A, Sodhi V, et al. The Risk of Adverse Pregnancy Outcomes Following Nonobstetric Surgery During Pregnancy: Estimates From a Retrospective Cohort Study of 6.5 Million Pregnancies. Ann Surg, 2017.PMID 27617856
- [5]Rasmussen AS, Christiansen CF, Ulrichsen SP, et al. Non-obstetric abdominal surgery during pregnancy and birth outcomes: A Danish registry-based cohort study. Acta Obstet Gynecol Scand, 2020.PMID 31774546
- [6]Timmerman D, Ameye L, Fischerova D, et al. Simple ultrasound rules to distinguish between benign and malignant adnexal masses before surgery: prospective validation by IOTA group. BMJ, 2010.PMID 21156740
- [7]Barcroft J, Pandrich M, Del Forno S, et al. Evaluating use of two-step International Ovarian Tumor Analysis strategy to classify adnexal masses identified in pregnancy: pilot study. Ultrasound Obstet Gynecol, 2024.PMID 38787921