Laparoscopic management of adnexal masses in pregnant women

To report on 14 cases of adnexal masses in the second trimester of pregnancy that were managed with laparoscopic surgery.

A retrospective study. During the period between January 1994 and January 1998, 14 women presented with adnexal masses in pregnancy and were surgically managed with laparoscopy. A retrospective chart review of these patients was used to determine factors, including gestational age, operating time, length of hospital stay, pathology results, pregnancy outcomes and complications.

Fourteen patients had laparoscopic removal of adnexal masses in their second trimester of pregnancy. Average gestational age was 16 weeks (range, 11.5-21), average operating time was 84 minutes (range, 32-145), and average hospital stay was 2.0 days (range, 1-5). Pathology revealed 4 serous cystadenomas, 3 mucinous cystadenomas, 3 mature teratomas, 3 functional cysts and 1 bilateral endometrioma. There were no postoperative complications except for one case of mild peritonitis, which resolved with expectant management. There were no cases of preterm labor associated with the surgery. Ten pregnancies continued to term without complications and delivered average-sized infants. Three pregnancies were in the third trimester without complications at this writing. There was one intrauterine fetal death at 31 weeks; it was found to be secondary to an acute cord accident on autopsy remote from surgery.

Significant ovarian masses are diagnosed relatively frequently in the pregnant woman. The risk of malignancy is low, but complications resulting from distention, rupture and/or torsion of the adnexa can be a significant concern. As laparoscopic procedures improve and our experience with laparoscopy in the pregnant woman increases, most of these patients can forego laparotomy and be managed safely by laparoscopic removal of the mass. This series outlines laparoscopic technique and outcomes after removal of significant adnexal masses in pregnancy.