# Emergency Surgery for Adnexal Torsion in Late Preterm Pregnancy Causing Term Vaginal Delivery: A Case Report and Literature Review

## TL;DR

A rare case of adnexal torsion in late preterm pregnancy was successfully treated with emergency surgery, leading to a full-term vaginal delivery.

## Contribution

This case report provides a novel clinical example of managing adnexal torsion in late preterm pregnancy with successful term delivery.

## Key findings

- Emergency laparotomy at 34 weeks gestation for adnexal torsion was safely performed with general anesthesia.
- Spontaneous labor occurred at 39 weeks, resulting in a vaginal delivery at 40 weeks.
- The case shows that timely surgical intervention can allow for term delivery despite late preterm torsion.

## Abstract

Adnexal cyst torsion in late preterm pregnancies is rare, but it frequently causes secondary uterine contractions. Thus, deciding on performing a simultaneous cesarean section due to the potential for early postoperative labor onset is crucial despite no obstetric indications. Here, we report a case of adnexal torsion at 34 weeks of gestation treated with emergency surgery, followed by a full-term vaginal delivery, along with a literature review. A 31-year-old primigravida at 34 weeks and four days of gestation presented to the emergency department with right lower abdominal pain. An emergency laparotomy was performed to achieve term delivery, suspecting right ovarian cyst torsion without signs of fetal distress. General anesthesia with sevoflurane was selected over spinal anesthesia, considering the incision height. The patient was placed in the left lateral decubitus position on the operating table to ensure proper visualization and maintain uterine circulation. A 4-cm transverse skin incision was made under ultrasound guidance, revealing the twisted right paratubal cyst immediately beneath. The cyst was excised, and the torsion was relieved. The postoperative course was uneventful, and spontaneous labor occurred at 39 weeks and six days of gestation, resulting in a vaginal delivery at 40 weeks. This case demonstrates that even late preterm adnexal torsion can be managed safely with appropriate surgical techniques, allowing for a subsequent term vaginal delivery.