Ovarian tumors complicating pregnancy. Emergency and elective surgery.
OBJECTIVE
To retrospectively evaluate the different effects and characteristics of ovarian surgery performed under emergency conditions and electively during pregnancy and to search for risk factors contributing to emergency ovarian surgery.


METHODS
Between 1980 and 1996, 174 patients undergoing adnexal surgery during pregnancy or the puerperium were reviewed at Veterans General Hospital-Taipei. Of these 174 patients, 32 underwent emergency surgery (group A), while 142 patients underwent elective surgery (group B). In order to search for differences between the emergency and elective operations, patients in both groups were analyzed, with particular emphasis on the characteristics and outcome of pregnancy.


RESULTS
In contrast to elective operations, there were five distinct aspects of emergency surgery. First, half of them occurred in the first trimester. Second, they contributed to 75% (9/12) of the total fetal wastage and 85.7% (6/7) of spontaneous fetal loss (P = .00016). Third, tumor sizes (11.1 +/- 4.2 cm) were significantly larger than those found (8.3 +/- 3.76 cm) in the elective surgery group (P < .05). Fourth, tumors less than 5 cm never caused symptoms requiring surgery. Fifth, an increasing incidence of completely extirpative surgery and general anesthesia was noted (P < .005). Incidence of tumors greater than 10 cm during pregnancy increased with malignancy (P = .0295) and before emergency surgery (P = .00001).


CONCLUSIONS
We could remove ovarian tumors greater than 10 cm in diameter or with a teratoma component at earlier stages of pregnancy (after the seventh week of gestation) to avoid unpredictable complications. This reduces the risks of malignancy and emergency surgery. There was no evidence of increasing risk of fetal loss when surgery was performed after the seventh week of gestation.
Wang
P H
PH
Department of Obstetrics and Gynecology, Veterans General Hospital-Taipei, National Yang-Ming University School of Medicine, Taiwan. phwang@vghtpe.gov.tw
Chao
H T
HT
Yuan
C C
CC
Lee
W L
WL
Chao
K C
KC
Ng
H T
HT
D000328:Adult; D017677:Age Distribution; D017558:Elective Surgical Procedures; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D015994:Incidence; D010051:Ovarian Neoplasms / Q000453:epidemiology / Q000601:surgery*; D010052:Ovariectomy / Q000009:adverse effects*; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000453:epidemiology / Q000601:surgery*; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology