A Case of Ovarian Torsion in the 3rd Trimester of Pregnancy

Background Ovarian torsion is a rare occurrence during pregnancy, especially in the third trimester. It is a gynecological emergency and needs to be promptly reversed in order to preserve ovarian function. Unfortunately, ovarian torsion is difficult to diagnose due to non-specific abdominal symptoms. It is especially difficult to diagnose in pregnancy due to the enlarged uterus which leads to trouble visualizing anatomy as well as similar symptom presentation that occurs in pregnancy. Case Information An unusual case of ovarian torsion in the third trimester presented with late onset of abdominal pain and non-reassuring fetal heart tones. The ovarian torsion was unable to be clearly visualized with ultrasound and was found upon emergent Cesarean delivery that was performed due to non-reassuring fetal heart tones. The ovary was found to be necrotic and a right salpingo-oophorectomy was performed. Conclusion It is rare for ovarian torsion to occur in pregnancy and even more rare to have an effect on the fetal status as presented in this case. Upon review of the literature, this case was found to be truly unique in the rarity of occurrence of ovarian torsion late in pregnancy, as well as the effect on the fetal status. Only 2 other case reports of intra-abdominal inflammatory conditions in the third trimester were identified to have caused fetal distress, resulting in an emergent Caesarian delivery.