Pain

It was 3.00AM in the morning. WFM woke me up saying she had acute pain in the right half of the lower abdomen. Earlier in the week, she had been getting vague aches and pains, so we didn't take this very seriously; we thought the pain might be due to something she had eaten the previous evening. I thought of giving an anti-spasmodic and went to the medicine cabinet to look for a Baralgan tablet. As often happens at such times, I found everything else except Baralgan. I changed and drove down to the nearest 24-hour chemist shop, a mile or so away for the medicine.

After taking the tablet, she seemed to feel a little better. I was pretty groggy, since I had woken up once at around midnight for an emergency call. The moment she told me she was feeling better, I turned around and went back to sleep.
 

Action Time

Around 6.00AM, I was again woken up by WFM. In agony she told me that she was sure this was something more serious than an upset tummy. The tablet had not particularly made any difference and she had waited this long before waking me up again only because she had hoped that the pain would go away in due course of time. When I reached out to feel her, her abdomen at the site of the pain felt rigid. This along with the persistence of the pain suggested something serious and ominous and the two thoughts that immediately came to my mind were acute appendicitis and ovarian torsion (twisting of the ovary). While I was wondering what to do, WFM took matters in her hand and insisted on being hospitalized. We called up our gynecologist's assistant, who on hearing the story told us to first proceed for an ultrasound and to prepare for hospitalization.

We simultaneously called up our family physician and the ultrasonologist. While we were preparing to leave for the ultrasound, the family physician came and gave her a strong sedative to reduce her pain. That was the first time since 3.00AM that WFM experienced a brief relief of pain, though it left her a little dazed. By 7.30AM we were at our ultrasonologist's clinic. One placement of the transducer on the abdomen and we knew that were dealing with a twisted ovary.
 

Twisted Ovary

Hyperstimulated ovaries are common in pregnancies resulting from assisted reproduction. These ovaries are large and pedunculated and have a tendency to twist around the pedicle. If the twist is severe, the blood vessels get completely occluded and the ovary undergoes infarction. This produces tremendous pain. The ultrasonologist kept looking for some evidence of blood flow through the twisted ovary and even though he performed all kinds of maneuvers including color Doppler, he did not succeed in finding the slightest semblance of flow.
 

The Hospital

This meant only one thing. Surgery. The twisted ovary had to come out. There is a way to untwist an ovary using keyhole surgery and endoscopy, but this is best done in the non-pregnant state when there is some evidence of blood flow and the possibility of salvage. Here we did not want to take a chance and so by 9.00AM, she was in the hospital. By 11.00AM she was in the operation theatre and by noon, the dead ovary was out. Along with it went the pain. And luckily, nothing happened to the pregnancy.

My colleague had gone off to the US just the night before for a four-month fellowship and my other colleague was to return the next day from her ten-day leave. This couldn't have been timed better. I had a load of pending work, no colleagues, and I had to constantly shuttle between my office and the hospital. Thankfully, my staff took over completely and with the help of my assistants, managed.

It took WFM a week to settle down and to get discharged. She went off directly to her parents' house and decided to stay there for a couple of months or so, before coming back home. Luckily her parents stay just a five minutes drive away from home and so it wasn't much of a problem working things out. 
 

Family Support

Everything went off smoothly in no small part due to the support of our family and friends. WFM's parents, my parents, our relatives and our close friends were all there for us. Such support can make all the difference between a stressful medical situation and a peaceful one. More about it next time.

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