Surgical treatment of adnexal masses in pregnancy: indications, surgical approach and pregnancy outcome.
OBJECTIVE
To analyze the indications, surgical approach and pregnancy outcome in women undergoing surgical treatment of adnexal masses in pregnancy.


METHODS
In this retrospective study, 51 women were enrolled. Preoperative sonographic appearance, the size of the tumor, patient's age, gestational age at the time of surgery and pregnancy outcome following a laparoscopic and/or laparotomy approach were evaluated. The data were obtained from the National Perinatal Informational System, National Cancer Registry, inpatient records, operative reports and pathology records, and responses to a questionnaire on pregnancy outcome mailed to all the patients.


RESULTS
Of the 51 pregnant women with adnexal masses, 27 were treated laparoscopically and 24 through laparotomy. Acute symptoms were the indication in 14 (27.4%) and tumor > 5 cm or sonographic appearance in 37 (72.6%). There were 44 (86.4%) benign and 7 (13.6%) malignant masses (4 borderline and 3 cancers). There were no differences in pregnancy outcome between emergency and planned surgery or between laparoscopy and laparotomy.


CONCLUSIONS
Surgical treatment of persistent adnexal masses in pregnancy, particularly those with a sonographic appearance of a complex tumor, is justified because of the high risk of torsion, rupture and malignancy. Immediate treatment of symptomatic masses permits conservative, fertility-preserving surgery and has no adverse effect on pregnancy outcome. Laparoscopic surgery and surgery in the first trimester do not impair pregnancy outcome.
Ribic-Pucelj
Martina
M
Department of Obstetrics and Gynecology, University Medical Centre Ljubljana, Slovenia. martina.ribic@obgyn.mf.uni-lj.si
Kobal
Borut
B
Peternelj-Marinsek
Suzana
S
D000291:Adnexal Diseases / Q000175:diagnosis / Q000601:surgery*; D000328:Adult; D005260:Female; D005833:Genital Neoplasms, Female / Q000175:diagnosis / Q000601:surgery*; D005865:Gestational Age; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D007813:Laparotomy / Q000379:methods; D008423:Maternal Age; D011247:Pregnancy; D011248:Pregnancy Complications; D011252:Pregnancy Complications, Neoplastic / Q000175:diagnosis / Q000601:surgery*; D011256:Pregnancy Outcome; D011261:Pregnancy Trimester, First; D011262:Pregnancy Trimester, Second; D012189:Retrospective Studies; D016896:Treatment Outcome