Case Report Ovarian Torsion in the Third Trimester of Pregnancy Leading to Iatrogenic Preterm Delivery Evangelia Vlachodimitropoulou Koumoutsea, Manish Gupta, Antony Hollingworth, and Anwen Gorry Department of Obstetrics and Gynaecology, Whipps Cross University Hospital, London E11 1NR, UK Correspondence should be addressed to Evangelia Vlachodimitropoulou Koumoutsea; evangelia.koumoutsea.11@ucl.ac.uk Received 22 December 2015; Revised 26 February 2016; Accepted 2 March 2016 Academic Editor: Anna Fagotti Copyright © 2016 Evangelia Vlachodimitropoulou Koumoutsea et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Ovarian torsion in the third trimester of pregnancy leading to a midline laparotomy and caesarean section for the delivery of a preterm baby is an uncommon event. As the woman is likely to present with nonspecifc symptoms of lower abdominal pain, nausea, and vomiting, ovarian torsion can ofen be misdiagnosed as appendicitis or preterm labour. Treatment and the opportunity to preserve the tube and ovary may consequently be delayed. We report the case of a multiparous woman who had undergone two previous caesarean sections at term, presenting at 35 weeks of gestation with a presumptive diagnosis of acute appendicitis. Ultrasonography described a cystic lesion 6 × 3cm in the right adnexa, potentially a degenerating fbroid or a torted right ovary. MRI of the pelvis was unable to provide further clarity. Te patient was managed by midline laparotomy and simultaneous detorsion of the ovarian pedicle and ovarian cystectomy together with caesarean section of a preterm infant. Tis report describes that prompt recognition and ensuring intraoperative access can achieve a successful maternal and fetal outcome in this rare and difcult scenario. Furthermore, we would like to emphasise that the risk for a pregnant woman and her newborn could be reduced by earlier diagnosis and management of ovarian masses (Krishnan et al., 2011). 1. Case Presentation A 33-year-old woman was booked for hospital care because of two previous caesarean deliveries. Te frst was an emergency caesarean at 42 weeks of gestation for fetal distress in labour. Te second was undertaken for failure to progress in spontaneous labour. In this pregnancy her last ultrasound scan was at 20 weeks of gestation and revealed no fetal abnormalities. Te patient presented at 35 + 2 weeks of gestation, with a 4-hour history of sudden onset and severe and constant abdominal pain in the right iliac fossa. She found changing position incredibly painful and examination displayed invol- untary guarding and rigidity of the right side of her abdomen. Te pain was associated with uncontrollable vomiting. Tere was no history of vaginal loss or bleeding and normal fetal movements had been felt. 2. Investigations On examination, the patient was in obvious distress. She was normotensive and tachycardic; pulse rate was 110 bpm; respiratory rate was 16/min; and oxygen saturations were 100% in air. She was afebrile. Abdominal palpation revealed an exquisitely tender abdomen with rigidity and guarding on the lower right side. Acute appendicitis was suspected and a prompt review by the surgical team was undertaken. Ultrasound assessment on the labour ward demonstrated fetal heart movements, cephalic presentation, and an anterior high lying placenta. Cervical length was 32 mm. Fetal moni- toring using cardiotocography was reassuring. Te patient was managed conservatively overnight, was nil by mouth, and required high doses of oral morphine and antiemetics. A pelvic ultrasound scan revealed a right sided 6 × 3 cm cystic lesion, consistent with a degenerating fbroid Hindawi Publishing Corporation Case Reports in Obstetrics and Gynecology Volume 2016, Article ID 8426270, 3 pages http://dx.doi.org/10.1155/2016/8426270