title: Adnexal masses in pregnancy: surgery compared with observation.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  In select cases, close observation is a reasonable alternative to antepartum surgery in patients with an adnexal mass during pregnancy.
authors.affiliation: Department of Obstetrics and Gynecology, Women & Infants' Hospital of Rhode Island, Brown University Medical School, Providence, Rhode Island, USA. KSchmele@mdanderson.org
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Schmeler
authors.forename: William W
authors.initials: WW
authors.lastname: Mayo-Smith
authors.forename: Jeffrey F
authors.initials: JF
authors.lastname: Peipert
authors.forename: Sherry
authors.initials: S
authors.lastname: Weitzen
authors.forename: Misty D
authors.initials: MD
authors.lastname: Manuel
authors.forename: Mary E
authors.initials: ME
authors.lastname: Gordinier
mesh_terms: D000291:Adnexal Diseases / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery* / Q000628:therapy; D000293:Adolescent; D000328:Adult; D001707:Biopsy, Needle; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007150:Immunohistochemistry; D008423:Maternal Age; D019370:Observation / Q000379:methods; D010048:Ovarian Cysts / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy; D010051:Ovarian Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy; D010052:Ovariectomy / Q000379:methods*; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000000981:diagnostic imaging / Q000601:surgery* / Q000628:therapy; D011256:Pregnancy Outcome; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal