Management of adnexal masses recognized incidentally during the cesarean: Our 5 years only central experience

Objective: The objective of the study was to review our approach to adnexal masses detected incidentally during cesarean section and the data in the literature. Material and Methods: This study was carried out by retrospectively scanning the files of patients who delivered by cesarean section between January 2015 and February 2020 in Süleyman Demirel University Faculty of Medicine Gynecology and Obstetrics Clinic. Patients with adnexal mass found in pre-operative examinations were excluded from the study. A total of 111 patients were included in the study. Results: January 2015–February 2020 in our hospital between 3700 cesarean deliveries was realized one of them in their 111 (3% of cesarean births); adnexal mass was detected during cesarean section. Main patient age was 32.26±6.03 (18–43) and the mean pregnancy number was 1.95±1.07 (1–6). Cephalopelvic disproportion is the most common (32.4%) cesarean indication; previous cesarean (21.6%) was followed up in the second frequency. Mean week of gestation performed by cesarean was 37.09±2.39. The mean adnexal mass size was 2.77±1.73 (1–10 cm). Fifty (45.1%) of the adnexal masses were observed in the right adnexal area, 55 (49.5%) in the left adnexal area, and 6 (5.4%) were followed them bilaterally. While cyst excision was performed in 110 patients, oophorectomy was performed in one patient. Pathology of 1 (0.9%) patient was reported as malignant. Conclusion: In pregnant women in the first trimester, obstetric ultrasonography performed routinely since both adnexal and should be examined in detail. Pelvic masses determined dimensions during cesarean section increases, whereas above 5 cm, especially torsion, hemorrhage or rupture must be removed because they have a risk of malignancy development.

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1. Whitecar P, Turner S, Higby K. Adnexal masses in pregnancy: A review of 130 cases undergoing surgical management. Am J Obstet Gynecol 1999;181(1):19–24.
2. Nelson MJ, Cavalieri R, Graham D, Sanders RC. Cysts in pregnancy discovered by sonography. J Clin Ultrasound 1986;14(7):509–12.
3. Kohler M. The adnexal mass in pregnancy. Postgrad Obstet Gynecol 1994;14(12):1–5.
4. Sherard GB 3rd, Hodson CA, Williams HJ, Semer DA, Hadi HA, Tait DL. Adnexal masses and pregnancy: A 12-year experience. Am J Obstet Gynecol 2003;189(2):358–62.
5. Condous G, Khalid A, Okaro E, Bourne T. Should we be examining the ovaries in pregnancy? Prevalence and natural history of adnexal pathology detected at first‐trimester sonography. Ultrasound Obstet Gynecol 2004;24(1):62–6.
6. Cavaco-Gomes J, Moreira CJ, Rocha A, Mota R, Paiva V, Costa A. Investigation and management of adnexal masses in pregnancy. Scientifica 2016;2016:3012802.
7. Baser E, Erkilinc S, Esin S, Togrul C, Biberoglu E, Karaca MZ, et al. Adnexal masses encountered during cesarean delivery. Int J Gynecol Obstet 2013;123(2):124–6.
8. Zanetta G, Mariani E, Lissoni A, Ceruti P, Trio D, Strobelt N, et al. A prospective study of the role of ultrasound in the management of adnexal masses in pregnancy. BJOG 2003;110(6):578–83.
9. Patenaude Y, Pugash D, Lim K, Morin L, Bly S, Butt K, et al. The use of magnetic resonance imaging in the obstetric patient. J Obstet Gynaecol Can 2014;36(4):349–55.
10. Spitzer M, Kaushal N, Benjamin F. Maternal CA-125 levels in pregnancy and the puerperium. J Reprod Med 1998;43(4):387–92.
11. Ulker V, Gedikbasi A, Numanoglu C, Saygı S, Aslan H, Gulkilik A. Incidental adnexal masses at cesarean section and review of the literature. J Obstet Gynaecol Res 2010;36(3):502–5.
12. Horowitz NS. Management of adnexal masses in pregnancy. Clin Obstet Gynecol 2011;54(4):519–27.
13. Struyk A, Treffers P. Ovarian tumors in pregnancy. Acta Obstet Gynecol Scand 1984;63(5):421–4.
14. Thornton JG, Wells M. Ovarian cysts in pregnancy: Does ultrasound make traditional management inappropriate? Obstet Gynecol 1987;69(5):717–21.
15. Dede M, Yenen M, Yilmaz A, Goktolga U, Baser I. Treatment of incidental adnexal masses at cesarean section: A retrospective study. Int J Gynecol Cancer 2007;17(2):339–41.
16. Bernhard LM, Klebba PK, Gray DL, Mutch DG. Predictors of persistence of adnexal masses in pregnancy. Obstet Gynecol 1999;93(4):585–9.
17. Cengiz H, Kaya C, Ekin M, Yeşil A, Yaşar L. Management of incidental adnexal masses on caesarean section. Niger Med J 2012;53(3):132.
18. Yen CF, Lin SL, Murk W, Wang CJ, Lee CL, Soong YK, et al. Risk analysis of torsion and malignancy for adnexal masses during pregnancy. Fertil Steril 2009;91(5):1895–902.
19. Leiserowitz GS, Xing G, Cress R, Brahmbhatt B, Dalrymple JL, Smith LH. Adnexal masses in pregnancy: How often are they malignant? Gynecol Oncol 2006;101(2):315–21.
20. Trimble EL. The NIH consensus conference on ovarian cancer: Screening, treatment, and follow-up. Gynecol Oncol 1994;55(3):S1–3.