Ovarian Torsion in the Third Trimester of Pregnancy Leading to Iatrogenic Preterm Delivery

Ovarian torsion in the third trimester of pregnancy leading to a midline laparotomy and caesarean section for the delivery of a preterm baby is an uncommon event. As the woman is likely to present with nonspecific symptoms of lower abdominal pain, nausea, and vomiting, ovarian torsion can often be misdiagnosed as appendicitis or preterm labour. Treatment and the opportunity to preserve the tube and ovary may consequently be delayed. We report the case of a multiparous woman who had undergone two previous caesarean sections at term, presenting at 35 weeks of gestation with a presumptive diagnosis of acute appendicitis. Ultrasonography described a cystic lesion 6 × 3 cm in the right adnexa, potentially a degenerating fibroid or a torted right ovary. MRI of the pelvis was unable to provide further clarity. The patient was managed by midline laparotomy and simultaneous detorsion of the ovarian pedicle and ovarian cystectomy together with caesarean section of a preterm infant. This report describes that prompt recognition and ensuring intraoperative access can achieve a successful maternal and fetal outcome in this rare and difficult scenario. Furthermore, we would like to emphasise that the risk for a pregnant woman and her newborn could be reduced by earlier diagnosis and management of ovarian masses (Krishnan et al., 2011)

Ovarian Torsion in the Third Trimester of Pregnancy Leading to Iatrogenic Preterm Delivery

Ovarian torsion in the third trimester of pregnancy leading to a midline laparotomy and caesarean section for the delivery of a preterm baby is an uncommon event. As the woman is likely to present with nonspecific symptoms of lower abdominal pain, nausea, and vomiting, ovarian torsion can often be misdiagnosed as appendicitis or preterm labour. Treatment and the opportunity to preserve the tube and ovary may consequently be delayed. We report the case of a multiparous woman who had undergone two previous caesarean sections at term, presenting at 35 weeks of gestation with a presumptive diagnosis of acute appendicitis. Ultrasonography described a cystic lesion 6 × 3 cm in the right adnexa, potentially a degenerating fibroid or a torted right ovary. MRI of the pelvis was unable to provide further clarity. The patient was managed by midline laparotomy and simultaneous detorsion of the ovarian pedicle and ovarian cystectomy together with caesarean section of a preterm infant. This report describes that prompt recognition and ensuring intraoperative access can achieve a successful maternal and fetal outcome in this rare and difficult scenario. Furthermore, we would like to emphasise that the risk for a pregnant woman and her newborn could be reduced by earlier diagnosis and management of ovarian masses (Krishnan et al., 2011)

The early benefits of Laparoscopic Sacrocolpopexy

Background: Prospective evaluation of the 6 months functional and clinical outcome of 27 patients treated with Laparoscopic Sacrocolpopexy (LSC). Methods: Pelvic organ prolapse was assessed by Baden-Walker system along with a validated quality of life questionnaire preoperatively and at 6 months postoperatively to assess vaginal, urinary, bowel and sexual symptoms. Results: At a mean 6 months follow-up, 96% of the symptomatic women had successful vaginal vault support with no recurrence of prolapse symptoms. Successful anatomical outcome (any prolapse <= stage 1) was found in 89%. Regarding the urinary functional symptoms, significant improvement was reported in the voiding function, painful symptoms and the relevant quality of life. Stress urinary incontinence resolved in 67% without concomitant continence surgery; 4% from the stress incontinence was de novo. Bowel symptoms were common, both pre- and postoperatively; 40% from the postoperative bowel symptoms was de novo. Sexually active women reported significant improvement in sexual function; there was one case of de novo dyspareunia. Conclusion: LSC is an effective treatment for vault prolapse as soon as in the 6-months follow-up. The outcome for anterior and posterior support is less predictable. The pelvic organ vaginal, urinary and sexual functional symptoms improve. The effects on bowel function are less clear. Long-term prospective studies are required to establish the duration of the benefits. (C) 2019 Published by Elsevier Masson SAS