Perioperative Outcomes in Pregnant Women Who Underwent Surgery for Adnexal Torsion / Resultados perioperatórios em mulheres grávidas submetidas a cirurgia para torção anexial

Abstract Objective To evaluate clinical characteristics, maternal and fetal outcomes in pregnant women who underwent surgery for adnexal torsion (AT). Methods All patients, who underwent surgical operation due to AT during pregnancy at the Department of Obstetrics and Gynecology, School of Medicine, Ege University between 2005 and 2020 were retrospectively investigated. Main clinical and perioperative outcomes were evaluated. Results A total of 21 patients who underwent surgery due to AT during pregnancy were included. Of all patients, 61.9% underwent laparoscopy and the remaining 38.1% underwent laparotomy. The most common surgical procedure was adnexal detorsion in both groups (48%). Mean gestational age at the time of diagnosis, duration of surgery and hospitalization were significantly lower in the laparoscopy group, when compared with the laparotomy group (p=0.006, p=0.001, and p=0.001, respectively.) One of the patients had an infection during the postoperative period. Spontaneous abortion was only observed in one case. Conclusion It can be concluded that the surgical intervention implemented for the exact diagnosis and treatment of AT (laparotomy or laparoscopy) did not have an unfavorable effect on pregnancy outcomes such as abortion, preterm delivery, and fetal anomaly. However, laparoscopy may be superior to laparotomy in terms of advantages.

Resumo Objetivo Avaliar as características clínicas, e os desfechos maternos e fetais em gestantes submetidas à cirurgia de torção anexial. Métodos Todas as pacientes operadas por torção anexial durante a gravidez no Departamento de Obstetrícia e Ginecologia da Faculdade de Medicina da Universidade de Ege entre 2005 e 2020 foram investigadas retrospectivamente. Os principais resultados clínicos e perioperatórios foram avaliados. Resultados Foraminclusas 21 pacientes operadas por torção anexial durante a gravidez. De todos as pacientes, 61,9% foramsubmetidas à laparoscopia e as 38,1% restantes foram submetidas à laparotomia. O procedimento cirúrgico mais comum foi apenas a destorção anexialemambos os grupos (48%).Aidade gestacionalmédia nomomento do diagnóstico, a duração da operação e da hospitalização foram significativamentemenores no grupo de laparoscopia em comparação com o grupo de laparotomia (p=0,006, p=0,001 e p=0,001, respectivamente.) Uma das pacientes teve uma infecção no pós-operatório. Apenas em um caso observamos aborto espontâneo. Conclusão Pode-se concluir que a intervenção cirúrgica implementada para o diagnóstico exato e tratamento da torção anexial (laparotomia ou laparoscopia) não teve efeito desfavorável nos desfechos da gravidez, como aborto, parto prematuro e anomalia fetal. No entanto, a laparoscopia pode ser superior à laparotomia em termos de vantagens.

Comparison of the success of histopathological diagnosis with dilatation-curettage and Pipelle endometrial sampling.

The aim of this study is to compare collection of sufficient material and diagnostic accuracy of Pipelle biopsy with curettage and hysterectomy. A total of 82 cases with indications for endometrial biopsy for any reason and in which endometrial biopsy was performed with dilatation and curettage (D&C) and Pipelle aspiration biopsy, and 66 cases in which an indication for hysterectomy was established for any reason were included in the study. Histopathological findings were examined in the following six groups: normal; endometrial polyps; hyperplasia without atypia; hyperplasia with atypia; atrophy; and insufficient material. Descriptive statistical methods and McNemar's test were used. When the histopathological compatibility between Pipelle and D&C was considered (n=82), a diagnosis that was different from that obtained by D&C was obtained in 22 of the 63 cases (34%), in whom normal endometrial histology was found with a Pipelle biopsy specimen. It was observed that only 1 of 13 cases of endometrial polyps was diagnosed with Pipelle biopsy. Insufficient material was obtained in six cases (7%) with Pipelle biopsies and three cases (4%) with D&C. While Pipelle biopsies and D&C have a nearly equal level of success in widespread endometrial lesions, Pipelle biopsies provide limited diagnostic accuracy in cases with focal pathologies.