Mete URAL ÜLKÜ, YEŞİM BAYOĞLU TEKİN, Figen ŞAHİN KIR

Bir olgu üzerinden gebelikte adneksiyel kitlelere yaklaşım

Ultrasonografinin yaygın kullanımı ile gebelikte adneksiyel kitlelerin tespiti artmıştır. Bu kitlelerin çoğu ilk trimester taraması sırasında rastlantısal olarak görülür. Adneksiyel kitlelerin takibinde genellikle gözlem yeterliyken komplike olanlar için cerrahi gerekebilir. Persiste olan büyük kitlelerde torsiyon, rüptür ve malignensi riskleri vardır. Cerrahide ise fetal kayıp, preterm eylem ve artmış emboli riski gibi komplikasyonlar görülebilir. Bu yazıda, 24. gebelik haftasında tespit edilen dev seröz kistadenom olgusu nedeniyle gebelikte adneksiyel kitlelere uygun yaklaşım, müdahalenin hangi durumlarda gerekli olduğu ve cerrahi yaklaşım yöntemleri literatür eşliğinde tartışılmıştır.

Approach to the adnexal masses in pregnancy due to a case

With the widespread use of ultrasound in pregnancy, adnexal masses are more frequently detected. Most of these masses are diagnosed incidentally at the first trimester screening. In the management of adnexal masses, observation is usually adequate but surgery may be required for complicated cases. Large persistent adnexal masses are at risk for torsion, rupture and malignancy. Intraoperative complications may occur such as fetal loss, preterm labor and increased risk of embolic events. In this article, we present a case of giant serous cystadenoma detected in the 24th week of gestation and discuss the appropriate approach to adnexal masses in pregnancy, the cases in which intervention is required and surgical procedures.

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1. Leiserowitz G. Managing ovarian masses during pregnancy. Obstet Gynecol Surv 2006;61(7):463-70. 2. Schmeler K, Mayo-Smith W, Peipert J, Weitzen S, Manuel M, Gordinier M. Adnexal masses in pregnancy: surgery compared with observation. Obstet Gynecol 2005;105(5 Pt 1):1098-103. 3. Kumari I, Kaur S, Mohan H, Huria A. Adnexal masses in pregnancy: A 5 year review. Aust N Z J Obstet Gynecol 2006;46(1):52-4. 4. Giuntoli R, Vang R, Bristow R. Evaluation and management of adnexal masses during pregnancy. Clin Obstet Gynecol 2006;49(3):492-505. 5. Glanc P, Salem S, Farine D. Adnexal masses in pregnant patient: A diagnostic and management challenge. Ultrasound Q 2008;24(4):225-40. 6. Ko Ma-Lee, Lai T, Chen S. Laparoscopic management of complicated adnexal masses in the first trimester of pregnancy. Fertil Steril 2009;92(1):283-7. 7. Yuen P, Ng P, Leung P, Rogers M. Outcome in laparoscopic management of persistent adnexal mass during the second trimester of pregnancy. Surg Endosc 2004;18(9):1354-7. 8. Sherard GB 3rd, Hodson CA, Williams HJ, Semer DA, Hado HA, Tait DL. Adnexal masses and pregnancy: A 12-year experience. Am J Obstet Gynecol 2003;189(2):358-63. 9. Hoover K, Jenkins TR. Evaluation and management of adnexal mass in pregnancy. Am J Obstet Gynecol 2011;205(2):97-102. 10. Yumi H. Guidelines for diagnosis, treatment, and use of laparoscopy surgical problems during pregnancy. Surg Endosc 2008;22(4):849-61.