Ovarian surgery during pregnancy and puerperium: twelve-year experience at the Veterans General Hospital-Taipei.
BACKGROUND
This study was performed in order to assess the surgical effects and characteristics of ovarian tumors during pregnancy and analyze their prognosis.


METHODS
Between 1982 and 1993, 121 patients who had undergone ovarian surgery during pregnancy or puerperium were reviewed at the Veterans General Hospital-Taipei. These patients were analyzed with particular emphasis on the length of gestation at the time of surgery, complications related to the stage of pregnancy, surgical and pathologic findings and the outcome of pregnancy.


RESULTS
Ovarian tumors were commonly detected during the second trimester (54.5%) and most of them (79.3%) were asymptomatic. The pathologic review found 38 patients (31.4%) with benign teratoma, 16 patients (13.1%) with corpus luteum and four patients (3.3%) with malignancy. There was a significant difference between emergent ovarian surgery and elective ovarian surgery in the spontaneous fetal wastage rate (14.1% vs 1%, p = 0.009). Compared with elective surgery, cases necessitating oophorectomy, with or without salpingectomy, increased significantly during emergency surgery (57% vs 36%, p = 0.03). All ovarian surgeries performed before a gestational age of seven weeks resulted in spontaneous fetal wastage.


CONCLUSIONS
Although the majority of the ovarian tumors detected during pregnancy were benign, emergency laparotomy was sometimes required, which led to an increase in the risk of a fetal wastage. Preconception counseling should be emphasized because early removal of non-functional ovarian tumor before conception, especially teratoma, would decrease the incidence of ovarian surgery during pregnancy. Furthermore, elective and well-prepared surgical intervention appears to be a crucial factor for favorable pregnancy outcome.
Department of Obstetrics and Gynecology, Veterans General Hospital-Taipei, National Yang-Ming University School of Medicine, Taiwan, ROC.
P H
PH
Wang
C C
CC
Yuan
H T
HT
Chao
K J
KJ
Yu
J Y
JY
Tseng
J H
JH
Hung
M L
ML
Yang
S P
SP
Chang
H T
HT
Ng
K C
KC
Chao
D000328:Adult; D005260:Female; D006801:Humans; D010051:Ovarian Neoplasms / Q000601:surgery*; D049590:Postpartum Period; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000601:surgery*; D011256:Pregnancy Outcome; D012189:Retrospective Studies