Center for Reproductive Medicine and Center for Prenatal Diagnosis, First Hospital, Jilin University, 71 Xinmin Street, Chaoyang District, Changchun, Jilin Province, China.
Medicine (Baltimore). 2021 Jan 22;100(3):e24009. doi: 10.1097/MD.0000000000024009.
Torsion is the most common gynecologic emergency of the adnexal mass occurring during pregnancy. We report the clinical data of a case of twin pregnancy with adnexal torsion after in vitro fertilization (IVF) and embryo transfer, in which the patient underwent surgery for adnexal detorsion and experienced preterm delivery. One child died as a neonate, and the other child was diagnosed with hematological disease, which, to our knowledge, has not been reported previously. We also performed a systematic literature review to increase knowledge of the need for prompt surgical intervention.
The patient was a 32-year-old pregnant woman, who presented to our center with acute onset of stabbing and non-radiating continuous lower left abdominal pain after urination, of 6 hours duration.
Physical examination revealed that the lower abdominal tenderness was worse on the left side, and there were no signs of peritonitis. Transvaginal ultrasonographic examination indicated a multiloculated left ovary measuring 12.1 × 7.1 cm with sparse blood flow. The size of the largest cyst was 7.2 × 6.6 cm, the right ovary appeared normal, and two live fetuses were seen.
laparoscopy was performed 1.5 hours later, which revealed a cystic and multilocular left ovary with a black purplish surface and thin wall. The left ovary and left fallopian tube had undergone 720° torsion (3 rotations), and detorsion was performed laparoscopy.
The left adnexa recovered to near normal appearance 20 minutes postoperatively. The patient was discharged from hospital 5 days postsurgery, without complications. Unfortunately, the patient delivered two preterm babies at 30 weeks of gestation.
We should be alert to the possible risk of adnexal torsion in pregnant women after IVF. Adnexal torsion necessitates prompt surgical intervention, detorsion and preserving ovarian function are the main treatment methods. Furthermore, the possibility of recurrence, and pregnancy outcomes for the patient, as well as newborn health, should be considered.
扭转是妊娠期间附件肿块最常见的妇科急症。我们报告了一例体外受精（IVF）和胚胎移植后发生附件扭转的双胎妊娠病例，患者接受了附件复位手术，并经历了早产。一个孩子出生后死亡，另一个孩子被诊断患有血液病，据我们所知，这在以前的报告中尚未出现。我们还进行了系统的文献复习，以增加对需要及时手术干预的认识。
患者是一位 32 岁的孕妇，在排尿后出现急性左侧下腹部刺痛和非放射性持续性疼痛，持续 6 小时。
体格检查发现左侧下腹压痛更明显，无腹膜炎征象。经阴道超声检查显示左侧卵巢多房性，大小为 12.1×7.1cm，血流稀疏。最大囊肿大小为 7.2×6.6cm，右侧卵巢正常，可见两个活胎。
1.5 小时后进行腹腔镜检查，发现左侧卵巢囊性、多房性，表面呈黑紫色，壁薄。左侧卵巢和左侧输卵管发生 720°扭转（3 圈），行腹腔镜复位。
左侧附件术后 20 分钟恢复至接近正常外观。患者术后 5 天出院，无并发症。不幸的是，患者在 30 周时早产了两个婴儿。
我们应该警惕 IVF 后孕妇附件扭转的可能风险。附件扭转需要及时手术干预，复位和保留卵巢功能是主要的治疗方法。此外，还应考虑患者的复发可能性、妊娠结局以及新生儿健康。
