Management and Outcomes of Ovarian Masses Measuring ≥5 Cm in Pregnancy - a Series of Six Cases

Adnexal masses in pregnancy are a diagnostic and management challenge that is increasingly being faced by obstetricians. The incidence of ovarian masses occurring during pregnancy is about 1 in 400-in 1,312 live births. Adnexal masses requiring surgical intervention in pregnancy have been reported to be around 1% to 2.3% of all gestations [1,2]. Only 0.04-0.05% of pregnant women are found to have ovarian masses ≥5cm in diameter. Most of the adnexal masses encountered during pregnancy are simple cysts <5cm in diameter and about 70% resolve by the early second trimester. The persistent cysts with gradual increasing in size required surgical management. The conventional method of surgical intervention is laparotomy if the mass is >5cm, solid, bilateral, or persists into the second trimester. Dermoid cysts is the most common around 25%, followed by corpus luteal cysts, functional cysts, and paraovarian cysts which are17%, Serous cystadenomas 14%, mucinous cyst adenomas are 11%, Enodmetriomas are 8%. The overall incidence of malignancy in an adnexal mass noted in pregnancy is 1-8%. Malignancy is not the only concern associated with an adnexal mass in pregnancy. Masses that persist into the second trimester are at risk for torsion, rupture, or labor obstruction [3,4]. The fifth most common surgical emergencies are ovarian torsions. During pregnancy diagnosis of ovarian torsion can be challenging. Ovarian torsions are commonly misdiagnosed since the signs and symptoms are non-specific and similar to other abdominal diseases [5].