Adnexal masses in pregnancy: A review of 130 cases undergoing surgical management

Abstract

Objective: Our purpose was to determine maternal and fetal outcome in patients undergoing surgery for pelvic mass in pregnancy. Study Design: Maternal and fetal records of 130 cases of adnexal masses associated with intrauterine pregnancy that required laparotomy or aspiration or that were diagnosed incidentally at the time of cesarean section were reviewed. The χ 2 and Fisher’s exact tests were used for statistical analysis. A P value of ≤.05 was considered significant. Results: The incidence of adnexal masses in pregnant women who required surgical management was 1 in 1312 live births. A malignant tumor or a tumor of low malignant potential was found in 6.1% of cases. In 10 patients the only finding at the time of laparotomy was leiomyomas. Ultrasonography was not helpful in distinguishing tumors of low malignant potential from benign neoplasms or in identifying the source of the pelvic mass in patients found to have only leiomyomas. There were 2 intrauterine fetal deaths and 1 neonatal death in this cohort of patients. Patients who underwent laparotomy after 23 weeks’ gestation had a significantly higher adverse pregnancy outcome compared with those who underwent laparotomy earlier in pregnancy ( P = .005). Conclusion: The incidence of an adnexal mass during pregnancy in our population was consistent with what has been reported in the literature. However, the percentage of malignant tumors or tumors of low malignant potential was 2-fold greater than previously reported. Preoperative ultrasonography was not helpful in differentiating tumors of low malignant potential from benign neoplasms. (Am J Obstet Gynecol 1999;181:19-24.)