Endometrioma In Pregnancy Research Articles

Natural history of endometriosis in pregnancy: ultrasound study of morphology of deep endometriosis and ovarian endometrioma.

To assess the morphological appearance of deep endometriosis and ovarian endometrioma in pregnancy using pelvic ultrasound examination. This was a prospective observational cohort study conducted over 3 years at University College London Hospital, which is a tertiary level referral unit for early pregnancy complications and an accredited endometriosis center. All women who participated provided written consent and were invited for surveillance ultrasound examination at the time of their routine scans in pregnancy. All scans were performed by a single operator to eliminate interobserver variability. The change in size of ovarian endometrioma and nodules was reported as change in their mean diameter. Ovarian endometrioma with irregular thick inner walls, hyperechoic papillary projections and/or high vascularity and hyperechoic nodules with moderate to high vascularity were reported as decidualized. Sixty-five women with a live, normally sited pregnancy and concomitant ultrasound features of deep and/or ovarian endometriosis were included in the study. The median age of the study population was 34 (range, 23-44) years, and the median gestational age at presentation was 7 + 6 (range, 3 + 6 to 18 + 0) weeks. From the cohort, 47/65 (72%) were nulliparous, 48/65 (74%) had a previous diagnosis of endometriosis and 19/65 (29%) conceived via in-vitro fertilization. There were 10/65 (15% (95% CI, 7-24%)) women with ovarian endometrioma alone, 28/65 (43% (95% CI, 31-55%)) with endometriotic nodules alone and the remaining 27/65 (42% (95% CI, 30-54%)) had both. Of the women with ovarian endometrioma who underwent follow-up, 29/34 (85% (95% CI, 73-97%)) experienced cyst regression, 2/34 (6% (95% CI, 0-14%)) experienced cyst growth, and in 3/34 (9% (95% CI, 0.0-18%)) women, cyst size was unchanged. In 10/34 (29% (95% CI, 14-45%)), there was complete resolution of all cysts. Of the women with nodules who underwent follow-up, 43/51 (84% (95% CI, 74-94%)) experienced nodule regression, 2/51 (4% (95% CI, 0-9%)) experienced nodule growth and, in 6/51 (12% (95% CI, 3-21%)) women, nodule size was unchanged. In 4/51 (8% (95% CI, 0-15%)) women, there was complete resolution of all nodules. In 5/37(14% (95% CI, 3-25%)) women who attended postnatal follow-up, complete resolution of all endometriotic lesions occurred during pregnancy. In 10/34 (29% (95% CI, 14-45%)) women with ovarian endometrioma and 27/51 (53% (95% CI, 39-67%)) women with nodules, a pattern of growth was observed in the first and second trimesters, followed by regression later in pregnancy. Features of decidualization were observed in 17/34 (50% (95% CI, 33-67%)) women with ovarian endometrioma, most commonly in the first trimester, and in 25/51 (49% (95% CI, 35-63%)) women with nodules, most commonly in the second trimester. For the majority of women, despite features of decidualization being common in the first and second trimesters, ovarian endometrioma and deep nodules regress during pregnancy. Morphological changes of endometriosis in pregnancy are difficult to differentiate from characteristics of malignant lesions. Better understanding of the appearance of endometriosis in pregnancy is vital to minimize intervention and help counsel women regarding their condition. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Ultrasound signs of ovarian tumors according to a standardized protocol

Objective: to identify the characteristic echographic features of benign ovarian tumors using the recommendations of the IOTA group.Materials and methods. Five articles published in the journal Ultrasound in Obstetrics & Gynecology for 2008–2019 were analyzed. Each article is devoted to a histologically verified pathology of the ovaries, representing four morphological variants of an ovarian tumor (strum, fibroma/fibrothecoma, uroepithelial tumor (Brenner's tumor) and cystadenofibroma, as well as endometrioma in pregnancy. The total number was 380 women. When describing pathological formations, the researchers used a single protocol recommended by the IOTA group. Evaluated twentyone parameters, including the morphology of the formation, the structure of fluid inclusions and the solid component, the presence of fluid in the retrouterine space and ascites, as well as the degree of tumor vascularization.Results. The analysis of the struma, fibroma (fibrothecoma), Brenner tumor, cystadenofibroma and endometrioma of pregnant women indicates that there are no reliable criteria for diagnosing the histological structure of the tumor, both by the age of the patients, the size of the formation, and by ultrasound signs. Hyperechoic inclusions, which are noted only in Brenner tumors, both benign and malignant, can serve as the only marker among the pathology under consideration. In the study of the listed benign neoplasms of the ovaries, no features of the blood supply were revealed. All neoplasms had vascularization from the complete absence of vessels (1 point) to their moderate number (3 points). Hypervascularization (4 points) occurred in struma, fibroma (fibrotecoma), and cystadenofibroma.Conclusions. The task of ultrasound examination is the timely detection of an ovarian tumor with a presumptive conclusion of the probability of malignancy, based on standardized protocols of the IOTA group, which is important for the correct routing of the patient.

Transvaginal Aspiration for Management of Huge Ovarian Endometrioma in Pregnancy

Study Objective To demonstrate a minimally invasive approach of a huge ovarian cyst during pregnancy. Design A step-by-step explanation of the patient's condition, diagnosis, surgical technique, and post-operative results. Setting The patient underwent transvaginal procedure in the lithotomy position and under intravenous sedation and ventilation by face mask. Patients or Participants A 34-year-old woman, gravida 1 at 12 weeks 5 days’ gestation, presented with huge ovarian cyst. A transvaginal ultrasound demonstrated ovarian cyst measuring 10.4 × 8.2 cm with no evidence of malignancy, no free fluid, and a normal-appearing contralateral ovary. The crown-rump length measured 5.92 cm. On non-enhanced magnetic resonance imaging (MRI), 11 × 7 cm sized cystic lesion with high signal intensity in T1-weighted image (WI) and T1-weighted fat suppressed image, low signal intensity in T2 WI suggesting endometrioma, located in cul-de-sac was noted. Because the cyst was huge and deeply located in cul-de-sac, and the uterus was enlarged to 13 weeks size, approach through laparoscopy or even laparotomy was thought to be difficult and the risk of manipulation for uterus was high. So, we decided to aspirate the ovarian cyst through the vaginal route. Interventions Ultrasound-guided transvaginal aspiration was performed using an 18-G needle. Measurements and Main Results The operation time was 4 hours and 35 minutes with 305 mL dark brownish fluid drained. The patient recovered well and was discharged 2days after the procedure. There was no intraoperative or postoperative complication. Postoperative ultrasound revealed neither recurrence nor fetal abnormality. Until delivery, the patient was free of symptom and ultrasound revealed neither recurrence nor fetal abnormality. Conclusion In select pregnant woman with endometrioma requiringintervention, the risks of surgery may be minimized with aspiration. Transvaginal ultrasound-guided aspiration is a safe, feasible, and effective minimally invasive procedure for huge ovarian endometrioma in pregnancy. To demonstrate a minimally invasive approach of a huge ovarian cyst during pregnancy. A step-by-step explanation of the patient's condition, diagnosis, surgical technique, and post-operative results. The patient underwent transvaginal procedure in the lithotomy position and under intravenous sedation and ventilation by face mask. A 34-year-old woman, gravida 1 at 12 weeks 5 days’ gestation, presented with huge ovarian cyst. A transvaginal ultrasound demonstrated ovarian cyst measuring 10.4 × 8.2 cm with no evidence of malignancy, no free fluid, and a normal-appearing contralateral ovary. The crown-rump length measured 5.92 cm. On non-enhanced magnetic resonance imaging (MRI), 11 × 7 cm sized cystic lesion with high signal intensity in T1-weighted image (WI) and T1-weighted fat suppressed image, low signal intensity in T2 WI suggesting endometrioma, located in cul-de-sac was noted. Because the cyst was huge and deeply located in cul-de-sac, and the uterus was enlarged to 13 weeks size, approach through laparoscopy or even laparotomy was thought to be difficult and the risk of manipulation for uterus was high. So, we decided to aspirate the ovarian cyst through the vaginal route. Ultrasound-guided transvaginal aspiration was performed using an 18-G needle. The operation time was 4 hours and 35 minutes with 305 mL dark brownish fluid drained. The patient recovered well and was discharged 2days after the procedure. There was no intraoperative or postoperative complication. Postoperative ultrasound revealed neither recurrence nor fetal abnormality. Until delivery, the patient was free of symptom and ultrasound revealed neither recurrence nor fetal abnormality. In select pregnant woman with endometrioma requiringintervention, the risks of surgery may be minimized with aspiration. Transvaginal ultrasound-guided aspiration is a safe, feasible, and effective minimally invasive procedure for huge ovarian endometrioma in pregnancy.

Transvaginal Sonographic Imaging and Associated Techniques for Diagnosis of Ovarian, Deep Endometriosis, and Adenomyosis: A Comprehensive Review.

Imaging of endometriosis and in particular deep endometriosis (DE) is crucial in the clinical management of women facing this debilitating condition. Transvaginal sonography (TVS) is the first-line imaging method and magnetic resonance imaging (MRI) may provide supplemental information. However, the delay in diagnosis of up to 10 years and more is of concern. This problem might be overcome by simple steps using imaging with emphasis on TVS and referral to tertiary care. Finally, TVS is crucial in mapping extent and location of disease in planning surgical therapy and counseling women regarding various therapeutic options. This review presents the available data on imaging of endometriosis with a focus on TVS and MRI for DE, adenomyosis, and ovarian endometriomas including endometriomas in pregnancy as well as the use of "soft markers." The review presents an approach that is in accordance with the International Deep Endometriosis Analysis (IDEA) group consensus statement.

OC04.04: Natural history of ovarian endometrioma in pregnancy

OC04.04: Natural history of ovarian endometrioma in pregnancy

Natural history of ovarian endometrioma in pregnancy.

BackgroundOvarian endometriomas are classified as benign ovarian lesions. During pregnancy endometriomas may undergo major morphological changes which are referred to as ‘decidualisation’. Decidualised ovarian endometrioma may resemble malignant ovarian tumours on ultrasound examination. The aim was to study variations in the morphology and size of ovarian endometriomas diagnosed on ultrasound during pregnancy.MethodsWe searched our database to identify pregnant women who were diagnosed with ovarian endometriomas on ultrasound in order to study the effect of pregnancy on their morphological characteristics. In women who underwent serial scans during pregnancy we examined the changes in the size of endometriomas with advancing gestation.ResultsTwenty four patients with a total of 34 endometriomas were included in the analysis. All women were managed expectantly during pregnancy. On the first ultrasound scan 29/34 (85.3%, 95% CI 73.4 - 97.2) endometriomas appeared unilocular with fine internal echoes (‘ground glass’ contents) and they were poorly vascularised on Doppler examination. 1/34 (2.9% 95% CI 0.0 - 8.5) endometrioma was multilocular, with regular margins, ‘ground glass’ contents and it was also poorly vascularised. 4/34 (11.8%, 95% CI 1.0 - 22.6) had sonographic features suggestive of decidualisation such as thick and irregular inner wall, papillary projections and highly vascular on Doppler examination. The endometriomas showed a tendency to decrease in size during pregnancy.ConclusionsPregnancy has a major effect on the size and morphological appearances of ovarian endometriomas. Rapid regression of decidualised endometriomas is a helpful feature which could be used to confirm their benign nature.

Decidualized ovarian endometriosis in pregnancy: a challenging diagnostic entity

The hormonal milieu that characterizes pregnancy may determine profound modifications of ovarian endometriomas leading to lesions mimicking malignancy. In this study, we report on our experience and perform a review of the literature on this issue. Data from women evaluated at our referral center for prenatal diagnosis were reviewed in order to identify those who were detected with an ovarian endometrioma in pregnancy mimicking malignancy. A review of the literature on this issue (1990-2008) was also performed, using the PubMed database. Three cases were identified at our center. The literature reports on a further 19 cases (11 studies). Sonographic and color Doppler examination consistently documented rapidly growing and abundantly vascularized intracystic excrescences. Conversely, the presence of septations or significant free fluid was never reported. The vast majority of cases underwent surgical removal. Interestingly, in our experience, in a woman who declined surgery and had spontaneous miscarriage at 10 weeks' gestation, the sonographic examination performed 6 weeks after dilatation and curettage revealed an unremarkable typical endometrioma, thus suggesting that it is a transitory transformation. Pregnancy-related modifications of an ovarian endometrioma leading to the rapid development of vascularized intracystic excrescences are an uncommon but possible event. An expectant management and serial monitoring should first be envisaged in these cases provided that other features of malignancy, such as septations or free fluid, are absent.

OP21.08: Decidualized hypervascularized ovarian endometrioma in pregnancy: can it be distinguished from cancer to avoid surgery?

institution between January 2003 and January 2006. Patients were not selected except for 3D-PD US availability. All women underwent 3D-PD US prior to surgery. Vascularization index (VI), Flow index (FI) and Vascularization-Flow index (VFI) from solid portions or papillary projections from the tumors were calculated using a virtual organ computer-aided analysis (VOCAL) program. In those tumors with more than one solid portion or papillary projection, the highest VI, FI and VFI values found were used for analysis. 2D Doppler (RI, PI and PSV) indexes were also obtained from vessels within the solid portions or papillary projections. The lowest RI and PI and the highest PSV (cm/sec) found were used for analysis. Definitive histological diagnosis was obtained in each case. Kruskal-Wallis test was used for comparisons. Results: Amongst 59 women, 12 had stage I primary cancers (5 lowmalignant potential tumors and 7 invasive tumors), 34 had advanced stage primary ovarian cancers and 13 had metastatic tumors to the ovary. Median VI and VFI were significantly higher in advanced stage tumors and metastatic tumors as compared with early stage tumors. No differences were found between advanced stage and metastatic cancers. No differences in RI, PI and PSV were found (Table 1) Conclusions: 3D-PD vascular derived indexes tend to higher in advanced stage and metastatic ovarian cancers as compared with early stage ovarian tumors. No differences were detected in 2D pulsed Doppler indexes.

Serial ultrasonographic evaluation of a decidualized endometrioma in pregnancy

Serial ultrasonographic evaluation of a decidualized endometrioma in pregnancy

Growth and rupture of an ovarian endometrioma in pregnancy

Pregnancy has long been considered to have beneficial effects on endometriosis. We describe a patient who underwent emergency exploratory laparotomy at gestation week 35 for rupture of an ovarian endometrioma.