A STUDY OF ADNEXAL MASSES IN PREGNANCY

BACKGROUND: Adnexal masses are an uncommon cause of complications in pregnancy.Mostly ovarian in origin, they can remain asymptomatic, or can develop complications such as torsion, hemorrhage, and rarely malignancy.Ultrasound remains the mainstay for diagnosis and characterization of these masses, as well as for their follow up.Such masses can be managed conservatively, but in cases of malignancy or complications, surgical intervention becomes necessary.Early diagnosis and prompt treatment of cases can help preserve fertility, conserve the present affected pregnancy and limit malignant disease spread.AIM: The purpose of the following study is to assess the incidence and the outcome of women with adnexal masses complicating pregnancy. SUBJECTS AND METHODS:A retrospective study of women with adnexal masses complicating pregnancy was undertaken in our institute from October 1 st , 2013 to September 30 th , 2014, for a period of one year.RESULTS: During the study period, 8 cases were found to have adnexal masses complicating pregnancy, the incidence being 0.56%. 2 cases presented with acute abdomen due to torsion (25%).Cystectomy could be done in 37.5% of cases.The most common histological pattern observed was cystadenoma (37.5%).There were no maternal or perinatal mortalities.CONCLUSION: The decision between expectant management and surgical management must be individualized.Asymptomatic patients with small (<5cm), static or slow growing adnexal masses that appear benign on ultrasonography can be managed expectantly with close follow up and serial ultrasonograms.Complications such as torsion, hemorrhage or rapid growth with suspicion of malignancy warrant immediate surgery.Surgery beyond the first trimester is found to be safe in pregnancy, however there is always an increased risk of fetal loss/ preterm birth compared to normal healthy pregnancies KEYWORDS: Adnexal masses, Pregnancy. INTRODUCTION:The fallopian tubes, ovaries and the surrounding connective tissues collectively are referred to as the adnexa.Adnexal masses are uncommon in pregnancy, with an incidence ranging from 1 in 1000 (0.1%), 1 to 12 in 1000(1.2%). 2 Some studies quote an incidence as high as 4%. 3 Such a wide range of incidence could be attributed to the availability and use of early prenatal ultrasonography.These adnexal masses are often detected incidentally, in asymptomatic patients.Majority of these masses are ovarian in origin and are benign.Ultrasound is an accurate and safe method for diagnosing the etiology of an adnexal mass and distinguishing benign from malignant pathology.There are several factors that need to be taken into consideration at time of detection of these adnexal masses.These include size, symptoms if any, gestational age and sonomorphology.Most ovarian cysts detected in the 1 st trimester are physiological, and tend to resolve by the 2 nd trimester.4 Complications of adnexal masses can be torsion, rupture, hemorrhage or malignancy.Torsion is the most common complication, with a reported incidence of 3% to 25%, 5 to as high as 43%.6 The incidence of cyst rupture is reported to be between 9% and 17%.7