Adnexal mass occurring with intrauterine pregnancy: Report of fifty-four patients requiring laparotomy for definitive management

Hess, L. Wayne; Peaceman, Alan M.; O’Brien, William F.; Winkel, Craig A.; Cruikshank, D. P.; Morrison, John C.

doi:10.1016/0002-9378(88)90212-8

Cited by 238 publications

(98 citation statements)

References 9 publications

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“…Previous studies reported that patients who underwent emergency surgery because of adnexal torsion or hemorrhage had a greater incidence of abortion and preterm delivery compared to patients who underwent elective laparotomy [9].…”

Section: Discussionmentioning

confidence: 97%

Management and Outcomes of Ovarian Masses Measuring ≥5cm in Pregnancy - a Series of Six Cases

Fatema¹,

Badi²,

Moon³

2016

MOJCR

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Ovarian masses ≥5cm in diameter have been found in only 0.04-0.05% of pregnant women. Most of the adnexal masses encountered during pregnancy are simple cysts <5cm in diameter and about 70% would resolve by the early second trimester. The persistent cysts with gradual increase in size required surgical management. Adnexal masses requiring surgical intervention in pregnancy have been reported for around 1% to 2.3% of all gestations. In the series we reviewed 6 cases at different trimesters of pregnancy with ovarian masses measuring ≥5cm that were managed surgically in a regional hospital in Oman. We observed the maternal perinatal outcome after removal of cysts either by Laparotomy or during cesarean delivery. Ovarian masses with acute complications warranted immediate surgical intervention irrespective of gestational age and incidental findings of ovarian masses during cesarean section required removal to avoid delayed diagnosis of malignancy and repeat surgery. spontaneously with no history of ovarian stimulation treatments. On general examination she was vitally stable. However abdominal examination revealed that a palpable mass at the middle of the lower abdomen corresponding to 20 weeks in size was tender on palpation. Baselines of all investigations were within normal limit. Eventually a radiology ultrasound revealed that the gravid uterus with intra uterine alive fetus corresponding to 8 weeks of gestation and a huge anechoic well defined cystic lesion in the middle of lower abdomen measuring 13.8x8.8cm with no doppler signal around it. Both ovaries were masked by the mass. Minimal amount of free fluid was seen in the pouch of Douglas. An urgent laparotomy was undertaken, during which a large unilocular thick walled right-sided ovarian cyst was detected measuring around 14x8.5cm in size (Figure 1). The cyst was twisted twice with clear fluid inside it. A right ovarian cystectomy was then carried out, and around 1700 ml clear fluid aspirated from the cyst. The remaining ovarian tissue and fallopian tube were preserved. Postoperatively she was placed on oral progesterone (Tab Dydrogesterone 10 mg BID) support upon hospital discharge. Histopathology report confirmed serous cyst adenoma in the ovary with signs of torsion. Tumor markers were within the normal limit. She was on regular ANC follow up which was uneventful. At 40 weeks and 1 day of gestation she delivered by a spontaneous vaginal delivery of a live baby of weighting 3 kg with Apgar score 9/1 minute and 10/5 minute. Keywords Case 2A 31 year old female G2P1 at 24 weeks of gestation arrived at our ANC clinic with complaints of a sudden onset of lower abdominal pain since the past 4 hours .She was registered at 9 weeks of gestation at the local health center and was put on regular ANC follow up afterwards. Upon physical examination, her vital signs were within normal limits but she appeared to be in distress due to continuous pain. Upon abdominal examination the lower right quadrant was revealed to be tender on palpation, with voluntary guardin...

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Section: Discussionmentioning

confidence: 97%

Management and Outcomes of Ovarian Masses Measuring ≥5cm in Pregnancy - a Series of Six Cases

Fatema¹,

Badi²,

Moon³

2016

MOJCR

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“…Of persistent adnexal masses, one in 1300 requires laparotomy, due to suspicion of malignancy. A total of 2% to 5% of adnexal masses that are removed during pregnancy are malignant (7). Ultrasonography can usually give an accurate description of the size and character of adnexal masses.…”

Section: Adnexal Massesmentioning

confidence: 99%

Obstetric MRI

Levine

2006

Magnetic Resonance Imaging

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Ultrasound is the imaging modality of choice for pregnant patients. However, MRI is increasingly utilized in patients in whom the sonographic diagnosis is unclear. These include maternal conditions unique to pregnancy such as ectopic pregnancy, placenta accreta, and uterine dehiscence. MRI is also being increasingly utilized in the assessment of abdominopelvic pain in pregnancy, in particular in assessment for appendicitis. Fetal MRI is performed to assess central nervous system (CNS) abnormalities and patients who are considering fetal surgery for conditions such as neural tube defects, congenital diaphragmatic hernia, and masses that obstruct the airway. In the future, functional MRI and fetal volumetry may provide additional information that can aid in our care of complicated pregnancies.

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“…According to current literature and long conductive series, the frequency of adnexal masses during pregnancy is estimated to be 1 in 81 to 1 in 2500 live births [10].…”

Section: Discussionmentioning

confidence: 99%

Ovarian Cancer and Pregnancy

Sofoudis¹

2017

Obstetrics

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The annual incidence rate of cancer is estimated to be more than 11,000 patients in the U.K. in the age group of 15-40 years, which corresponds to 4% of all cancer patients. The diagnosis of cancer is followed by devastating consequences for the patients and their families in this age group. Although the treatment of cancer is of crucial significance, it should also examine the impact of the disease on fertility at the time of the diagnosis and the damages caused from the surgical treatment, chemotherapy, or radiotherapy. The gynecological cancer, especially the diagnosis of ovarian cancer, the prevention, and treatment, as well as the fertility preservation in young women, represent the gold standard for all gynecologists. The crucial disadvantage remains the difficulty in primary diagnosis of ovarian cancer and the coexistence with pregnancy, focusing on the fertility preservation and maintaining pregnancy. In the absence of large perspective randomized trials and cohort studies, the therapeutic mapping and optimal management of these patients are difficult. In order to establish detailed guidelines, it is necessary to ensure surgical mapping depending on the cancer staging and the quality of life of the patients.

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Adnexal mass occurring with intrauterine pregnancy: Report of fifty-four patients requiring laparotomy for definitive management

Cited by 238 publications

References 9 publications

Management and Outcomes of Ovarian Masses Measuring ≥5cm in Pregnancy - a Series of Six Cases

Management and Outcomes of Ovarian Masses Measuring ≥5cm in Pregnancy - a Series of Six Cases

Obstetric MRI

Ovarian Cancer and Pregnancy

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