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O&G CasesEarly pregnancy care

O&G Cases · Early pregnancy care

Ovarian torsion in pregnancy — emergency management station

Emergency station: suspected ovarian torsion at 10 weeks in an IVF pregnancy with a known adnexal mass. Tests the recognition of the torsion clock, the surgical decision and approach, the counselling about ovarian conservation versus oophorectomy, and the structured communication with the woman and the theatre team. Includes assessor key and marking domains.

resus3 min readVerification in progress

Target exams

FRANZCOGMRCOGABOG
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Target exams

FRANZCOGMRCOGABOG
Prompt
A 31-year-old woman at 10 weeks gestation, conceived by IVF, presents to the emergency department with two hours of sudden severe right-sided lower abdominal pain and vomiting. Her pulse is 108, blood pressure 104/66, she is distressed and cannot get comfortable. She had a 7 cm right adnexal mass identified at her dating scan last week. You are the obstetric registrar on call.

Station brief

Format. Emergency management station, approximately 12 minutes. You are the obstetric registrar on call. The emergency department registrar has clerked her; the anaesthetist and theatre team are contactable. The assessor will run the clock and feed you new findings. [1]

Candidate instruction. Recognise and manage suspected ovarian torsion in pregnancy. Verbalise the time-critical decision, the surgical approach, the counselling about ovarian conservation, and your communication with the woman and the theatre team. [1][2]

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References6ShowHide
  1. [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. [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. [3]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
  4. [4]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
  5. [5]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
  6. [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
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