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Management of the adnexal mass in pregnancy

Goh, Williama; Bohrer, Justinb; Zalud, Ivicac

Current Opinion in Obstetrics and Gynecology: April 2014 - Volume 26 - Issue 2 - p 49–53
doi: 10.1097/GCO.0000000000000048
MATERNAL-FETAL MEDICINE: Edited by James F. Smith Jr.

Purpose of review With the increased use of ultrasonography in the first trimester, up to 1% of all pregnancies are diagnosed with an adnexal mass. Yet, the management of asymptomatic adnexal masses in pregnancy continues to be controversial as management guidelines are mainly based on case–control or observational studies. The purpose of this article was to review the recent literature and provide clinical guidance on patient management.

Recent findings This review will highlight the increasing sensitivity of ultrasound imaging in diagnosing the rare malignant lesion, allowing for antenatal expectant management of benign asymptomatic adnexal masses until delivery or postpartum. The recent literature also highlights the well tolerated use of laparoscopy for the antenatal removal of suspicious or symptomatic masses and that expectant management of asymptomatic masses does not increase the risk of adverse pregnancy outcomes.

Summary Most adnexal masses are benign and ultrasound characteristics can help guide the assessment of asymptomatic ovarian masses. When surgical management is chosen, laparoscopy can be safely performed in pregnancy. Ovarian torsion is a complication for persistent masses in pregnancy.

aHawaii Permanente Medical Group, Honolulu, Hawaii

bUniversity of Wisconsin School of Medicine, Madison, Wisconsin

cJohn A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA

Correspondence to William Goh, MD, MSCR, Moanalua Medical Center, 3288 Moanalua Road, Honolulu, HI 96819, USA. E-mail:

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins