Adnexal masses during pregnancy: diagnosis, treatment, and prognosis

Cathcart, Ann M.; Nezhat, Farr; Emerson, Jenna; Pejović, Tanja; Nezhat, Ceana H.; Nezhat, Camran

doi:10.1016/j.ajog.2022.11.1291

Cited by 31 publications

(23 citation statements)

References 103 publications

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“…index did not change significantly during laparoscopic surgery. [8][9][10] In our study, those who underwent laparotomy had a significantly higher miscarriage rate than those who had laparoscopic surgery (28.7% vs 9.78%). However, the difference was not statistically significant.…”

Section: Discussionmentioning

confidence: 88%

The risk factors for miscarriage of viable intrauterine pregnancies in patients with heterotopic pregnancy after surgical intervention

Ruan,

Zhang,

Chen

et al. 2023

Medicine

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To summarize the clinical characteristics and explore the risk factors for miscarriage of a viable intrauterine pregnancy following surgical intervention in patients with heterotopic pregnancy (HP). A total of 106 women diagnosed with HP that underwent surgical intervention in the Women’s Hospital School of Medicine Zhejiang University between January 2014 and December 2021 were included in this retrospective study. They were divided into a miscarriage group (n = 13) and an ongoing pregnancy group (n = 93) according to the outcomes of the HP within 2 weeks after surgery. Data regarding clinical characteristics, surgical conditions, postoperative recovery, and complications were collected and compared between the groups. Logistic multivariate analysis was performed to explore the risk factors for miscarriage in patients with HP within 2 weeks of surgical intervention. Among the 106 women with HP, 80 had tubal HP, 8 had cornual HP, and 18 had interstitial HP. Eighty-seven (82.1%) patients developed clinical symptoms that manifested primarily as abnormal vaginal bleeding and/or abdominal pain, whereas 19 (17.9%) patients had no clinical symptoms. The mean gestational age on the day of surgery was 7.2 weeks (inter-quartile range, 6.4–8.3). The miscarriage rate within 2 weeks of surgical intervention was 12.3% in patients with HP. Compared to the ongoing pregnancy group, the miscarriage group had a higher body mass index, earlier gestational age at treatment, and higher volume of hemoperitoneum (P < .05 for all). Logistic multivariate analysis indicated that the women with a hemoperitoneum volume > 200 mL had significantly higher risk of miscarriage after adjusting covariates [OR (odds ratio) = 5.285, 95% CI (confidence interval) (1.152–24.238), P < .05]. Hemoperitoneum volume was independently associated with miscarriage of viable intrauterine pregnancies in patients with HP within 2 weeks of surgical intervention.

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Section: Discussionmentioning

confidence: 88%

The risk factors for miscarriage of viable intrauterine pregnancies in patients with heterotopic pregnancy after surgical intervention

Ruan,

Zhang,

Chen

et al. 2023

Medicine

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“…Almost all surgical and anesthetic techniques used today have few side effects. Whenever possible, surgery (either open or endoscopic) should be performed during the second trimester 20 . In the second trimester, the risk of miscarriage is the lowest and the size of the uterus does not radically change the positions and relations of intraabdominal and thoracic organs, thereby allowing different interventions 21,22 .…”

Section: Discussionmentioning

confidence: 99%

Cancer during pregnancy: Twenty‐two years of experience from a tertiary referral center

Milosevic,

Likic Ladjevic,

Dotlic

et al. 2024

Acta Obstet Gynecol Scand

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IntroductionCancer complicating pregnancy is a rare but potentially life‐threatening condition for both the mother and her child. The aim of the present study was to assess the outcomes for mothers and children after pregnancy complicated by malignancy and to investigate which parameters are important for their 1‐year survival.Material and methodsThe study included 84 pregnant women diagnosed with malignant tumors during pregnancy from 2001 to 2022. The pregnancy course and outcome, as well as parameters that could influence the survival and condition of the mother and child were evaluated. Mothers and children were followed up for 1 year after delivery to assess their condition/complications and overall survival.ResultsMost malignancies were gynecological (31%) or hematological (23.8%) and were diagnosed and surgically treated in the second trimester. Most children (69%) showed adequate growth and development throughout pregnancy but were delivered before term (53.6%) to allow mothers to receive therapy. Adjuvant therapy during pregnancy mostly caused a transitory deterioration of the child's condition, while surgery did not significantly impact the pregnancy course. Deliveries, on average, occurred during the 33.01 ± 6.16 gestational week (range: 20–40) and mostly by cesarean section (76.2%). For mothers, the pregnancy survival rate was 95.2% and survival after 1 year was 87.5%. However, 37.5% of women were still ill and required additional therapy 1 year postpartum. The pregnancy survival rate for children was 94%, whereas the 1‐year survival rate was 76.2%. Most children had a favorable condition (alive, adequately growing and developing, and without complications) at birth (81%) as well as at the 1‐year follow‐up (63.7%). Regression analysis identified the following predictors of favorable 1‐year maternal condition: applying therapy during pregnancy, no progression of the malignancy during pregnancy, and delivery at a later gestational week. Predictors of favorable 1‐year condition of children were lower histopathological grade of malignancy, surgery as therapy for malignancy, obtaining higher birthweight, and delivery by cesarean section.ConclusionsIf the malignancy is not progressing, pregnancy should be continued as long as possible for the child to obtain adequate birthweight. Both surgery and chemotherapy were safe therapeutic choices, as most pregnancies continued successfully after therapy.

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“…Asymptomatic cysts that are <6 cm in diameter are generally benign and may be managed conservatively with close US follow-up [ 4 ]. However, reported rates of torsion range from 3 to 12% in cysts with a mean size of 10 cm; furthermore, obstruction of labor has been reported in 3% of cases with cysts >3 cm, and 2–10% of patients required hospitalization for pain [ 5 ]. Pregnant patients have a 1% increased risk of torsion compared to nonpregnant patients [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

Successful use of single-port laparoscopic surgery for ovarian cyst removal during pregnancy: a case series of three cases

Akihiko

Okubo

Nagae

et al. 2023

Journal of Surgical Case Reports

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Pregnant patients have an increased risk of torsion compared to that seen in nonpregnant patients, and those with larger cysts undergo torsion more frequently, which can cause obstructions during labor. The risks associated with emergent surgery are higher than those with elective surgery. Laparoscopic surgery can be safely performed during pregnancy. Single-port laparoscopic surgery is reported to be a minimally invasive laparoscopic technique. We report three cases of ovarian dermoid cysts, which were successfully removed during pregnancy through elective single-port laparoscopic surgery. In all cases, imaging showed a dermoid cyst and the cyst size was greater than 6 cm. All patients requested the surgery. The ovarian cysts were successfully removed by single-port laparoscopy without additional ports and without intra- or postoperative complications. All pregnancies progressed well and delivered vaginally at full term. The single-port laparoscopic approach is useful for removing ovarian cysts during pregnancy.

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Adnexal masses during pregnancy: diagnosis, treatment, and prognosis

Cited by 31 publications

References 103 publications

The risk factors for miscarriage of viable intrauterine pregnancies in patients with heterotopic pregnancy after surgical intervention

The risk factors for miscarriage of viable intrauterine pregnancies in patients with heterotopic pregnancy after surgical intervention

Cancer during pregnancy: Twenty‐two years of experience from a tertiary referral center

Successful use of single-port laparoscopic surgery for ovarian cyst removal during pregnancy: a case series of three cases

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