Adnexal masses in pregnancy : Surgery compared with observation

To estimate whether the delay of surgery impacts the risk of adverse maternal and fetal outcomes in patients diagnosed with an adnexal mass during pregnancy. A review was performed of pregnant patients diagnosed with an adnexal mass 5 cm or greater in diameter. Data collected included age, gravity/p...

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Bibliographic Details
Published in:	Obstetrics and gynecology (New York. 1953) Vol. 105; no. 5; pp. 1098 - 1103
Main Authors:	SCHMELER, Kathleen M, MAYO-SMITH, William W, PEIPERT, Jeffrey F, WEITZEN, Sherry, MANUEL, Misty D, GORDINIER, Mary E
Format:	Journal Article
Language:	English
Published:	New York, NY Elsevier Science 01-05-2005
Subjects:	Adnexal Diseases - diagnostic imaging Adnexal Diseases - pathology Adnexal Diseases - surgery Adnexal Diseases - therapy Adolescent Adult Biological and medical sciences Biopsy, Needle Cohort Studies Female Follow-Up Studies Gestational Age Gynecology. Andrology. Obstetrics Humans Immunohistochemistry Maternal Age Medical sciences Observation - methods Ovarian Cysts - diagnostic imaging Ovarian Cysts - surgery Ovarian Cysts - therapy Ovarian Neoplasms - diagnostic imaging Ovarian Neoplasms - surgery Ovarian Neoplasms - therapy Ovariectomy - methods Pregnancy Pregnancy Complications, Neoplastic - diagnostic imaging Pregnancy Complications, Neoplastic - surgery Pregnancy Complications, Neoplastic - therapy Pregnancy Outcome Probability Retrospective Studies Risk Assessment Treatment Outcome Ultrasonography, Prenatal Pregnancy Mass Treatment Surgery Gynecology Observation Female Adnexa uteri Obstetrics Comparative study
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Summary:	To estimate whether the delay of surgery impacts the risk of adverse maternal and fetal outcomes in patients diagnosed with an adnexal mass during pregnancy. A review was performed of pregnant patients diagnosed with an adnexal mass 5 cm or greater in diameter. Data collected included age, gravity/parity, gestational age at diagnosis, and presenting symptoms. Ultrasound examinations were evaluated for mass size and complexity. Pregnancy outcome, complications, and surgical pathology were reviewed. Between 1990 and 2003, 127,177 deliveries were performed at our institution. An adnexal mass 5 cm in diameter or greater was diagnosed in 63 (0.05%) patients. Pathologic diagnosis was available for 59 (94%) patients. The remaining 4 patients were lost to follow-up and excluded from the analysis. Antepartum surgery was performed in 17 patients (29%): 13 because of ultrasound findings that suggested malignancy and 4 secondary to ovarian torsion. The remaining patients were observed, with surgery performed in the postpartum period or at time of cesarean delivery. The majority of masses were dermoid cysts (42%). Four patients were diagnosed with ovarian cancer (6.8% of masses, 0.0032% of deliveries), and one patient (1.7%) had a tumor of low malignant potential. Antepartum surgery due to ultrasound findings that caused concern was performed on all 5 women diagnosed with a malignancy or borderline tumor, compared with 12 (22%) of the patients with benign tumors (P < .01). In select cases, close observation is a reasonable alternative to antepartum surgery in patients with an adnexal mass during pregnancy.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0029-7844 1873-233X
DOI:	10.1097/01.AOG.0000157465.99639.e5