Purpose

This study aims to analyze the experience of a tertiary health center about the management of adnexal masses that have been diagnosed during pregnancy or detected accidentally during cesarean delivery.

Methods

This is a retrospective review of 160 women who underwent concurrent surgery for adnexal mass during cesarean section, 24 women who delivered vaginally and subsequently had surgery due to the prenatal diagnosis of adnexal mass and 10 women who underwent surgery for adnexal mass during pregnancy. Corresponding to the delivery and surgery times, 200 women who had no diagnosis of pregnancy-associated adnexal mass served as controls.

Results

The women in the control group and study groups had statistically similar gestational age at delivery, birth weight and preterm delivery (p > 0.05 for all). Miscarriage was significantly more frequent in women undergoing surgery for adnexal mass during pregnancy (p = 0.001). The women who had surgery for adnexal mass during pregnancy, at the time of cesarean section and following delivery were statistically similar with respect to surgery type and histopathological diagnosis (p > 0.05 for both). Malignancy was detected in none of the patients who underwent surgery for adnexal mass during pregnancy. Acute abdomen was the indication for the emergency surgery in six patients (3.5%) who had surgery for adnexal mass during pregnancy. Four patients (2.4%) had surgery for adnexal mass during pregnancy due to the high index of suspicion for malignancy.

Conclusion

The risk of malignancy was relatively lower in this cohort of adnexal masses detected during pregnancy and cesarean delivery. Surgical management of adnexal masses should be postponed to postpartum period as such management leads to an increased risk of miscarriage. Unless there is a need for emergent surgery or cancer staging, vaginal delivery should be encouraged in women diagnosed with adnexal mass during pregnancy.

中文翻译：

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附件包块与妊娠：9年单中心经验

目的

本研究旨在分析三级卫生中心对妊娠期间诊断出的或剖腹产期间意外发现的附件肿块的处理经验。

方法

这是对 160 名在剖宫产期间接受附件包块同步手术的妇女、24 名因产前诊断附件包块而阴道分娩并随后接受手术的妇女以及 10 名在怀孕期间接受附件包块手术的妇女的回顾性研究。对应于分娩和手术时间，200 名未诊断出妊娠相关附件包块的女性作为对照。

结果

对照组和研究组妇女的分娩胎龄、出生体重和早产在统计学上相似（ 均p > 0.05）。怀孕期间接受附件包块手术的女性流产率明显更高 ( p  = 0.001)。在怀孕期间、剖腹产时和分娩后接受附件包块手术的女性在手术类型和组织病理学诊断方面具有统计学相似性（ 两者均p > 0.05）。怀孕期间接受附件肿块手术的患者均未检测到恶性肿瘤。 6 名在妊娠期间接受附件包块手术的患者（3.5%）以急腹症为急诊手术指征。由于高度怀疑恶性肿瘤，四名患者（2.4%）在怀孕期间接受了附件包块手术。

结论

在怀孕和剖腹产期间检测到的附件肿块队列中，恶性肿瘤的风险相对较低。附件肿块的手术治疗应推迟到产后，因为这种治疗会导致流产风险增加。除非需要紧急手术或癌症分期，否则应鼓励妊娠期间诊断出附件肿块的女性进行阴道分娩。