Abstract
Adnexal masses can be found in 0.19 to 8.8% of all pregnancies. Most masses are functional and asymptomatic and up to 70% resolve spontaneously in the second trimester. The main predictors of persistence are the size (>5 cm) and the imagiological morphocomplexity. Those that persist carry a low risk of malignancy (0 to 10%). Most malignant masses are diagnosed at early stages and more than 50% are borderline epithelial neoplasms. Ultrasound is the preferred method to stratify the risk of complications and malignancy, allowing medical approach planning. Pregnancy and some gestational disorders may modify the levels of tumor markers, whereby their interpretation during pregnancy should be cautious. Large masses are at increased risk of torsion, rupture, and dystocia. When surgery is indicated, laparoscopy is a safe technique and should ideally be carried out in the second trimester of pregnancy.
Highlights
Adnexal masses originate in the ovaries, fallopian tubes, or surrounding tissue
Adnexal masses can be found in women of any age, and pregnancy is no exception, and a period associated with some particular adnexal formations
The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) stated that laparoscopy can be safely performed in any trimester of pregnancy [60]. This society has developed some technical recommendations for performing laparoscopy in pregnant women, which include the following: (1) patient must be positioned in left lateral position; (2) initial access to the abdominal cavity can be safely performed by open surgery (Hasson) with a Veress needle or by optical trocar, as long as the location takes into account the uterine fundal height and previous incisions; (3) CO2 insufflation with 10–15 mmHg pressure is safe, but intraoperative CO2 monitoring by capnography is recommended; (4) pneumatic compression devices are recommended in intra- and postoperative period as well as early postoperative ambulation; (5) tocolytics should not be used prophylactically but should be considered perioperatively in the presence of preterm labor signs [60]
Summary
Adnexal masses originate in the ovaries, fallopian tubes, or surrounding tissue. They may present as different histological types and their clinical significance may vary largely depending mainly on tumor size, clinical presentation, and risk of malignancy. Adnexal masses can be found in women of any age, and pregnancy is no exception, and a period associated with some particular adnexal formations. The systematic use of ultrasound in the first trimester of pregnancy led to increased identification of asymptomatic and once clinically undetectable adnexal masses, bringing to debate their guidance and their implications during pregnancy
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