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      Surgical Management of Adnexal Masses in Pregnancy

      research-article
      , MBBS, MRCOG , , MBBS, FRCOG, FRCSC, , MBBS, FRCOG
      JSLS : Journal of the Society of Laparoendoscopic Surgeons
      Society of Laparoendoscopic Surgeons
      Adnexal masses, Pregnancy, Laparoscopy

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          Abstract

          Surgical management of adnexal masses during pregnancy appears to have favorable outcomes for both mother and fetus.

          Abstract

          Background and Objectives:

          Our objective was to review the surgical management, surgical outcomes, and obstetric outcomes of adnexal masses in pregnancy.

          Methods:

          A retrospective review was performed of pregnant women before 20 weeks of gestation who underwent laparoscopy or laparotomy for management of an adnexal mass during the period of January 2005 to June 2012 at a university-affiliated hospital.

          Results:

          Thirty-five pregnant women underwent surgical removal of adnexal masses during the 7.5-year study period: 21 (60.0%) underwent laparoscopic surgery, and 14 (40.0%) underwent laparotomy. The left upper quadrant entry technique was used in 20 women. Conversion to laparotomy was required in 2 women because of extensive pelvic adhesions. The mean gestational age at surgery was 15.2 ± 1.9 weeks. All women had undergone ovarian cystectomy. A malignant mass was found in 3 (8.6%) women. The laparoscopy group had a significantly less blood loss (67.4 ± 55.8 vs 153.6 ± 181.0 mL, P = .048) and shorter mean hospital stay (2.8 ± 1.0 vs 3.8 ± 1.1 days, P = .006) than the laparotomy group. One woman miscarried soon after surgery. There was no significant difference in obstetric outcomes between the laparoscopy and laparotomy groups.

          Conclusion:

          Surgical management of adnexal masses during pregnancy appears to have favorable outcomes for the mother and the fetus.

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          Most cited references13

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          Laparoscopy during pregnancy: a study of five fetal outcome parameters with use of the Swedish Health Registry.

          Our purpose was to compare five fetal outcome variables between laparoscopy and laparotomy performed during pregnancy with use of the Swedish Health Registries from 1973 to 1993. A dataset was produced by linking computerized records from three Swedish Health Registries. The dataset includes records for women who were delivered between 1973 and 1993 and had an operation within 1 year before giving birth. The data were divided according to surgical procedure(s) and grouped according to diagnostic code(s). The following end points were studied in singleton births: birth weight, gestational duration, intrauterine growth restriction, congenital malformations, stillbirths, and neonatal deaths. In the analysis confounding by maternal age and parity, year of birth of the infant, maternal smoking, period of involuntary infertility, and maternal cohabitation was taken into consideration. A chi 2 analysis was used to compare proportions. Variables were stratified with use of the Mantel-Haenszel procedure. Risk ratios were calculated for observed/expected ratios when outcomes for the total population were compared or as odds ratios when laparoscopy and laparotomy cohorts were compared. Expected values were calculated from the total population of women with singleton pregnancies. The study covered 2,015,000 deliveries in Sweden from 1973 to 1993. Data for this study were restricted to singleton pregnancies who had nonobstetric operations between the fourth and twentieth weeks of pregnancy. Too few laparoscopic procedures were performed after 20 weeks to allow comparison. A total of 2181 laparoscopies and 1522 laparotomies met criteria for analysis. There were no significant differences between the two groups in any demographic variable. Pregnancies with operations were compared with the total population for birth weight, gestational duration, growth restriction, infant survival, and fetal malformations. On the basis of relative risks, there was an increased risk for infants in both laparoscopy and laparotomy groups to weigh < 2500 gm, to be delivered before 37 weeks, and to have an increased incidence of growth restriction compared with the total population. There was no difference between laparoscopy and laparotomy in cumulative infant survival up to 1 year (odds ratio 0.85, 95% confidence interval 0.48 to 1.51). There was no difference in the rate of fetal malformations between laparoscopy (risk ratio 1.09, 95% confidence interval 0.90 to 1.11), laparotomy (risk ratio 1.08, 95% confidence interval 0.85 to 1.11), and the total population. There is no difference in five fetal outcome variables for patients undergoing laparoscopy versus laparotomy in singleton pregnancies between 4 and 20 weeks of gestation.
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            • Article: not found

            Adnexal masses in pregnancy: a review of 130 cases undergoing surgical management.

            Our purpose was to determine maternal and fetal outcome in patients undergoing surgery for pelvic mass in pregnancy. Maternal and fetal records of 130 cases of adnexal masses associated with intrauterine pregnancy that required laparotomy or aspiration or that were diagnosed incidentally at the time of cesarean section were reviewed. The chi(2) and Fisher's exact tests were used for statistical analysis. A P value of
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              Adnexal masses and pregnancy: a 12-year experience.

              Our purpose was to describe pregnancy-associated adnexal masses in eastern North Carolina. A retrospective study was performed of 60 adnexal masses resected during pregnancy at a regional referral hospital from January 1990 to March 2002. Adnexal masses occurred in 0.15% of pregnancies. Average gestational age at diagnosis and surgery was 12 and 20 weeks, respectively. Fifty percent of ovarian tumors were mature cystic teratomas, 20% were cystadenomas, and 13% were functional ovarian cysts. Malignancy occurred in 13%. Tumors with low malignant potential comprised 63% of malignancies. Average cyst size was 11.5 cm for malignancies and 7.6 cm for benign lesions (P value <.05). The preterm birth rate was 9%, the miscarriage rate was 4.7% after elective cases, and average Apgar scores were 7.5 and 8.7 at 1 and 5 minutes. The incidence of malignancy in pregnancy-associated adnexal masses was high. Ultrasonography detected internal excrescences in the majority of tumors with low malignant potential. Fetal outcomes were not affected.
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                Author and article information

                Contributors
                Journal
                JSLS
                JSLS
                jsls
                jsls
                JSLS
                JSLS : Journal of the Society of Laparoendoscopic Surgeons
                Society of Laparoendoscopic Surgeons (Miami, FL )
                1086-8089
                1938-3797
                Jan-Mar 2014
                : 18
                : 1
                : 71-75
                Affiliations
                Department of Obstetrics and Gynecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR.
                Department of Obstetrics and Gynecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR.
                Department of Obstetrics and Gynecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR.
                Author notes
                Address correspondence to: Dr. Siew-Fei Ngu, Department of Obstetrics and Gynecology, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong SAR. Telephone: (+852) 2255-3111, Fax: (+852) 2855-0947, E-mail: ngusiewf@ 123456hku.hk
                Article
                JSLS-D-13-00123
                10.4293/108680813X13693422521007
                3939346
                24680147
                12f92554-fe8f-48b7-877a-334c451bcc04
                © 2014 by JSLS, Journal of the Society of Laparoendoscopic Surgeons.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License ( http://creativecommons.org/licenses/by-nc-nd/3.0/us/), which permits for noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited and is not altered in any way.

                History
                Categories
                Scientific Papers

                Surgery
                adnexal masses,pregnancy,laparoscopy
                Surgery
                adnexal masses, pregnancy, laparoscopy

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