Adnexal Mass In

Pregnancy

Ario danianto
 IDENTITY

Name : Ms. C C
Age : 30 y.o
Address : Peterongan, Jombang
RM : 12.30.20.31
LMP : 09 Sept 2013
Parity : GII P0010

2
 07-01-2014
Sent by OBGYN (Jombang) with
GII P00010 19-20 Week S/L +
Cystoma ovarii (multilokuler) +
SOT
201 clinic I Tgl. 07-
Outpatient
4
01-2014
Obstetrik Statuse
VT : v/v : fluksus(-), Diagnose GII
fluor(+) P0010 21/22 Week
P : SLIU + BOH +
Closed smooth SOT (D) + kista
ovarium (S)
CU : AF ~ 20 Planning :
week -USG FM
AP (D) : mass (+) 5 cm, solid, - Ca 125, Ca 19-9,
mobile, pain (-)
AP (S) : mass (+) cyst, mobile,
USG FM (07-01-2014) :
Breech /S/L
BPD : 5,48 ~ 22/23 week
FL : 373 ~ 21/22 week
HC : 20,19 ~ 22/23 week
AC : 17,79 ~ 22/23 week
Plac. Corpus anterior/gr I/Amnion fluid enough
Hiperechoic mass in corpus anterior uterine
6,18x7,88 cm
Hipoechoic mass in lateral uterine bersepta 6,77 cm x 7,07
cm. Papile (+)
Inscribe : gravida + mioma + kista ovarium
Lab (22-01-2014) :
Hb : 11,4 Consult 10
L : 15.900 Ca 125 : e
16,9 outpatient
Plt : 282.000 Ca 19-9 clinic
: <1,2
Oncologyoutpatientclinic(22012014)
RMI<200
VT:
V/V:flux()fluor()
P :close,smooth
CU :~pregnant24week
ApD/S:cysticmass(+)8cm,mobile
Diagnose:
Gravida24Week+ovarialcyst(D)
Plan:konservatif
Tumorboard
 Incidence of adnexal masses in
pregnancy ranges from 1 in 81 to 1
in 8000 pregnancies
incidence of malignancy in an
adnexal mass in pregnancy is 1-8%
Masses that persist into the second
trimester are at risk for torsion,
rupture, or labor obstruction

Hoover. Evaluation and management of adnexal mass in pregnancy. Am J

 Adnexal masses in pregnancy are
diagnosed incidentally during a screening
ultrasound in the first trimester
If an adnexal mass is palpated on
examination, ultrasound is use to
confirmation
Determining those adnexal masses in
which conservative management with
observation is possible vs those requiring
surgical intervention
Hoover. Evaluation and management of adnexal mass in pregnancy. Am J
Sonographic characteristics of an
adnexal mass

Hosam. Management of ovarian masses in pregnancy. Treds in urology

Etiology of ovarian tumors during
pregnancy

Leiserowitz. Managing ovarian masses during pregnancy. Obstet Gynecol

 Tumor markers
CA-125 levels are elevated in pregnancy,
particularly in the first trimester
CA-125 also elevated with other benign
disease processes such as menses,
uterine fibroids,and endometriomas
AFP, HCG, and LDH altered by
pregnancy
The primary value of tumor markers in
pregnancy is in the ability to follow their
levels as an indicator of tumor control
Hoover. Evaluation and management of adnexal mass in pregnancy. Am J
Spencer, Robarts. Review Management of adnexal masses in pregnancy.
 Management

Still controversial
Some investigators recommending
observation, and others, surgical
management
The main consideration in choosing
intervention versus expectant management
centers on the risks to the mother and fetus
Most ovarian masses in pregnancy will
spontaneously resolve, and aggressive
surgical management is not required

Hoover. Evaluation and management of adnexal mass in pregnancy. Am J

 Surgical Management
Following indications:
1) a strong suspicion of malignancy
and/or large size (810 cm),
2) symptomatic complaints
3) an increased risk of
torsion/rupture/obstruction of labor

Leiserowitz. Managing ovarian masses during pregnancy. Obstet Gynecol

 Surgical Management
Surgical management suggests a
trend toward improved fetal and
maternal outcomes by utilizing
midgestation (17-27 weeks)
The complications, including
spontaneous miscarriage, rupture of
membranes, preterm labour and
preterm birth

Hoover. Evaluation and management of adnexal mass in pregnancy. Am J

 Observational management

Appropriate for asymptomatic

adnexa masses and adnexal mass
without features of malignancy
Supported by the fact that up to
71% of benign appearing ovarian
masses will either decrease in size
or resolve spontaneously

Hoover. Evaluation and management of adnexal mass in pregnancy. Am J

Spencer, Robarts. Review Management of adnexal masses in pregnancy.