Adnexal Masses in Pregnancy

Abstract

With the widespread use of routine abdominal ultrasound examination during pregnancy, adnexal masses are observed with increasing frequency. Most patients are clinically asymptomatic at the time of presentation, and most of the adnexal masses detected during early pregnancy disappear during the first 16 weeks of pregnancy. Ovarian tumors are estimated to occur in about 1 in 1,000 pregnancies and of these 3% are malignant. Here we present an overview about frequency, diagnostic procedures and pathological characteristics of these ovarian tumors. Moreover, current modalities for treatment during pregnancy are summarized. Surgical treatment of the adnexal masses has to be performed with adequate staging and debulking equal to the treatment of non-pregnant women. However, whereas during organogenesis abortion has to be considered prior to chemotherapy, later in pregnancy surgical debulking as complete as possible, followed by taxol-platinum chemotherapy is indicated. If the fetus is not viable at the time of primary surgery, neoadjuvant chemotherapy and complementation of surgery after delivery of the baby should be performed. It should be stressed that chemotherapy for ovarian cancer applied during pregnancy appears to be safe. However, no studies have evaluated the long-term consequences for children exposed to intra-uterine chemotherapy. Aspiration of cysts should be avoided, as the correlation between the histological evaluation of an ovarian malignancy and the cytological evaluation of aspirates is poor. Moreover, spillage of malignant cysts is hazardous for the patient.

A study of incidental adnexal masses during caesarean section and its management

“…Aspiration of cysts should be avoided, as the correlation between the histological evaluation of an ovarian malignancy and the cytological evaluation of aspirates is poor. Moreover, spillage of malignant cysts is hazardous for the patient 17 .…”

Torted benign ovarian cyst in the first trimester. The gynaecologist’s dilemma

“…Adnexal masses between 6 and 8 cm have a higher risk of torsion compared with other sizes with about 60% of these occurring between 10 and 17 weeks gestation [2]. The risk of torsion in pregnancy is increased due to altered anatomical positioning of abdominal organs [3], and also as a result of enlarged ovaries following ovulation induction in cases of assisted conception [4].…”

Laparoscopic Management of Ovarian Cysts in Pregnancy: Study of Surgical Outcome and Obstetric Outcome.

“…The frequency of ovarian tumors is about 1 in 1000 pregnancies 3 Most of the cases are benign cysts out of which mature cystic teratoma accounts for 50% of the cases, followed by benign cyst adenomas(20 %) , functional cysts (13%) and ovarian cancer (0.6%), while symptomatic ovarian tumors which are associated with pregnancy ranges from 1:8 -1:2328 .…”