Ovarian Tumors in Pregnancy: Diagnosis and Management

Abstract

Ovarian tumors first diagnosed during pregnancy often present a challenge for both the obstetrician and gynecologists providing pregnancy care and for the consulting subspecialists. Although the vast majority of these tumors is benign, on rare occasions, patients present with tumors that turn out to be malignant requiring more comprehensive and extensive surgical procedures that are more likely to lead to pregnancy loss. Hence accurate knowledge of tumor characteristics, especially the ultrasound appearance and gestational age at diagnosis, are key prerequisite for establishing the most effective management plan not just for the index but also for future pregnancies. The primary objective of the current review is to provide practical guidelines for the evaluation and management of ovarian tumors first diagnosed during pregnancy.

Keywords

ovarian tumors - complicated pregnancy - management of ovarian tumors

• References

• 1 Whitecar MP, Turner S, Higby MK. Adnexal masses in pregnancy: a review of 130 cases undergoing surgical management. Am J Obstet Gynecol 1999; 181 (1) 19-24
• 2 Sherard III GB, Hodson CA, Williams HJ, Semer DA, Hadi HA, Tait DL. Adnexal masses and pregnancy: a 12-year experience. Am J Obstet Gynecol 2003; 189 (2) 358-362, discussion 362–363
• 3 Schmeler KM, Mayo-Smith WW, Peipert JF, Weitzen S, Manuel MD, Gordinier ME. Adnexal masses in pregnancy: surgery compared with observation. Obstet Gynecol 2005; 105 (5 Pt 1) 1098-1103
• 4 Ueda M, Ueki M. Ovarian tumors associated with pregnancy. Int J Gynaecol Obstet 1996; 55 (1) 59-65
• 5 Bernhard LM, Klebba PK, Gray DL, Mutch DG. Predictors of persistence of adnexal masses in pregnancy. Obstet Gynecol 1999; 93 (4) 585-589
• 6 Hill LM, Connors-Beatty DJ, Nowak A, Tush B. The role of ultrasonography in the detection and management of adnexal masses during the second and third trimesters of pregnancy. Am J Obstet Gynecol 1998; 179 (3 Pt 1) 703-707
• 7 Nelson MJ, Cavalieri R, Graham D, Sanders RC. Cysts in pregnancy discovered by sonography. J Clin Ultrasound 1986; 14 (7) 509-512
• 8 Zanetta G, Mariani E, Lissoni A , et al. A prospective study of the role of ultrasound in the management of adnexal masses in pregnancy. BJOG 2003; 110 (6) 578-583
• 9 Fang YM, Gomes J, Lysikiewicz A, Maulik D. Massive luteinized follicular cyst of pregnancy. Obstet Gynecol 2005; 105 (5 Pt 2) 1218-1221
• 10 Spitzer RF, Wherrett D, Chitayat D , et al. Maternal luteoma of pregnancy presenting with virilization of the female infant. J Obstet Gynaecol Can 2007; 29 (10) 835-840
• 11 Caspi B, Levi R, Appelman Z, Rabinerson D, Goldman G, Hagay Z. Conservative management of ovarian cystic teratoma during pregnancy and labor. Am J Obstet Gynecol 2000; 182 (3) 503-505
• 12 Curtis M, Hopkins MP, Zarlingo T, Martino C, Graciansky-Lengyl M, Jenison EL. Magnetic resonance imaging to avoid laparotomy in pregnancy. Obstet Gynecol 1993; 82 (5) 833-836
• 13 Leiserowitz GS, Xing G, Cress R, Brahmbhatt B, Dalrymple JL, Smith LH. Adnexal masses in pregnancy: how often are they malignant?. Gynecol Oncol 2006; 101 (2) 315-321
• 14 Prakash A, Li TC, Ledger WL. The management of ovarian cysts in premenopausal women. Obstet Gynecol 2004; 6: 12-15
• 15 Bromley B, Benacerraf B. Adnexal masses during pregnancy: accuracy of sonographic diagnosis and outcome. J Ultrasound Med 1997; 16 (7) 447-452, quiz 453–454
• 16 Wheeler TC, Fleischer AC. Complex adnexal mass in pregnancy: predictive value of color Doppler sonography. J Ultrasound Med 1997; 16 (6) 425-428
• 17 Timor-Tritsch LE, Lerner JP, Monteagudo A, Santos R. Transvaginal ultrasonographic characterization of ovarian masses by means of color flow-directed Doppler measurements and a morphologic scoring system. Am J Obstet Gynecol 1993; 168 (3 Pt 1) 909-913
• 18 Kier R, McCarthy SM, Scoutt LM, Viscarello RR, Schwartz PE. Pelvic masses in pregnancy: MR imaging. Radiology 1990; 176 (3) 709-713
• 19 Kurtz AB, Tsimikas JV, Tempany CMC , et al. Diagnosis and staging of ovarian cancer: comparative values of Doppler and conventional US, CT, and MR imaging correlated with surgery and histopathologic analysis—report of the Radiology Diagnostic Oncology Group. Radiology 1999; 212 (1) 19-27
• 20 Balan P. Ultrasonography, computed tomography and magnetic resonance imaging in the assessment of pelvic pathology. Eur J Radiol 2006; 58 (1) 147-155
• 21 Telischak NA, Yeh BM, Joe BN, Westphalen AC, Poder L, Coakley FV. MRI of adnexal masses in pregnancy. AJR Am J Roentgenol 2008; 191 (2) 364-370
• 22 Togashi K. Ovarian cancer: the clinical role of US, CT, and MRI. Eur Radiol 2003; 13 (Suppl 04) L87-L104
• 23 Balan P. Ultrasonography, computed tomography and magnetic resonance imaging in the assessment of pelvic pathology. Eur J Radiol 2006; 58 (1) 147-155
• 24 Jacobs IJ, Fay TN, Stabile I, Bridges JE, Oram DH, Grudzinskas JG. The distribution of CA 125 in the reproductive tract of pregnant and non-pregnant women. Br J Obstet Gynaecol 1988; 95 (11) 1190-1194
• 25 Kobayashi F, Sagawa N, Nakamura K, Nonogaki M, Ban C, Fujii S. Mori TMechanism and clinical significance of elevated CA 125 levels in the sera of pregnant women. Am J Obstet Gynecol 1989; 162: 563-566
• 26 Leiserowitz GS. Managing ovarian masses during pregnancy. Obstet Gynecol Surv 2006; 61 (7) 463-470
• 27 Grendys Jr EC, Barnes WA. Ovarian cancer in pregnancy. Surg Clin North Am 1995; 75 (1) 1-14
• 28 Yen CF, Lin SL, Murk W , et al. Risk analysis of torsion and malignancy for adnexal masses during pregnancy. Fertil Steril 2009; 91 (5) 1895-1902
• 29 Stepp KJ, Tulikangas PK, Goldberg JM, Attaran M, Falcone T. Laparoscopy for adnexal masses in the second trimester of pregnancy. J Am Assoc Gynecol Laparosc 2003; 10 (1) 55-59
• 30 Soriano D, Yefet Y, Seidman DS, Goldenberg M, Mashiach S, Oelsner G. Laparoscopy versus laparotomy in the management of adnexal masses during pregnancy. Fertil Steril 1999; 71 (5) 955-960
• 31 Platek DN, Henderson CE, Goldberg GL. The management of a persistent adnexal mass in pregnancy. Am J Obstet Gynecol 1995; 173 (4) 1236-1240
• 32 Caspi B, Ben-Arie A, Appelman Z, Or Y, Hagay Z. Aspiration of simple pelvic cysts during pregnancy. Gynecol Obstet Invest 2000; 49 (2) 102-105