Adnexal masses in pregnancy: a challenge in evaluation and management

With increased use of ultrasound in early pregnancy, detection of adnexal masses in pregnancy has become more common. Adnexal masses in pregnancy have a wide spectrum of clinical manifestations and imaging characteristics. Therefore, it is important that the obstetrician be skilled in the diagnosis and management of adnexal masses in pregnancy. Common adnexal lesions seen in pregnancy include simple cysts, hemorrhagic cysts, leiomyomas, and hyperstimulated ovaries in patients who have undergone fertility treatments. Adnexal masses associated with pain include ovarian torsion and heterotopic pregnancy. Some adnexal lesions are detected incidentally that includes teratomas, endometriomas, hydrosalpinx, cystadenoma, and cystadenocarcinoma. Sonography is important in diagnosing, monitoring, and determining the malignant potential of these adnexal masses. In the absence of symptoms or sonographic findings concerning for malignancy, patients should be expectantly managed. However, an adnexal mass suspicious for malignancy, at risk for torsion, or clinically symptomatic, surgical management is recommended. When surgery is indicated, laparoscopy is safe and feasible and both perinatal and maternal outcomes are favorable when performed by trained and experienced operators.