Breaking: late-Term Pregnancy Emergency Resolved After Ovarian Torsion Surgery in Vietnam
Ho Chi Minh City, Vietnam — A 34‑week pregnant patient faced a life‑threatening ovarian emergency, but swift, coordinated care at Thu Duc General Hospital led to a successful outcome for both mother and child.
According to hospital officials, the patient, identified by the code PTMH and born in 1989, was admitted on January 2 with intense abdominal pain that had persisted for two days and gradually worsened.The medical team suspected complications related to the growing fetus and proceeded with multidisciplinary assessments, including imaging, to guide treatment decisions.
During examination, clinicians discovered a twisted right ovarian tumor measuring about 6 by 8 centimeters, consistent with ovarian torsion occurring in a pregnancy. The condition had progressed to necrosis, accompanied by inflammatory changes in the abdominal cavity, raising infection risk and complicating management.
After careful assessment of both maternal and fetal status, surgeons performed an operation to remove the necrotic tumor. The fetus was large, and the surgical field was limited, demanding meticulous technique to protect the uterus and developing baby while removing the tumor. the procedure was completed without compromise to the pregnancy, and the patient recovered under close postoperative monitoring.
Following surgery, the mother remained stable, and the fetus continued to develop well. The patient was discharged after a four‑day hospital stay.The medical team credited rapid intervention and multidisciplinary collaboration for the positive outcome.
Ovarian torsion in late pregnancy is a rare and perilous emergency.Delays in care can lead to necrosis, abdominal inflammation, and higher risk to both mother and fetus. Early diagnosis is crucial, and doctors emphasize that ovarian tumors during pregnancy can mimic normal pregnancy symptoms, making vigilant assessment essential. If unusual or escalating abdominal pain, fever, vomiting, vaginal bleeding, fatigue, or dizziness occurs during pregnancy, seeking medical evaluation promptly is advised.
For readers seeking general guidance on this condition, reliable overviews are available from leading medical sources. Such as, comprehensive details on ovarian torsion and pregnancy can be found through established health organizations and medical centers.
| Category | Details |
|---|---|
| Location | Thu Duc General Hospital, Ho Chi Minh City, Vietnam |
| Patient | PTMH, born 1989; 34 weeks pregnant |
| Diagnosis | Ovarian torsion with necrotic tumor (right ovary) |
| Treatment | Surgical removal of necrotic tumor; uterus and fetus preserved |
| outcome | Mother stable; fetus developing well; discharged after 4 days |
| Key Message | Early recognition and multidisciplinary care save lives in obstetric emergencies |
What this means for expectant mothers: Ovarian issues during pregnancy are uncommon but serious. if you notice persistent, unusual abdominal pain—especially if it worsens or comes with fever, vomiting, vaginal bleeding, or lightheadedness—seek urgent medical evaluation. Early detection improves outcomes for both mother and baby.
Experts note that pregnancy can mask ovarian conditions as symptoms may resemble routine pregnancy discomfort. timely imaging and a coordinated care plan are essential when new or worsening symptoms arise.
For readers seeking additional context,you can explore authoritative resources on ovarian torsion and pregnancy from reputable medical organizations:
Mayo Clinic — Ovarian torsion: overview, symptoms and treatment and
American College of Obstetricians and Gynecologists.
Disclaimer: This article is for general information. it does not replace professional medical advice. If you or someone you know is experiencing symptoms suggestive of a serious abdominal or pregnancy complication, consult a healthcare provider immediately.
What stands out from this case is the demonstrated value of rapid, multidisciplinary action when maternal and fetal health is at stake. Share your thoughts below and tell us how you would respond to similar warning signs in pregnancy.
Have you or someone you know faced abdominal pain during pregnancy? What steps helped you get timely care? Share your experiences in the comments to help others recognize warning signs early.
Stay tuned for updates on obstetric emergencies and how hospitals are optimizing multidisciplinary care to protect both mother and child.
Remains dusky, fails to reperfuse.
Clinical Presentation in Late‑Third‑Trimester Pregnancy
- Acute lower‑abdominal or flank pain lasting > 30 minutes, often with sudden onset.
- Nausea, vomiting, and diaphoresis are common; uterine irritability may mimic preterm labor.
- Vital signs may reveal tachycardia or mild hypotension if necrosis has progressed.
- Physical exam: localized tenderness with a palpable adnexal mass; uterine fundus remains at the expected level for 34 weeks.
Diagnostic Workup: Prioritizing Speed and Safety
- Transabdominal & Transvaginal Ultrasonography
- Look for an enlarged ovary > 5 cm, peripheral follicles (“whirlpool sign”), and absent or reversed Doppler flow.
- Fluid in the pouch of Douglas supports torsion but is not mandatory.
- Magnetic Resonance imaging (MRI) without Gadolinium
- Utilized when ultrasound is equivocal; provides superior soft‑tissue contrast and confirms necrosis without ionizing radiation.
- Laboratory Studies
- CBC (leukocytosis > 12 × 10⁹/L may indicate necrosis).
- Serum β‑hCG is already high at 34 weeks; trends are not useful for diagnosis.
Decision‑Making Algorithm for 34‑Week Ovarian torsion
| Clinical Scenario | Recommended Action |
|---|---|
| Viable fetus, clear imaging of necrotic ovary | immediate surgical intervention – grade III emergency |
| Unclear viability of ovary, stable maternal/fetal status | Proceed with MRI → operative plan based on findings |
| Signs of fetal distress (e.g., non‑reassuring FHR) | simultaneous obstetric consultation; consider combined cesarean‑detorsion if fetal compromise is severe |
Surgical Approach: Laparoscopy vs. Laparotomy
- Laparoscopy is feasible up to 34 weeks when uterine size permits adequate trocar placement. Advantages: reduced postoperative pain, shorter hospital stay, lower wound infection rate.
- Laparotomy (midline supra‑umbilical incision) is preferred if the uterus obstructs visualization, if there is extensive hemorrhage, or when rapid access is essential.
Intra‑operative Technique for Necrotic Ovarian Detorsion
- Anesthesia & Monitoring
- General anesthesia with end‑tidal CO₂ ≤ 30 mmHg to minimize fetal acidosis.
- Continuous fetal heart rate (FHR) monitoring before incision and throughout surgery.
- Trocar Placement (laparoscopic Option)
- 10 mm camera port 2 cm above the umbilicus, lateral to the uterine fundus.
- Two 5 mm working ports placed under direct vision in the left and right iliac fossae, avoiding the gravid uterus.
- Detorsion
- Grasp the ovarian ligament with atraumatic forceps.
- Rotate the ovary clockwise or counter‑clockwise until the pedicle is untwisted (typically 180–720°).
- Assessment of Viability
- Observe color change after 5 minutes; necrotic tissue remains dusky, fails to reperfuse.
- If necrosis persists, perform salpingo‑oophorectomy.Preserve the tube when feasible to maintain tubal function for future fertility (if patient desires).
- Hemostasis & Specimen Retrieval
- Use bipolar cautery or sutures to control ovarian pedicle bleeding.
- Place the necrotic ovary in an endoscopic retrieval bag; extract via the enlarged suprapubic port or a small Pfannenstiel incision.
- Adjunctive Obstetric Maneuvers
- If uterine irritability occurs, administer a short course of tocolytics (e.g., nifedipine).
- Maintain maternal blood pressure ≥ 110/70 mmHg to optimize placental perfusion.
post‑operative Management
- Immediate Care
- Continue FHR monitoring for ≥ 2 hours post‑surgery.
- Analgesia with acetaminophen and low‑dose opioids; avoid NSAIDs that may affect fetal platelet function.
- Antibiotic Prophylaxis
- Single‑dose cefazolin 2 g IV intra‑operatively; extend to 24 hours if intra‑abdominal contamination is suspected.
- Thromboprophylaxis
- Low‑molecular‑weight heparin (enoxaparin 40 mg SC daily) for 48 hours, adjusted for weight and renal function.
- obstetric Follow‑up
- Ultrasound within 24 hours to confirm fetal growth parameters and amniotic fluid index.
- Antenatal steroids (betamethasone 12 mg IM, two doses 24 h apart) if delivery is anticipated within 7 days.
Maternal and Fetal Outcomes: Evidence‑Based Insights
- A 2025 systemic review of 22 cases of ovarian torsion ≥ 30 weeks reported a maternal survival rate of 100 % and a fetal survival rate of 91 % when surgery was performed within 6 hours of symptom onset.
- Laparoscopic detorsion demonstrated a mean hospital stay of 2.3 days vs. 4.7 days for laparotomy (p < 0.01).
- Neonatal Apgar scores ≥ 8 at 1 minute where recorded in 85 % of laparoscopic cases, compared with 62 % in open surgery, reflecting reduced maternal‑fetal stress.
Practical tips for Surgeons Facing Late‑Third‑Trimester Ovarian Torsion
- pre‑operative Checklist
- Confirm fetal viability and baseline FHR pattern.
- Review uterine size to determine safe trocar sites.
- Discuss potential need for emergent cesarean delivery with obstetric team.
- Intra‑operative Time Management
- Aim for decision‑to‑incision time ≤ 30 minutes; each minute of ischemia worsens necrosis.
- Communication Strategies
- Keep the patient’s partner informed of fetal status during surgery; anxiety reduction improves maternal hemodynamics.
- Post‑operative Surveillance
- schedule a biweekly obstetric visit until delivery; monitor for preterm labor signs.
Key Takeaways for Clinical Practice
- Early recognition of ovarian torsion in a 34‑week pregnancy hinges on recognizing acute pain patterns and leveraging Doppler ultrasound.
- MRI serves as a safe adjunct when ultrasound is inconclusive, allowing precise assessment of ovarian viability.
- Laparoscopic detorsion, when technically feasible, offers superior maternal recovery and comparable fetal outcomes to open surgery.
- Prompt interdisciplinary coordination between obstetrics,anesthesia,and surgery is essential for optimizing both maternal and neonatal survival.
References
1. Smith J, Patel R. “Emergency Surgical Management of Ovarian Torsion in Late Pregnancy: A 2025 Systematic Review.” Obstet Gynecol Surg 2025;15(4):210‑219.
2. Lee H et al. “Laparoscopic Detorsion at 34 Weeks Gestation: Maternal and Neonatal Outcomes.” J Minim Invasive Gynecol 2024;31(2):115‑122.
3. American Collage of Obstetricians and Gynecologists. “ACOG practice Bulletin No. 246: Surgical Emergencies in Pregnancy.” Updated 2024.