Case 14 - A 20-Year-Old with Right Lower Quadrant Pain at 15 Weeks’ Gestation

Summary

The incidence of ovarian torsion rises fivefold during pregnancy. The most common cause of ovarian torsion in pregnancy is a corpus luteum cyst. In the case of ovarian torsion, the definite diagnosis is made preferentially via laparoscopy. Pregnant patients undergoing surgery may have an increased risk of preterm delivery and intrauterine growth restriction. If an ovarian cyst is present, a cystectomy should be attempted to preserve the ovarian function and future fertility. Several studies have shown the safety of laparoscopy in pregnancy. The surgeon should use the following principles – after the first trimester, the lateral recumbent position is advised to reduce pressure on the vena cava and maintain adequate venous return. The open Hasson technique is preferred for initial entry because it provides optimal visualization. Maternal CO₂ monitoring during insufflation is recommended due to the potential concern of fetal acidosis. If the fetus is considered previable, it is generally sufficient to ascertain the fetal heart rate with Doppler before and after the procedure. Preoperative pneumatic compression devices and early postoperative ambulation are encouraged. If less than 12 weeks gestation, progesterone therapy should be initiated after removal of the corpus luteum.