A guide to management: Adnexal masses in pregnancy
Forego surgery in most cases until delivery—or until the risky first trimester has passed
IN THIS ARTICLE
Small series of laparoscopic procedures to manage an adnexal mass during pregnancy suggest that this approach is most applicable during the first (for highly selected emergent cases) or early second trimester to manage masses less than 10 cm in diameter, particularly when adnexectomy is planned.
Laparoscopy may be considered “minimally invasive” because it reduces manipulation of the pregnant uterus during adnexal surgery. However, it is more difficult to assess and remove ovarian cysts laparoscopically, although an early ovarian malignancy could be staged via laparoscopy by an experienced surgeon.
Considerations during laparotomy
When performing a laparotomy or cesarean section for an adnexal mass, the surgeon must take into account a number of variables when selecting the type of incision (ie, vertical vs transverse). In general, if malignancy is suspected, or if uterine manipulation is to be minimized, a vertical incision is best. Other considerations include a prior scar, body habitus, obstetric issues, and the patient’s wishes.
The author reports no financial relationships relevant to this article.
