Comparison of subsequent pregnancy outcomes after surgery for adnexal masses performed in the first and second trimester of pregnancy

Abstract

Objective:To determine whether surgery for adnexal masses in the first trimester of pregnancy affects subsequent pregnancy outcomes compared to surgery in the second trimester.Methods: Data were retrospectively reviewed from women who underwent adnexal mass surgery before 26 weeks of gestation at a university hospital between July 2008 and June 2018. Women who underwent surgery in the first trimester were classified as group 1 (n=78) and those in the second trimester were classified as group 2 (n=48).Information on clinical characteristics and pregnancy outcomes was obtained from medical records and follow-up interviews and compared between two groups.Results: There were no differences in age, parity, mass size, laparoscopy, and operation time between the two groups. A total of 98 cases were confirmed as ovarian torsion, including 72 cases in group 1 and 26 cases in group 2. Accordingly, adnexectomy was performed more often in group 1 (P=0.002). No significant differences concerning the rate of abortion, preterm birth, or cesarean delivery were found.Conclusion: Surgery for adnexal masses performed in the first trimester is almost as safe as that in the second trimester. Surgery should be performed for women with a complex adnexal mass in the first trimester to avoid unfavorable complications. K E Y W O R D SAdnexal masses; Adnexal torsion; First trimester; Pregnancy outcomes; Second trimester; Surgery During the study period, a total of 160 women underwent surgery for adnexal masses before 26 weeks of gestation (Fig. 1). Among them, six women did not want to continue the pregnancy and received aspiration and curettage. For two women, the pregnancy was terminated by intraamniotic injection of ethacridine lactate because of fetal malformation (one for Down syndrome and the other for serious hydronephrosis of the fetus). The remaining 152 women continued the pregnancy, including 26 women lost to follow-up. Finally, 126 (82.9%) women met the inclusion criteria. In total, 78 cases were included in group 1 and 48 cases were included in group 2. The median age of gestation at the time of surgery was 9 weeks in group 1 and 15 5/7 weeks in group 2.Data showing the patients' characteristics are shown in Table 1.There was no difference in terms of maternal age, parity, or adnexal mass size between the two groups. Significantly more emergency surgeries were performed in group 1 compared with group 2 (75 [96.2%] vs 29 [60.4%], P<0.001). There were more twin pregnancies and more patients conceived through assisted reproductive technologies (ART) in group 1 (P=0.008 and P=0.007, respectively).The characteristics of the surgical procedure are shown in Table 2.There were no significant differences between the two groups regarding use of laparoscopy or operation time. However, surgical indications were significantly different. Suspected ovarian torsion occurred significantly more frequently in cases in group 1 (75 [96.2%], P<0.001), while a persistent mass was more frequent in group 2 (19 [39.6%], P<0.001). A total of 98 cases we...

Adnexal masses detected during pregnancy: A tertiary center experience

“…Th e most striking point of our study is that many authors analyzed adnexal cyst by calculating the size of the cyst cm in diameter and making an inference. 15 Our study is remarkable in this respect and in the current study we have calculated cyst volume. Th e mean cyst diameter was 8.8±7.7 cm and the mean cyst volume was 607±166 mm3, but no appreciable diff erences were found.…”

A comparison of laparoscopy versus laparotomy for the management of adnexal masses during pregnancy over the last 16 years: retrospective study

“…In our study, 22 cases in laparoscopy and 16 cases in laparotomy were performed in the rst trimester respectively, and the indications for procedure were acute pelvic pain in which cyst torsion was demonstrated during procedure and persistent cyst with solid portion. Increasing studies have been published attesting to the safety of laparoscopic operation during early pregnancy [12][13][14] . Postponing necessary operations until after parturition may increase the rates of complications for mother and fetus.…”

Management of adnexal masses' torsion during pregnancy

“…It might be a threat for the pregnancy. Surgical intervention may cause risks to the mother and her fetus, while observation without intervention may also lead to unfavorable complications, such as ovarian torsion or the development of a tumor [ 4 ]. The management requires a balance between the maternal-fetal risks of surgery, the risks of mass-related complications, and the likelihood of a malignancy, all of which are considered within each patient´s distinct clinical scenario and gestational age [ 6 ].…”

“…Conservative treatment is discussed outside the emergency; however, the occurrence of acute complications such as torsion of the appendix requires more or less invasive surgical procedures [ 3 ]. Surgical intervention may cause risks to the mother and her fetus, while observation without intervention may also lead to unfavorable complications, such as ovarian torsion or the development of a tumor [ 4 ].…”