Prediction of ovarian tumor type in pregnant women is of great clinical significance, however, it is vastly difficult. In the last 5–10 years gynecologists were suggested to use RMI (Risk of Malignancy Index) in non-pregnant women, however the value of the test for obstetric practice has yet to be established. The study was aimed to determine RMI-IV and RMI-V during preoperative non-invasive prediction of ovarian tumor type in pregnant women. Retrospective and prospective clinical and laboratory data of 114 pregnant women aged 20–38 were collected. Among them 15 patients had malignant ovarian tumors (MOTs), 28 had borderline ovarian tumors (BOTs), and 71 had benign ovarian tumors. Color Doppler and pulsed wave Doppler ultrasound was performed. The levels of СА-125 were defined by enzyme immunoassay. Models IV, V were used to assess the risk of ovarian cancer. A moderate non-significant increase in blood levels of СА-125 compared to patients with benign ovarian tumors and BOTs was found in pregnant women with MOTs. Patients with BOTs and MOTs showed higher RMI-IV and RMI-V values compared to the group of pregnant women with benign ovarian tumors. Extreme values are required to guarantee the differences in the diagnosis of tumors (RMI-IV > 3500 indicate the presence of MOTs, the values below 100 indicate no malignancy). Similar RMI-V values are 1500 and 60. However, in most cases, availability of RMI-IV and RMI-V is insufficient for decision making, and a comprehensive approach has to be used. Thus, it is difficult to define ovarian mass type in pregnant women using RMI only. Comprehensive clinical assessment with the use of imaging methods is required for preoperative prediction of ovarian mass type in pregnant women, along with the use of prognostic models taking into account the majority of descriptive “morphological” tumor characteristics.

Prognozirovanie haraktera opuholej yaichnikov u beremennyh imeet vazhnoe klinicheskoe znachenie, no znachitel'no zatrudneno. V poslednie 5–10 let u neberemennyh v ginekologii predlozheno ispol'zovat' RMI (Risk of malignancy index), odnako v akusherskoj praktike cennost' etogo issledovaniya eshche ne ustanovlena. Cel'yu issledovaniya bylo opredelit' RMI-IV i RMI-V pri dooperacionnom neinvazivnom prognozirovanii haraktera opuholej yaichnikov u beremennyh. Retro i prospektivno otobrany dannye kliniko-laboratornogo obsledovaniya 114 beremennyh 20–38 let, iz kotoryh 15 pacientok imeli zlokachestvennye opuholi yaichnikov (ZOYA), 28 pacientok — pogranichnye opuholi yaichnikov (POYA) i 71 pacientka — dobrokachestvennye opuholi yaichnikov (DOYA). Provodili ul'trazvukovoe issledovanie (UZI) s ispol'zovaniem cvetovoj dopplerografii i impul'snovolnovoj dopplerometrii. Opredelyali koncentraciyu SA-125 s pomoshch'yu immunofermentnogo analiza. Dlya ocenki riska raka yaichnikov ispol'zovali modifikacii IV, V. V krovi beremennyh s ZOYA bylo vyyavleno umerennoe statisticheski ne znachimoe povyshenie SA-125 po sravneniyu s takovymi znacheniyami u pacientok s DOYA i POYA. Po sravneniyu s gruppoj beremennyh s DOYA, pacientki s POYA i ZOYA demonstrirovali povyshennyj uroven' RMI-IV i RMI-V. Dlya garantirovannogo razlichiya v diagnostike opuholej neobhodimy kraevye znacheniya (RMI-IV — vyshe 3500 ukazyvayut na ZOYA, nizhe 100 — na otsutstvie zlokachestvennogo processa). Dlya RMI-V analogichnymi znacheniyami yavlyayutsya 1500 i 60. Odnako dlya prinyatiya resheniya v bol'shinstve nablyudenij nalichiya tol'ko pokazatelej RMI-IV i RMI-V bylo nedostatochno i trebovalos' ispol'zovat' kompleksnyj podhod. Takim obrazom, opredelit' harakter novoobrazovanij yaichnikov u beremennyh trudno, esli ispol'zovat' tol'ko indeksy RMI. Dlya dooperacionnogo prognozirovaniya haraktera opuholej yaichnikov u beremennyh trebuetsya kompleksnoe klinicheskoe obsledovanie s ispol'zovaniem vizualizacionnyh metodov, primenenie modelej prognozirovaniya, uchityvayushchih bol'shoe kolichestvo opisatel'nyh «morfologicheskih» harakteristik opuholej.

Borderline ovarian tumors (BOTs) are common in women in their reproductive years. In more than one-third of patients tumors are detected at the age of 15–29, the average age at initial diagnosis is 40. The study was aimed to improve methods for BOTs diagnosis in pregnancy and to determine the possibilities of organ preservation treatment. A group of 300 pregnant women with various tumor-like formations and ovarian tumors was examined. Of them, 25 patients had borderline epithelial tumors (22 patients had serous and 3 patients had mucinous tumors). Ultrasound examination together with blood serum CА-125, sFas, VEGF and IL6 level assessment were performed prior to surgery. The results obtained were compared with the results of morphological studies. Organ preservation and radical surgical treatment were carried out, and chemotherapy, if necessary. Perinatal outcomes were studied when performing the cross-comparison. It was discovered, that ultrasonography and logistic regression analysis made it possible to distinguish between benign ovarian tumors, BOTs and malignant ovarian tumors. The levels of VEGF above the 500 pg/ml, IL6 above the 8.1 pg/ml and CА-125 above the 300 U/ml indicated the high probability of malignant ovarian tumors in pregnant women. Only the morphological study of ovarian tissue, obtained regardless of surgical methods, ensured understanding of the ovarian tumor’s true nature during pregnancy. At the same time, in three pregnant women with ovarian tumors, the morphological examination revealed some tissue areas common both for BOTs and malignant ovarian tumors. Thus, the predominance of the tumor early stages, relatively mild course and, favorable prognosis in patients with BOTs make it possible to use gentle surgical treatment making it possible to preserve menstrual function and fertility.

Clinical observations of gastrointestinal (GIT) cancer in pregnant women are presented. It is emphasized that early warning signs, typical of the initial manifestations of gastrointestinal stromal tumors, remains underestimated against the background of pregnancy. Frequently, common stages of the disease (III–IV) are detected accidentally after the manifestation of symptoms (gastrointestinal bleeding, formations palpated through the abdominal wall) or due to the detection of metastatic ovarian tumors, which manifest themselves as an independent disease. Long-term results of treatment of patients with secondary ovarian malignancies remain unfavorable. Conclusion. Pregravid training should be at the forefront and include a complete examination of patients, especially those with untypical complaints, in level 3 institutions with appropriate laboratories and modern methods of instrumental research. Key words: pregnancy, gastrointestinal malignancies, ultrasound

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