Elective vs. Conservative Management of Ovarian Tumors in Pregnancy

Abstract

Ovarian tumors are reported in 1 of every 200 pregnancies and may cause serious problems such as torsion, infarction, and obstruction of vaginal delivery. These tumors have typically been removed by elective surgery, preferably in the second trimester. Because abdominal surgery significantly stresses both the mother and fetus, this study was planned to determine the optimal management of ovarian tumors in 89 pregnant women with tumors requiring surgery. Surgery was emergent because of torsion of the tumor in 36 cases (group A) and elective in 53 cases (group B). The 2 groups were similar in maternal age, parity, and gestational age at the time of surgery. Emergency surgery was done in the first, second, and third trimesters in 22, 5, and 9 women, respectively. Elective surgery was done in the second trimester in two thirds of cases and in the first trimester in the others. Mean birth weights were similar for the 2 groups, but preterm births were significantly more frequent in group A (22% vs. 4%). There was no group difference in gestational age at preterm delivery. Tumors were of comparable size in the 2 groups, and there was no difference in their location. Most tumors were 6 to 10 cm in size. Nearly 10% of women in both groups had bilateral ovarian tumors. There were no perinatal deaths, and no difference was noted in rates of vaginal or cesarean delivery. Dermoid cyst was the most common histologic diagnosis, accounting for 36% of group A and 45% of group B cases. Two group A tumors but none of those in group B were malignant. In this series, the risk of adverse pregnancy outcomes was not greater when surgery was delayed until symptoms of ovarian tumor developed rather than being done electively. The authors favor a conservative approach to pregnant women who have an ovarian tumor.