The management of a persistent adnexal mass in pregnancy

OBJECTIVE: Our purpose was to evaluate the pathologic features and outcome of pregnancy complicated by a persistent adnexal mass that was managed conservatively or with surgical intervention. STUDY DESIGN: A review was performed of patients who were seen with an adnexal mass in pregnancy from January 1988 to June 1994. We included patients with simple or complex masses>-6 cm that were persistent on ultrasonographic evaluation. We excluded cysts that spontaneously resolved by 16 weeksʹ gestation and those diagnosed after delivery. RESULTS: Thirty-one patients of 43,372 deliveries were identified with persistent adnexal masses that met the above criteria. Nineteen (59%) of these patients had operative intervention, whereas 12 (41%) were managed conservatively. Of the patients who had surgery, nine had functional cysts, six had mature cystic teratomas, and four had other benign cysts. Complications within 12 hours of surgery included one spontaneous abortion and one patient with rupture of membranes. Twelve patients were managed nonsurgically. Seven patients had conservative management, whereas five patients had percutaneous drainage of simple cysts (negative results on cytologic study) that were symptomatic. CONCLUSIONS: Although the incidence of ovarian cancer in pregnancy is low, the incidental finding of an adnexal mass in pregnancy is becoming more common. Because complications of abdominal surgery are increased in pregnancy, surgical management of this prenatal complication needs to be reconsidered. Our data support a randomized clinical study to determnie optimal management of an adnexal mass in pregnancy.