Adnexal Mass during Pregnancy: A Review

Abstract

Objective The purpose of this review was to determine the likelihood of malignancy or complications with ultrasonographic diagnosis of adnexal masses in pregnancy and to evaluate the obstetrical outcomes.

Materials and Methods A review of literature was performed using keywords “adnexal mass and pregnancy” or “ovarian mass and pregnancy.”

Results Out of the 340 abstracts reviewed, 313 were excluded. The incidence of adnexal mass in pregnancy varied from 0.1 to 2.4%, with an average of 0.02%. Regarding the likelihood of malignancy, in seven publications, there were 557 women with 563 adnexal masses. Of these 563 masses, 48% were classified as simple and 52% as complex. Among the simple masses, 1% were malignant. Among the complex masses, 9% were malignant. When comparing laparoscopy and laparotomy, the rate of preterm contractions was found to be higher in patients undergoing laparotomy and this was statistically significant. Other measures, such as spontaneous abortion, vaginal bleeding, < 37 week delivery, and intrauterine fetal demise, were not found to have a significant difference.

Conclusion Adnexal masses in pregnancy occur infrequently and depending on whether the surgery was performed emergently or electively, via laparoscopy or laparotomy, the outcomes will vary.

Keywords

adnexal mass - pregnancy - malignancy

• References

• 1 Hoover K, Jenkins TR. Evaluation and management of adnexal mass in pregnancy. Am J Obstet Gynecol 2011; 205 (2) 97-102
• 2 Zanetta G, Rota S, Chiari S, Bonazzi C, Bratina G, Mangioni C. Behavior of borderline tumors with particular interest to persistence, recurrence, and progression to invasive carcinoma: a prospective study. J Clin Oncol 2001; 19 (10) 2658-2664
• 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 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
• 5 Platek DN, Henderson CE, Goldberg GL. The management of a persistent adnexal mass in pregnancy. Am J Obstet Gynecol 1995; 173 (4) 1236-1240
• 6 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
• 7 Sunoo CS, Terada KY, Kamemoto LE, Hale RW. Adnexal masses in pregnancy: occurrence by ethnic group. Obstet Gynecol 1990; 75 (1) 38-40
• 8 Balthazar U, Steiner AZ, Boggess JF, Gehrig PA. Management of a persistent adnexal mass in pregnancy: what is the ideal surgical approach?. J Minim Invasive Gynecol 2011; 18 (6) 720-725
• 9 Moore RD, Smith WG. Laparoscopic management of adnexal masses in pregnant women. J Reprod Med 1999; 44 (2) 97-100
• 10 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
• 11 Bernhard LM, Klebba PK, Gray DL, Mutch DG. Predictors of persistence of adnexal masses in pregnancy. Obstet Gynecol 1999; 93 (4) 585-589
• 12 Spitzer M, Kaushal N, Benjamin F. Maternal CA-125 levels in pregnancy and the puerperium. J Reprod Med 1998; 43 (4) 387-392
• 13 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
• 14 Reis LA, Harkins D, Krapcho M , et al. SEER Cancer Statistics Review, 1975–2003. Bethesda, MD: s.n., National Cancer Institute; 2006
• 15 Heintz AP, Odicino F, Maisonneuve P , et al. Carcinoma of the ovary. Int J Gynaecol Obstet 2003; 83 (1) (Suppl. 01) 135-166
• 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 Young RH, Dudley AG, Scully RE. Granulosa cell, Sertoli-Leydig cell, and unclassified sex cord-stromal tumors associated with pregnancy: a clinicopathological analysis of thirty-six cases. Gynecol Oncol 1984; 18 (2) 181-205
• 18 Ballard CA. Ovarian tumors associated with pregnancy termination patients. Am J Obstet Gynecol 1984; 149 (4) 384-387
• 19 Hess LW, Peaceman A, O'Brien WF, Winkel CA, Cruikshank DP, Morrison JC. Adnexal mass occurring with intrauterine pregnancy: report of fifty-four patients requiring laparotomy for definitive management. Am J Obstet Gynecol 1988; 158 (5) 1029-1034
• 20 Mathevet P, Nessah K, Dargent D, Mellier G. Laparoscopic management of adnexal masses in pregnancy: a case series. Eur J Obstet Gynecol Reprod Biol 2003; 108 (2) 217-222
• 21 Chittacharoen A, Wangpusayavisut A. O-Prasertsawat P. Adnexal masses in pregnancy. J Med Assoc Thai 2005; 88 (2) 37-40
• 22 Kumari I, Kaur S, Mohan H, Huria A. Adnexal masses in pregnancy: a 5-year review. Aust N Z J Obstet Gynaecol 2006; 46 (1) 52-54
• 23 Ueda Y, Enomoto T, Miyatake T , et al. A retrospective analysis of ovarian endometriosis during pregnancy. Fertil Steril 2010; 94 (1) 78-84
• 24 Koo YJ, Kim TJ, Lee JE , et al. Risk of torsion and malignancy by adnexal mass size in pregnant women. Acta Obstet Gynecol Scand 2011; 90 (4) 358-361
• 25 Koo YJ, Lee JE, Lim KT, Shim JU, Mok JE, Kim TJ. A 10-year experience of laparoscopic surgery for adnexal masses during pregnancy. Int J Gynaecol Obstet 2011; 113 (1) 36-39
• 26 Koo YJ, Kim HJ, Lim KT , et al. Laparotomy versus laparoscopy for the treatment of adnexal masses during pregnancy. Aust N Z J Obstet Gynaecol 2012; 52 (1) 34-38
• 27 Türkçüoğlu I, Meydanli MM, Engin-Ustün Y, Ustün Y, Kafkasli A. Evaluation of histopathological features and pregnancy outcomes of pregnancy associated adnexal masses. J Obstet Gynaecol 2009; 29 (2) 107-109
• 28 Hong JY. Adnexal mass surgery and anesthesia during pregnancy: a 10-year retrospective review. Int J Obstet Anesth 2006; 15 (3) 212-216
• 29 Kort B, Katz VL, Watson WJ. The effect of nonobstetric operation during pregnancy. Surg Gynecol Obstet 1993; 177 (4) 371-376
• 30 Lavery JP, Koontz WL, Layman L, Shaw L, Gumpel U. Sonographic evaluation of the adnexa during early pregnancy. Surg Gynecol Obstet 1986; 163 (4) 319-323
• 31 Usui R, Minakami H, Kosuge S, Iwasaki R, Ohwada M, Sato I. A retrospective survey of clinical, pathologic, and prognostic features of adnexal masses operated on during pregnancy. J Obstet Gynaecol Res 2000; 26 (2) 89-93
• 32 Visser BC, Glasgow RE, Mulvihill KK, Mulvihill SJ. Safety and timing of nonobstetric abdominal surgery in pregnancy. Dig Surg 2001; 18 (5) 409-417
• 33 Yuen PM, Ng PS, Leung PL, Rogers MS. Outcome in laparoscopic management of persistent adnexal mass during the second trimester of pregnancy. Surg Endosc 2004; 18 (9) 1354-1357