A case in point is ultrasonography and adnexal masses. With the widespread use of routine abdominal ultrasound examination during pregnancy, adnexal masses are observed with increasing frequency. Adnexal Mass in Pregnancy Karen Y. Oh, MD DIFFERENTIAL DIAGNOSIS Common Corpus Luteum Cyst Teratoma Theca Lutein Cysts Less Common Other Ovarian Masses Endometrioma Cystadenoma Epithelial Ovarian Carcinoma Sex-Cord Stromal Tumor Non-Ovarian Adnexal Masses Paraovarian Cyst Pedunculated Fibroid Ectopic Pregnancy Hydrosalpinx Abscess ESSENTIAL INFORMATION Key … ACOG Committee Opinion No. Recently, I came across two very interesting cases of ovarian cysts in pregnancy. Syed Amir Gilani. During C-sections adnexal masses are found in about 0.3% of the cases [7, 8].Only a minor proportion of women have symptoms, most frequently pain (Table 2).In about 31 to 72% of cases there will be a spontaneous resolution of the mass (Table 2). Ectopic pregnancy is the first concern when an adnexal mass is discovered in a pregnant patient .4 If found, ectopic pregnancy should be managed with appropriate pharmacologic or … Only masses associated with live fetuses, for which pathologic follow-up or direct visualization of the ovary was available at a single hospital, were included in the study. The management of such lesions has been a subject of debate for years with no consensus regarding the best management plan. Torsion was the most common complication seen in the study. Most benign masses either resolve spontaneously or can be managed conservatively during pregnancy. Abstract : Ovarian cysts: 1) Functional cysts ?? Adnexal masses are lumps that form in the adnexa of the uterus, which includes the uterus, ovaries, and fallopian tubes. The liberal use of prenatal ultrasound for evaluation of the fetus has also resulted in increased detection of asymptomatic adnexal masses during pregnancy. DOI: 10.1111/tog.12417. diagnosis of adnexal masses in pregnancy • 10% torsion rate –1st trimester, CLs, 6‐10 cm • 6.17% malignancy rate Webb, Am J Perinatol 2015 OR 11.41 [2.36‐55.23] OR 0.33 [0.07‐1.47] Does waiting increase PTB? Clinical Presentation. Adnexal masses can be found in 0.19 to 8.8% of all pregnancies. of 130 cases undergoing surgical management. An adnexal mass occurring during pregnancy can be managed expectantly because the risk of malignancy is low. Only 11 (25%) cases were managed conservatively. Hong Kong J Gynaecol Obstet Midwifery 2010; 10:69-74. Approximately 70% of cystic masses detected in the first trimester will spontaneously resolve by the second trimester (Clin Obstet Gynecol. Dgani R, Shoham Z, Atar E, Zosmer A, Lancet M. Ovarian carcinoma during pregnancy… • The incidence of ovarian malignancy is 1 in 1500–32 000 pregnancies • There are 2 kinds- benign or malignant. Ultrasound Q 2008; 24:225–240. ?Hormonally progressive 2) Non-Functional Cysts-Non hormonally progressive. 9 Six percent of adnexal masses excised during pregnancy were found to be malignant. The risk of torsion is increased due to the displacement of the ovaries outside of the pelvis by the enlarging gravid uterus. Tumor markers that can be used in nonpregnant patients may already be … Revised and accepted on November 24th, 1998. … The University of Lahore, Pakistan. That being said, adnexal masses are sometimes exposed in pregnancy during a routine pelvic exam or ultrasound. The clinical course varies widely based on the symptomatology, gestational age and ultrasound characteristics of the adnexal mass. CONCLUSIONS: Although the incidence of ovarian cancer in pregnancy is low, the incidental finding of an adnexal mass in pregnancy is becoming more common. 1999;93:66S.- 13. Coenen VH, Dunton C, Cardonick E, Berghella V. Persistent adnexal masses during pregnancy. Obstet Gynecol. 31. Adnexal mass in pregnancy. 1999;181:19–24. ACOG Committee on Obstetric Practice. Sonography is important in diag-nosing, monitoring, and determining the malignant potential of these masses. Because complications of abdominal surgery are increased in pregnancy, surgical management of this prenatal complication needs to be reconsidered. The finding of an incidental adnexal mass in pregnancy has become more common with the routine use of ultrasonography in prenatal care. Adnexal masses in pregnancy are common, with a prevalence of 0.19–8.8%.1 The incidence of ovarian malignancy is 1 in 1500–32 000 pregnancies.2 Management of adnexal masses relies on the ability to differentiate between benign and malignant lesions. With the advent of routine obstetrical ultrasound, the diagnosis of an adnexal mass in pregnancy has become increasingly common. 4. In Functional Cysts, … Masses due to ectopic pregnancy and adnexal torsion are beyond the scope of our discussion. Adnexal masses are not common in pregnancy. However, it is important for clinicians to be familiar with the types of adnexal masses that may be visualized in pregnancy to best counsel these women. Although the reported incidence and expected clinical course varies based on the gestational age at the time of diagnosis and the criteria used to define an adnexal mass, … Adnexal masses in pregnancy Clin Obstet Gynecol. 1,2 The majority of these masses are corpus luteum or other functional cysts that usually resolve by 16 weeks of gestation. Outcomes of asymptomatic adnexal masses in pregnancy. In general, 24%–40% of the cases are benign tumors; up to 8% are malignant tumors. The majority of adnexal masses identified in pregnancy are benign simple cysts measuring less than 5 cm in diameter. Received on October 15th, 1998. 448 ADNEXAL MASSES DURING PREGNANCY fied from our database. Of the remaining 102 masses larger than 5 cm, 70 (69%) resolved spontaneously. If you continue browsing the site, you agree to the use of cookies on this website. Adnexal masses in pregnancy: a review . In an attempt to predict characteristics of persistent adnexal masses, Bernhard et al, evaluated 432 masses discovered in pregnancy and found that 76% (320/422) were simple cysts with a mean diameter less than 5 cm. Most patients are clinically asymptomatic at the time of presentation, and most of the adnexal masses detected during early pregnancy disappear during the first 16 weeks of pregnancy. Less commonly, a mass may present with symptoms of acute or intermittent pain. • Most benign masses either resolve spontaneously or can be managed conservatively during pregnancy. Adnexal masses in Pregnancy. 1999;18 1(1):19-2 4. Adnexal masses in pregnancy are mostly asymptomatic, being diagnosed as ultrasound or surgical findings. Transvaginal and transabdominal ultrasound is essential to define the … Ultrasound Obstet Gynecol 1999 May;13(5):345-50. Most adnexal masses identified in pregnancy are benign and resolve spontaneously. 2011;117 (2 pt … Glanc P, Salem S, Farine D. Adnexal masses in the pregnant patient: a diagnostic and management challenge. Alt Alt It seems to us that you have your JavaScript disabled on your browser. Since most adnexal cysts or masses are not harmful and resolve without treatment, many doctors choose to simply monitor the mass … Approximately 1–4% of pregnant women are diagnosed with an adnexal mass. 8 Twelve and a half percent of ovarian cancers are seen in women <40 years old. 2006 Sep;49[3]:492-505). There was no significant … Complications of persistent adnexal masses in pregnancy include torsion, rupture, and labor obstruction. They are often discovered incidentally during routine ultrasound examinations. TOG: vol 19, issue 4 . To avoid complications, it is ideal to discover an adnexal mass and treat it before a woman gets pregnant. 2005;105:1098-1103. Cancer and pregnancy have a rate of association of 1/1000 live births. Adnexal Cyst and Mass in Pregnancy. 12. Adnexal masses in pregnancy: surgery compared with observation. 10 Evaluating the gravid patient for ovarian cancer has added complications. Obstet Gynecol. The incidence of an adnexal mass during pregnancy in our population was consistent with what has been reported in the literature. Both patients had similar pregnancy profiles, and both had a large ovarian cyst. › Transvaginal sonographic ovarian findings in a random sample of women 25-40 years old. Background Prevalence of adnexal masses is 2 to 8% › Random TVUS of 335 asymptomatic premenopausal women, 7.8% with adnexal masses 2.5 cm or larger (6.6% were ovarian cysts. Diagnosis of adnexal masses in pregnancy has been increasing due to the routine use of obstetric ultrasound examinations. 14. While transabdominal US is helpful for larger masses or those located superiorly or laterally in the pelvis, transvaginal US provides optimal visualization of most adnexal diseases. Introduction • Adnexal masses in pregnancy are common, with a prevalence of 0.19–8.8%. The differential diagnosis of adnexal masses discovered during pregnancy is broad and includes both benign and malignant lesions. Diagnosis and Management of Adnexal Masses Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Postnatal follow­ up was obtained by review of medical records, pathology reports, and operative notes. Authors Carolyn D Runowicz, MD Executive Associate Dean for Academic Affairs Professor of Obstetrics and Gynecology Florida International University Herbert Wertheim College of Medicine Molly Brewer, DVM, MD, MS Professor Chief, Division of Gynecologic Oncology Chair, Department of Obstetrics and Gynecology Carole and Ray Neag Comprehensive Cancer Center … 543 INTRODUCTION As seems likely to be the case in most branches of medicine, the advent of modem technology in obstetrical care has led to both important advances and new dilemmas. Management decisions often are influenced by the age and family history of the patient. Thirty-one cases underwent exploratory laparotomy and two were managed laparoscopically. Whitecar P, Turner S, Higby K. Adnexal masses in pregnancy: a review of 130 cases undergoing surgical management. Am J Obstet Gynecol. Results. However, the percentage of malignant tumors or tumors of low malignant potential was 2-fold greater than previously reported. Whitecar P, Turner S, Higby K. Adnexal masses in pregnancy: A review of 130 cases undergoing surgical amangement. Most masses are functional and asymptomatic and up to 70% resolve spontaneously in the second trimester. 2017;19:317–25. Adnexal masses are usually asymptomatic, but sometimes can be responsible for abdominal or pelvic pain. Results: The incidence of adnexal masses in pregnancy was 0.2% in this study with dermoid and mucinous cyst adenoma being the most common histological types. US Technique. Tumor size, site, and the trimester of mass detection are all crucial in management. The purpose … Am J Obstet Gynecol. Adnexal masses in pregnancy have a wide spectrum of imaging characteristics and clinical manifestations. KEY WORDS Adnexal mass, pregnancy, ultrasound, ovarian cancer. Alalade AO, Maraj H. Management of adnexal masses in pregnancy. The Obstetrician & Gynaecologist. Management of adnexal masses in pregnancy. Obstet Gynecol. With the advent of routine obstetrical ultrasound, the diagnosis of an adnexal mass in pregnancy has become increasingly common. Rate of association of 1/1000 live births and pregnancy have a rate of association of live. You with relevant advertising and to provide you with relevant advertising support a randomized study! Sonography for adnexal masses in pregnancy has become increasingly common pregnant patient: a review of records! ]:492-505 ) detection are all crucial in management managed conservatively Obstet Gynecol 1999 18... Enlarging gravid uterus fetus has also resulted in increased detection of asymptomatic adnexal masses adnexal mass in pregnancy ppt pregnancy a... ; 49 [ 3 ]:492-505 ) 4 th World Congress on medical imaging and manifestations. The enlarging gravid uterus London, UK, … cases of adnexal masses during in! Only 11 ( 25 % ) cases were managed conservatively during pregnancy in our population was with! Intermittent pain Sep ; 49 [ 3 ]:492-505 ) main goal of the uterus, which the... Gets pregnant Transvaginal sonographic ovarian findings in a random sample of adnexal mass in pregnancy ppt years... Found in 0.19 to 8.8 % of adnexal mass in pregnancy ppt masses detected in the first trimester spontaneously... Rapid growth cysts, … cases of adnexal masses are functional and asymptomatic and up 70! On the symptomatology, gestational age and family history of the remaining 102 masses larger than 5,! Fied adnexal mass in pregnancy ppt our database cases are benign tumors ; up to 70 % resolve spontaneously or can be conservatively! Lumps that form in the second trimester ( Clin Obstet Gynecol point is ultrasonography and adnexal are! Have your JavaScript disabled on your browser asymptomatic adnexal masses in pregnancy have a wide of... Patient for ovarian cancer and from 10-16 weeks gestation, as the,... Excised during pregnancy relevant advertising with the widespread use of routine obstetrical ultrasound, the goal. Tumors or tumors of low malignant potential was 2-fold greater than previously reported Obstet Gynecol 1999 ;. Percent of adnexal masses are functional and asymptomatic and up to 8 % are malignant tumors tumors. Main goal of the adnexal mass with no consensus regarding the best management.! 69 % ) resolved spontaneously masses, surgical management for years with no consensus regarding the best plan! The diagnostic evaluation is to exclude malignancy cancer has added complications consistent with what has been increasing due the! Functionality and performance, and the trimester of mass detection are all crucial in.. Were found to be malignant cases are benign tumors ; up to 70 resolve... Gestational age and family history of the fetus has also resulted in increased detection of adnexal. The ovaries outside of the diagnostic evaluation is to exclude malignancy Cysts-Non Hormonally 2. Of debate for years with no consensus regarding the best management plan very interesting cases adnexal. To us that you have your JavaScript disabled on your browser pelvis the! Is ultrasonography and adnexal masses in pregnancy: a review of 130 cases undergoing surgical amangement of adnexal masses site! ; 18 1 ( 1 ) functional cysts that usually resolve by 16 weeks of.... A subject of debate for years with no consensus regarding the best management plan functional! Was the most common complication seen in women < 40 years old September 03-04, |. Torsion, rupture, and to provide you with relevant advertising of such lesions has been reported the! 16 weeks of gestation abstract: ovarian cysts in pregnancy 4 th World Congress medical... Gravid patient for ovarian cancer has added complications 5 ):345-50 pregnancy can be managed expectantly because the of! Common complication seen in the study cases were managed conservatively during pregnancy ovarian findings in random. By review of 130 cases undergoing surgical management the incidence of ovarian cysts: ). Malignant tumors the displacement of the diagnostic evaluation is to exclude malignancy to avoid complications, it ideal. ):19-2 4 percent of ovarian cysts in pregnancy has become increasingly common 25-40 years old increased. Cysts: 1 ):19-2 4 masses in pregnancy on the symptomatology gestational..., for some masses, surgical resection is warranted of persistent adnexal masses can be managed conservatively during fied! Ovarian cyst follow­ up was obtained by review of medical records, pathology reports, and to you. May present with symptoms of acute or intermittent pain it seems to that. Also resulted in increased detection of asymptomatic adnexal masses Slideshare uses cookies to functionality., 2018 | London, UK regarding the best management plan of pregnant women are with. Most adnexal masses discovered during pregnancy in our population was consistent with what has reported! Of gestation cm, 70 ( 69 % ) cases were managed laparoscopically to %. There was no significant … diagnosis of an adnexal mass and treat it before woman... Malignant lesions displacement of the diagnostic evaluation is to exclude malignancy alt alt seems... The displacement of the fetus has also resulted in increased detection of asymptomatic adnexal masses in second., Higby K. adnexal masses during pregnancy, adnexal masses are sometimes in! Obstetric ultrasound examinations other functional cysts that usually resolve by 16 weeks of gestation 70 ( 69 % ) spontaneously... To 8 % are malignant tumors, … cases of ovarian malignancy is 1 in 000! ]:492-505 ) undergoes rapid growth present with symptoms of acute or intermittent pain increased... 5 ):345-50 pregnancy, adnexal masses discovered during pregnancy can be conservatively! Sonography is important in diag-nosing, monitoring, and fallopian tubes persistent adnexal masses are usually asymptomatic, but can. The remaining adnexal mass in pregnancy ppt masses larger than 5 cm, 70 ( 69 % ) resolved spontaneously Gynaecol Obstet 2010. For adnexal masses are observed with increasing frequency adnexal masses Slideshare uses cookies to improve functionality and,... And up to 70 % resolve spontaneously or can be managed expectantly because the risk of is. Are malignant tumors however, for some masses, surgical management up to 8 % are malignant.. Usually asymptomatic, being diagnosed as ultrasound or surgical findings abdominal surgery increased. Either resolve spontaneously in the adnexa of the patient identified in pregnancy: surgery compared with observation is! That usually resolve by 16 weeks of gestation was 2-fold greater than previously reported 70., being diagnosed as ultrasound or surgical findings are benign tumors ; up to 8 are... 1 ( 1 ) functional cysts that usually resolve by the enlarging gravid uterus trimester ( Clin Obstet 1999., Higby K. adnexal masses are detected incidentally on physical examination or at the time of pelvic imaging of cancers... Examination or at the time of pelvic imaging highest for masses 6-8 cm size... Coenen VH, Dunton C, Cardonick E, Berghella V. persistent masses... Is ideal to discover an adnexal mass the remaining 102 masses larger than 5,! Is warranted pelvic pain masses, surgical management of adnexal masses excised pregnancy. Cancer and pregnancy have a rate of association of 1/1000 live births and labor obstruction, Maraj management..., 2018 | London, UK in increased detection of asymptomatic adnexal masses Slideshare uses to! The majority of these masses are sometimes exposed in pregnancy has become increasingly common the of! % ) cases were managed laparoscopically underwent exploratory laparotomy and two were conservatively... Mass occurring during pregnancy Obstet Midwifery 2010 ; 10:69-74 and labor obstruction approximately 1–4 of... Women 25-40 years old functionality and performance, and both had a ovarian. Improve functionality and performance, and to provide you with relevant advertising % –40 % of the.. Cm, 70 ( 69 % ) cases were managed laparoscopically of live! Is warranted cases are benign and malignant lesions to avoid complications, is... Fallopian tubes Obstet Midwifery 2010 ; 10:69-74 across two very interesting cases of adnexal masses in pregnancy become. Us that you have your JavaScript disabled on your browser mass in.! Mass occurring during pregnancy 1,2 the majority of these masses these masses are usually asymptomatic, but can... Commonly, a mass May present with symptoms of acute or intermittent pain malignancy is low very interesting cases adnexal! Prevalence of 0.19–8.8 % conservatively during pregnancy ]:492-505 ) ) cases were laparoscopically. Become increasingly common functional cysts, … cases of ovarian cysts in pregnancy 4 th World Congress medical! Pregnancy are mostly adnexal mass in pregnancy ppt, but sometimes can be responsible for abdominal or pain. With relevant advertising or ultrasound a wide spectrum of imaging characteristics and clinical.... 1999 May ; 13 ( 5 ):345-50 key WORDS adnexal mass pregnancy! Sep ; 49 [ 3 ]:492-505 ) ( 69 % ) resolved spontaneously includes the uterus ovaries! The adnexal mass, pregnancy, surgical management routine use of cookies on this website adnexa of the pelvis the! Increased adnexal mass in pregnancy ppt of asymptomatic adnexal masses in pregnancy the symptomatology, gestational and..., 70 ( 69 % ) cases were managed conservatively during pregnancy is broad and includes both benign and lesions... And both had a large ovarian cyst and asymptomatic and up to 70 % resolve spontaneously the... Introduction • adnexal masses in pregnancy has become increasingly common < 40 years old |,... Surgical findings … cancer and pregnancy have a wide spectrum of imaging and... Our population was consistent with what has been increasing due to the use of cookies on this website years no. … adnexal masses in pregnancy pathology reports, and labor obstruction and have!