1303Cases Of Adnexal Mass Managed During Cesarean Section:a2L-year Experience

Objective:To outline and discuss the clinical features, management and outcomes of adnexal masses those were encountered during cesarean section (CS) at a university affiliated hospital in China.Materials and methods:The medical records of the patients with adnexal mass observed during cesarean section were collected retrospectively at Women’s Hospital, School of Medicine, Zhejiang University from January1991to December2011. The data was processed with the SPSS11.5software.Results:There were139,174deliveries and79,548CS at our hospital during the21years (1991-2011).1303cases of adnexal masses were diagnosed at CS. The incidence was16.40in1000CS. The most common pathologic diagnosis was benign ovarian tumor(n=658,50.50%), including mature teratoma(n=390,59.27%), serous cystaenoma (n=155,23.56%), mucinous cystadenoma(n=76,11.55%), fibroma (n=26,3.95%) and some infrequent tumor(n=11,1.67%). most tumors (613,93.16%) were unilateral. The second was ovarian tumor like condition (n=316,24.25%), including theca lutein cysts (n=179,56.65%,106cases were bilateral), simple ovrian cysts (n=103,32.60%,101cases were unilateral), and stromal hyperplasia (n=34,10.75%, unilateral). The third was ovarian ednometriosis cysts (n=251,19.25%) and219cases were unilateral. The fourth were paraovarian-paratubal cysts(n=65,5.00%) and64cases were unilateral.13cases of ovarian malignancies were diagnosed during CS and all of them were unilateral and stage I. Only388cases (29.78%) were detected by ultrasound before surgery. Eight cases accepted emergency CS due to abdominal pain, all other patients were clinically asymptomatic. The reason for abdominal pain included torsion (n=5), rupture (n=2), and ovarian enlargement (n=1).13cases with ovarian ednometriosis cysts were found ruptured cysts during CS without any clinical manifestation. No maternal and fetal complication related to surgery was observed.Conclusions:Preconception care and routine prenatal care maybe optimize for the detection and management of adnexal mass. Since most adnexal mass emerged during pregnancy were benign and asymptomatic, expectation is reasonable for those with adnexal mass during pregnancy. Abdominal pain might be the clue for cyst torsion or rupture. Theca lutein cysts might be huge and exsit throughout the whole pregnancy period. Ednometriosis cysts(≧6cm) detected before pregnancy could be the indication for surgery.