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Introduction Ovarian torsion is a rare but emergent condition in women. It is one of the most common gynecologic surgical emergencies. Pregnancy is a risk factor for adnexal torsion as well as corpus luteum cyst, ovarian hyperstimulation syndrome (OHSS), and assisted reproductive technologies (ART) In view of the physiological and anatomic change related to the pregnancy, the diagnosis of ovarian torsion in pregnant women becomes more challenging. The clinical symptoms are nonspecific and can be misdiagnosed with other acute abdominal conditions such as appendicitis, renal colic, cholecystitis, intestinal obstruction, pelvic inflammatory disease, ectopic pregnancy, ruptured ovarian cysts, and non-functional ovarian cysts A prompt diagnosis is necessary for conservative, organ-preserving management, as after 36-48 hours of torsion irreversible changes to the ovary occur. Materials and methods A 25 year old female , G2P1L1 with a 5 weeks period of gestation came to our emergency department with history of 1 month of amenorrhea, and complaints of acute severe pain abdomen since 2:30pm of 28/10/22 with no known comorbidities . On admission, her general condition was good, vitals were stable, abdomen was soft, tenderness in right illiac fossa,no active bleed on local examination. Routine investigations were found to be normal and bHCG levels was 725.66mIU/ml . Emergency Ultrasound pelvis showed Features suggestive of right ovarian torsion with large paraovarian cyst of intrauterine gestational sac corresponding to 5 weeks vascularity with mild to moderate hemoperitoneum. Patient was posted for emergency laparotomy Procedure Intraoperatively, right hemorrhagic, gangrenous ovary with a cyst of 9 X 10cms with one turn of torsion, hemoperitoneum of about 200 ml was noted, left adnexa and right fallopian tube were normal. Postoperatively patient recovered well. Serial bHCG levels were monitored till discharge and was 1295.3 mIU/ml on post operative day 2 and 2033.6 mlU/ml on post operative day 4. Early pregnancy scan was done on post operative day 4 that showed a Single intrauterine gestation with gestational age of 5 weeks. Fetal pole embryo, amniotic fluid was not visualised and mild fluid in the pouch of douglas and pelvis. Patient was discharged on Post operative day 5. Discussion When Pregnant Women Present With Sudden-onset pain, local tenderness,nausea,and vomiting,clinicians should think of adnexal torsion,especially in lack of fever.It necessitates prompt surgical intervention because any delay leads to irreversible ovarian necrosis. Conclusion When pregnant women present with Sudden-onset pain, focal tenderness, nausea,and vomiting, we should think of adnexal torsion,especially in lack of fever. Then,using ultrasound, adnexal enlargement or masses should be explored seriously. They should take invasive and urgent therapy to preserve ovaries and prevent complications.