Adnexal Masses in Pregnancy

Abstract

INTRODUCTION: Adnexal mass in pregnancy is a common finding with now routine ultrasound use. Incidence of adnexal mass=1–2% with malignancy complicating is reported in 2–3% of cases. We sought to determine if the size of persistent adnexal mass can be used as a predictor of patients requiring surgical intervention. METHODS: We performed an institutional review board-approved retrospective cohort analysis of all women with persistent adnexal mass found on ultrasonography during pregnancy at our institution over the 5-year period, January 2008 to March 2013. Charts reviewed for maternal demographics, operative characteristics, and neonatal outcomes. Ultrasound mass size, septae, echogenicity, wall thickness, and papillary projections were evaluated. Statistical analyses were then performed using NCSS software. RESULTS: Thirteen thousand six hundred seventy-seven births occurred over the study period. Forty-one women were identified with persistent adnexal mass. Twenty-five of these adnexal masses were 5 cm or greater and 14 adnexal masses less than 5 cm. A significant higher body mass index in the large mass group (34.5 compared with 26.5 kg/m2, P=.01) was found. Patients with large masses were more likely to undergo surgery. Average cyst volume was 769 cc (range 220–9,216 cc). The large adnexal mass group was more likely to deliver preterm (36.6 compared with 38.2 weeks of gestation, P=.01) with significant lower birth weight neonates (2,944 compared with 3,169 g, P=.01). CONCLUSIONS: Routine ultrasonography has increased detection of adnexal masses during pregnancy. Large-sized masses may be predictors of preterm birth. Ultrasound characteristics, including size, may help differentiate need for surgical intervention. Risk factors and symptomatology dictate the need for operative intervention.