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RCOG World Congress 2023
June 12 - 14, 2023 | London, UK
EP.1434
Management of Adnexal Torsion: Middle-Eastern College of Obstetricians and Gynaecologists (MCOG) Guideline.
Part of Topic
Early Pregnancy Complications and Gynaecology
Objective
•Adnexal torsion is one of the most frequent gynaecologic surgical emergencies affecting females of all ages.
•Establishing the diagnosis is usually challenging as the symptoms are non-specific.
•The delay in diagnosis can result in loss of ovarian function.
•The objective is to review the evidence and provide recommendations on diagnosing and managing adnexal torsion in different age groups.
Methods
•Our approach started with defining relevant clinical questions. In this guideline, we aimed to appraise evidence on the diagnosis and treatment of ovarian torsion.
•A literature search was conducted on internationally recognized guidelines between January 2000 to January 2022 to define the current global practice.
•Each clinical question was assigned to a panel of 2 researchers, who appraised how the question was addressed by available guidelines, the evidence supporting current recommendations, and the presence of controversies and gaps.
•The third step was to conduct a systematic search of the literature on PUBMED, SCOPUS and Cochrane library were searched for from January 2000 to April 2020, using the following terms: ["Ovarian" OR "Adnexal"] AND ["Torsion"] AND ["management" OR "diagnosis"].
•Retrieved articles were reviewed by two researchers independently through a 3-step selection process through revision of titles, abstracts, and full articles, respectively.
•Eligible studies were appraised for methodology, and results and recommendations were made by consensus.
•Recommendations were classified based on the Oxford Centre for Evidence-based Medicine–Levels of Evidence.
Results
•The evidence obtained was reviewed and evaluated by the Obstetrics and Gynaecology practice guidelines Committee of the Middle-Eastern College of Obstetricians and Gynaecologists (MCOG) under the leadership of the principal authors.
•The diagnosis should be considered in females with acute abdominal pain, and surgery should be performed as soon as possible to minimize trauma to the ovary.
•Laparoscopy is the preferred surgical approach for detorsion. Conservative surgical treatment, including detorsion with or without cystectomy, should be performed even in cases of a blue-black ovary.
•Salpingo-oophorectomy should only be considered in postmenopausal women, fertility not desired, non-viable ovary or when malignancy is suspected.
Conclusion
•The MCOG practice guideline for the management of adnexal torsion aims to provide an overview of the current evidence for assessing and treating this condition.
•The guideline includes algorithms based on current evidence to guide the diagnosis and management of adnexal torsion in females of all age groups.