ReviewObstetricsEvaluation and management of adnexal mass in pregnancy
Section snippets
Differential diagnosis
Similar to the nonpregnant state, a functional cyst is the most common adnexal mass in pregnancy. A corpus luteum persisting into the second trimester accounts for 13-17% of all cystic adnexal masses.5, 6 However, the differential diagnosis throughout pregnancy also includes benign masses such as the benign cystic teratoma (7-37% incidence), serous cystadenoma (5-28% incidence) and mucinous cystadenoma (3-24% incidence), endometrioma (0.8-27% incidence), paraovarian cysts (<5%), and leiomyoma
Evaluation
Most adnexal masses in pregnancy are diagnosed incidentally during a screening ultrasound in the first trimester.5 If an adnexal mass is palpated on examination, ultrasound is the preferred radiological method of confirmation because of its ability to differentiate morphology. This will ultimately allow stratification of risk without compromising maternal and fetal safety.10 The ultimate goal of an ultrasound evaluation is to aid the physician in determining those adnexal masses in which
Management
Currently there is disagreement among authors regarding the best management of adnexal masses in pregnancy, with some investigators recommending observation, and others, surgical management.1, 4, 5, 22 Most ovarian masses identified in pregnancy will spontaneously resolve, and aggressive surgical management is not required. Characteristics favorable for resolution include masses that are simple in nature by ultrasound, less than 5-6 cm in diameter, and diagnosed before 16 weeks.3 Larger masses
Observation
Observational management of adnexal masses in pregnancy is supported by several small retrospective, observational studies.1, 4, 5, 12 These studies demonstrated good maternal and fetal outcomes comparable with those seen in older studies.15, 26 Observational management is also supported by the fact that up to 71% of benign appearing ovarian masses will either decrease in size or resolve spontaneously. Some masses with more complex features have also been shown to resolve.15, 26
A consensus
Surgical approach
Traditionally, surgery for adnexal masses in pregnancy has been performed by laparotomy. However, recently there has been a great deal of debate about the role of laparoscopy in the management of adnexal masses in pregnancy.8, 23, 25 Those authors in favor of a laparotomic approach raise several concerns regarding laparoscopy in pregnancy including the lack of data regarding the effects of a pneumoperitoneum; possible injection of carbon dioxide into the uterine cavity; possible injury to the
Conclusion
Because of the widespread use of antenatal ultrasound for pregnancy dating and aneuploidy screening, the diagnosis of adnexal masses in pregnancy has become more common. Therefore, it is imperative that the obstetrician be skilled in the diagnosis and management of adnexal masses in pregnancy. The use of ultrasound to characterize the malignant potential of a mass provides the patient with the potential for several management options. Observation is a viable option for those who are
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Cited by (98)
Adnexal masses during pregnancy: diagnosis, treatment, and prognosis
2023, American Journal of Obstetrics and GynecologyMaternal Medical Disorders of Fetal Significance
2023, Avery's Diseases of the NewbornA case of huge ovarian cyst in second trimester: A rare case report
2022, Annals of Medicine and SurgeryUltrasonographic evaluation of ovarian mass for predicting malignancy in pregnant women
2021, Gynecologic OncologyBorderline serous tumor of the ovary discovered during pregnancy: A case report
2021, International Journal of Surgery Case ReportsManagement of borderline ovarian tumours during pregnancy: Results of a French multi-centre study
2021, European Journal of Obstetrics and Gynecology and Reproductive Biology
Reprints not available from the authors.