| Objective:To evaluate the clinical features, diagnostic mode, management strategy and the outcomes of patients with adnexal masses in pregnancy.Methods:A retrospective study of251cases of patients with adnexal masses in pregnancy diagnosed by surgery and pathology over a6-year period at the Obstetrics and Gynecology Department in Qilu Hospital of Shandong University, a tertiary referral center, between January2007and December2012, statistically analyzing the incidence, clinical manifestation, pathological pattern, treatment strategy, prophylactic tocolysis during the perioperative period and their effects on the outcomes of pregnancy.Results:The constituent ratio of pregnancy with adnexal mass was1.17%(251/21403),5cases (1.99%,5/251) were found by pelvic examination,119cases (47.41%,119/251) were found by ultrasonography, among which60cases (50.42%,60/119) were found in the first and second trimesters,127cases (50.60%,127/251) were found during the Cesarean section; and18cases (7.17%,18/251) were found before pregnancy,39cases (15.54%,39/251) were found in the first trimester,22cases (8.76%,22/251) were found in the second trimester, and172cases (68.53%,172/251) were found in the third trimester; complications occurred in18cases (7.17%,18/251), among which torsion happened in13cases (72.22%,13/18), while rupture happened in the other5cases (27.78%,5/18);47patients (37.90%,47/124) who were found by pelvic examination or ultrasonography underwent surgical treatment during the pregnancy,21cases (44.68%,21/47) were in the first trimester, among which15cases were given induced abortion at the same time according to their requirements and1case underwent radical hysterectomy and lymphadenectomy because of clear cell carcinoma of ovary,21cases (44.68%,21/47) were in the second trimester,5cases were in the third trimester(10.64%,5/47), among which1case underwent simple salpingo-oophorectomy because of borderline mucinous cystadenoma of ovary and1case underwent therapeutic Cesarean section because of metastatic bilateral ovarian tumors, the premature infant survived, the remaining31patients were willing to keep pregnancy after operation and given prophylactic tocolysis during the perioperative period, among which2patients had been loss to follow-up, while the other29patients were all full-term pregnancy and delivered29term infants which all survived, the overall survival incidence of infants delivered by patients after operation during pregnancy was at least93.55%(29/31);251cases were diagnosed by operation and pathology, in the whole pathologic results, benign ovarian tumors accounted for40.24%(101/251), most of which were mature teratomas (71.29%,72/101), tumor-like ovarian lesions accounted for41.43%(104/251), most of which were ovarian endometrial cysts (40.38%,42/104), ovarian borderline tumors and malignant tumors accounted for0.80%(2/251) respectively, besides, oviduct cysts accounted for15.54%(39/251), most of which were mesosalpinx cysts (38.46%,15/39),30cases (11.95%,30/251) had bilateral adnexal masses, including29cases of benign ovarian lesions and1case of oviduct lesion, most of which were mature teratomas and ovarian endometrial cysts, accounting for9.72%(7/72) and16.28%(7/43) respectively in their own pathologic type;17patients gave up pregnancies, while234patients continued pregnancies, in which227cases were singleton pregnancy and7cases were twin pregnancy;211patients delivered by Cesarean section, while the other21cases delivered naturally, and totally achieved239newborns, consisting of214term infants and18preterm infants which were all caused by obstetric factors,3preterm infants died and the other newborns all had good prognoses.Conclusion:It is of great significance for ultrasonography to diagnose and monitor adnexal mass in pregnancy. The incidence of pregnancy with adnexal mass is low, most of which are benign and few are malignant, and torsion is the most common complication. Treatment strategy varies according to different gestational weeks and most of patients with benign ovarian lesions can have a smooth pregnancy and a good prognosis for both mother and infant by conservative treatment; however, patients should be interfered timely who have symptoms or highly suspected malignant tumors; prophylactic tocolysis during the perioperative period can effectively prevent miscarriage and preterm and lead to a satisfactory outcome of pregnancy. |
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