Clinicopathological Profile and Obstetric Outcome of Pregnant Women with Persistent Adnexal Masses

Abstract

Background: Ascertaining the nature of adnexal mass in a pregnant woman and timely decision for surgical or conservative management is a dilemma. Present study was conducted to evaluate clinicopathological features and obstetric outcomes of pregnancies with persistent adnexal masses.

Method: A retrospective study was conducted and case records of pregnant women with persistent adnexal mass diagnosed during pregnancy or incidentally during caesarean delivery (CS), between January 2012 and June 2022 were reviewed. A total of 63 cases were recruited. The clinicopathological profile and clinical outcome were analyzed.

Results: During the study period, 63 pregnant women were diagnosed with persistent adnexal masses during pregnancy. Diagnosis was predominantly incidental either during routine USG (54.0%), or during CS (27.0%), and only 12.7% presented with acute abdomen. Forty-two cases were diagnosed during first or early second trimester. Out of these 42 women, 21 were managed conservatively and 11 masses were removed at time of CS. Out of total of 63 pregnancies with adnexal masses, 53 underwent surgical management. The majority i.e., 90% were benign and 10% were malignant; with mature teratoma being most common (32%) histology. In four of five malignant cases, diagnosis was made in antenatal period itself. All benign masses had uneventful course during pregnancy; only one had cyst rupture at 35 weeks and one was diagnosed with malignancy.

Conclusion: Adnexal masses having benign features on imaging can be managed conservatively till delivery as the chance of missing malignancy is minimal. Surgery for adnexal masses in pregnancy doesn't adversely affect feto-maternal outcomes.

Keywords: Adnexal mass; Histopathology; Perinatal outcome; Pregnancy; Surgical management.