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

2014
Outpatient clinic I Tgl. 07-01-2014
Obstetrik Statuse Diagnose  GII P0010
VT : v/v : fluksus(-), fluor(+) 21/22 Week SLIU + BOH
P : Closed smooth +
CU : AF ~ 20 week SOT (D) + kista
AP (D) : mass (+) Ø 5 cm, solid, ovarium (S)
mobile, pain (-) Planning :
AP (S) : mass (+) cyst, mobile, pain -USG FM
(-) - Ca 125, Ca 19-9,
CD : normal
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 Ø 6,18x7,88
cm
Hipoechoic mass in lateral uterine bersepta Ø 6,77 cm x 7,07
cm. Papile (+)
Inscribe : gravida + mioma + kista ovarium

Lab (22-01-2014) : Consult 10 e

Hb : 11,4 outpatient
L : 15.900 Ca 125 : 16,9
clinic
Plt : 282.000 Ca 19-9 : <1,2
Oncology outpatient clinic (22-01-2014)

RMI < 200

VT :

V/V : flux (-) fluor (-)

P : close, smooth

CU : ~ pregnant 24 week

Ap D/S : cystic mass (+) Ø 8 cm, mobile

Diagnose :

Gravida 24 Week + ovarial cyst (D)

Plan : - konservatif

- Tumor board
• 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 Obstet Gynecol 2011.
• 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 Obstet Gynecol 2011.
Sonographic characteristics of an
adnexal mass

Hosam. Management of ovarian masses in pregnancy. Treds in urology sexual health jan 2009
Etiology of ovarian tumors during
pregnancy

Leiserowitz. Managing ovarian masses during pregnancy. Obstet Gynecol Surgery 2006.
 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, βHCG, 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 Obstet Gynecol 2011.
Spencer, Robarts. Review Management of adnexal masses in pregnancy. RCOG;8:14-19, 2006.
 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 Obstet Gynecol 2011.
 Surgical Management

• Following indications:

• 1) a strong suspicion of malignancy and/or

large size (8–10 cm),

• 2) symptomatic complaints

• 3) an increased risk of
torsion/rupture/obstruction of labor

Leiserowitz. Managing ovarian masses during pregnancy. Obstet Gynecol Surgery 2006.
 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 Obstet Gynecol 2011.
 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 Obstet Gynecol 2011.
Spencer, Robarts. Review Management of adnexal masses in pregnancy. RCOG;8:14-19, 2006.