Preoperative Predictive Score of Ovarian Torsion in Pregnancy

STUDY OBJECTIVE: To develop a risk score calculator for the prediction of adnexal torsion during pregnancy. DESIGN: A retrospective cohort study between 3.2011-4.2020. SETTING: Tertiary medical center. PATIENTS OR PARTICIPANTS: All women who underwent surgical diagnostic procedure due to suspected adnexal torsion in pregnancy. Overall, 156 women were included. INTERVENTIONS: Operative laparoscopy. MEASUREMENTS AND MAIN RESULTS: We collected demographic and clinical characteristics. The presence or absence of adnexal torsion during the surgical procedure was recorded. Adnexal torsion was identified in 131 (83.9%) of the surgical procedures. The rate of previous ovarian torsion was lower in the torsion group [OR(95%CI) 0.29(0.11-0.79), p=0.01]. Pregnancy following assisted reproductive technology (ART) was more common in the torsion group [OR(95%CI) 7.0(1.99-24.54), p<0.001]. Reported left sided pain was lower in the torsion group [OR(95%CI) 0.41(0.17-0.97), p=0.04], while duration of symptoms <8 hours was higher [OR(95%CI) 7.31(1.65-32.43), p=0.002], as was pain score (0-10) (mean 8.5 vs. 7.2, p=0.007). On physical examination, women appeared in more pain in the torsion group, had more peritoneal irritation, and less left adnexal tenderness [OR(95%CI) 4.34(1.74-10.8), p=0.001; 4.59(1.67-23.23), p=0.02; 0.27(0.11-0.66), p=0.003, respectively]. In blood analysis, white blood cells concentration was higher in the torsion group (11.3 vs. 9.9 K/microL, p=0.01), as was the neutrophils to lymphocytes ratio (3.4 vs. 2.5, p=0.01) and the maximal diameter of the affected ovary (70 vs. 55 mm, p=0.02). After multivariate analysis, three risk factors remained significantly independently associated with ovarian torsion; previous ovarian torsion was negatively associated [aOR(95%CI) 0.24(0.04-0.80), p=0.03], while ART and women that appeared in pain were positively associated [aOR(95%CI) 9.8(2.22-43.6), p=0.003; 3.8 (1.23-12.18), p=0.02, respectively]. Calculated risk for adnexal torsion was 0%, 68.2%, 90.4% and 100% in the presence of 0, 1, 2 and 3 risk factors respectively. CONCLUSION: Our risk score calculator may assist clinicians in the prediction of adnexal torsion during pregnancy.