Adnexal Masses In Pregnancy

Clinical description

Adnexal masses are not uncommon in pregnancy. During the first trimester, thecorpus luteum of pregnancy may be palpated or detected on US; it is too frequently removed because of pain.

The differential diagnosis also includes ectopic pregnancy, acute salpingitis or PID, ovarian tumour, uterine leiomyoma, and acute appendicitis.

Complications usually occur during the first trimester and range from rupture,torsion, and infarction to malignancy.

Signs and symptoms

History Abdominal pain, nausea/vomiting, abdominal swelling, +/- light PVB ExamMay be difficult to palpate on pelvic exam and/or abdominal exam InvestigationsUltrasound

Treatment

• If mass < 5 cm, then most resolve without intervention. Treat symptoms.
• If mass 5-10 cm, then manage based on patient’s age, US findings, etc.
• Consider close observation with US every 2 wks.
• If mass increases in size, persists into the second trimester, and/or hasmalignant characteristics on

US, then consider staging laparotomy

• If mass > 10 cm without symptoms
• If first trimester, then observe closely with US every 2 wks for growth orcomplications
• If second trimester, then perform exploratory laparotomy with removal
• Discuss risks and benefits with patient
• If severe pain at any size, then perform emergency laparotomy forsuspected torsion or rupture
• The optimal timing for exploratory laparotomy is 16-18 wks gestation.
• At >20 wks gestation closely observe mass to avoid precipitating preterm labour (PTL).
• Send all surgical specimens for histopathology
• If corpus luteum on histopathology and ≤ 7-12 wks gestation, thenreplace progesterone with

appropriate dose. (Hormorin 200mg od)

• NB: There is no role of tumor markers (CA-125) in pregnancy