Adnexal Masses in Pregnancy

Abstract

Importance: Adnexal masses are identified in approximately 0.05% to 2.4% of pregnancies, and more recent data note a higher incidence due to widespread use of antenatal ultrasound. Whereas most adnexal masses are benign, approximately 1% to 6% are malignant. Proper diagnosis and management of adnexal masses in pregnancy are an important skill for obstetricians.Objective: The aim of this study was to review imaging modalities for evaluating adnexal masses in pregnancy and imaging characteristics that differentiate benign and malignant masses, examine various types of adnexal masses, and understand complications of and explore management options for adnexal masses in pregnancy.Evidence Acquisition: This was a literature review using primarily PubMed and Google Scholar.Results: Ultrasound can distinguish between simple-appearing benign ovarian cysts and masses with more complex features that can be associated with malignancy. Radiologic information can help guide physicians toward recommending conservative management with observation or surgical removal during pregnancy to facilitate diagnosis and treatment. The risks of expectant management of an adnexal mass during pregnancy include rupture, torsion, need for emergent surgery, labor obstruction, and progression of malignancy. Historically, surgical removal was performed more routinely to avoid such complications in pregnancy; however, increasing knowledge has directed management toward conservative measures for benign masses. Surgical removal of adnexal masses is increasingly performed via minimally invasive techniques including laparoscopy and robotic surgery due to a decreased risk of surgical complications compared with laparotomy.Conclusions and Relevance: Adnexal masses are increasingly identified in pregnancy because of the use of antenatal ultrasound. Clear and specific guidelines exist to help differentiate between benign and malignant masses. This is important for management as benign masses can usually be conservatively managed, whereas malignant masses require excision for diagnosis and treatment. A multidisciplinary approach, including referral to gynecologic oncology, should be used for masses with complex features associated with malignancy. Proper diagnosis and management of adnexal masses in pregnancy are an important skill for obstetricians.Target Audience: Obstetricians and gynecologists, family physicians Learning Objectives: After completing this activity, learners should be better able to compare different types of adnexal masses found in pregnancy, including incidence, clinical features, and imaging characteristics; evaluate an adnexal mass with imaging and laboratory tests; describe complications related to an adnexal mass in pregnancy; and determine management and/or surgical approaches for removal.

Application of transumbilical single port laparoscopic surgery for adnexal masses in pregnancy

“…For surgery during pregnancy, traditional laparoscopy has greatly reduced incisional trauma compared with laparotomy. LESS provides higher benefits, mainly manifested as following: (1) with the umbilicus as a single channel, the incision with a length of 2-2.5 cm is incised layer by layer at the umbilicus to facilitate the surgeon to enter the abdominal cavity under direct vision, effectively avoiding the intestinal injury caused by blind puncture in traditional laparoscopic surgery and the damage to the uterus that increases during pregnancy 2 ; (2) LESS gives the surgeon a wider field of view and has the advantages of both upper and lower levels, while abdominal incision of LESS is larger than traditional laparoscopy, allowing the surgeon to separate and explore the intraoperative technique; if the nature of the patient's mass is difficult to determine macroscopically, the surgeon can touch the mass combined with experience to make a rough judgment 3,4 ; (3) solved the dilemma of removing teratoma tissue during minimally invasive surgery. The umbilical incision of LESS avoids intraoperative aspiration of the tumor body, it is large enough to completely remove the tumor body, and avoids cutting bone tissue in the abdominal cavity.…”

“…Since the advent of prenatal ultrasound, the incidence of adnexal masses during pregnancy has increased to between 0.05% and 2%, the majority of which are physiological ovarian cysts and benign tumors; the incidence of ovarian cyst torsion ranges from 1% to 22%. 1 There are no unique clinical manifestation of adnexal masses during pregnancy, and the majority of patients can pay attention to severe pain caused by adnexal torsion or rupture. With the development of laparoscopic techniques, laparoscopic surgery has gradually replaced laparotomy 2 as the procedure of choice for the treatment of adnexal masses in pregnancy.…”

Effect of Two-Port Laparoscopic Surgery on Pregnancy Outcomes of Patients with Concurrent Adnexal Masses

“…Corpus luteum cysts are the most common type of adnexal masses, accounting for 13–17% of such masses. Corpus luteum cysts spontaneously regress in the second trimester [ 9 , 10 ]; therefore, close observation is a reasonable option. However, surgical management is required for persistent masses with suspicious malignancy.…”

Paratubal Cystectomy in a Pregnant Woman Using the Single-Incision Laparoscopic Surgery (SILS) Technique

“…As such, pregnant patients with features of ovarian malignancy are a group who require surgical intervention. Alongside increasing the suspicion of malignancy, ovarian masses that are large (>10 cm) or increasing in size pose a risk of torsion or obstructed labour and are an indication for surgery [ 14 ]. Another important consideration is the risk of emergency surgery in the event of ovarian torsion and its apparent predisposition towards preterm birth [ 15 ].…”