Tubo-Ovarian Abscess in Second Trimester of Pregnancy after Transvaginal Oocyte Retrieval: Challenges in Management

A 39-year-old primigravida female presented at 16 weeks gestation, with new onset of severe abdominal pain with nausea and vomiting. Her medical history was significant for infertility and ovarian endometrioma during oocyte retrieval. Current gestation was complicated by an emergent laparoscopy with drainage of a ruptured endometrioma in the first trimester. On examination, she had acute abdomen and sonogram showed a viable pregnancy and a 10 cm left adnexal mass. Emergent laparoscopy was performed with aspiration of abdominopelvic pus, ovarian cystectomy and lysis of adhesions. She delivered a live infant at 39.4 weeks via cesarean delivery secondary to arrest of dilation. We believe that when surgical intervention is required, laparoscopy should be considered in the management of tubo-ovarian abscess in pregnancy in the hands of a skilled laparoscopic surgeon.