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.