Abstract
Sonographic examination performed during the first trimester offers a comprehensive assessment of much more than the gestational contents. Incidental pelvic findings not yet concealed by the growing uterus can be discovered before they become large or symptomatic. This is especially important for adnexal masses, which when exposed to gestational hormones can grow, become torsed, hemorrhage, or metastasize in the cases of ovarian cancer. Gravid and nongravid women are affected by fibroids, dermoids, cysts, and appendicitis, but symptoms of pain and bloating can mimic normal discomforts of pregnancy. Sonography remains the diagnostic imaging test of choice to not only localize patient’s symptoms and characterize incidental masses of pregnancy, but also guide therapeutic planning if needed.
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References
AIUM-ACR-ACOG-SMFM-SRU practice parameter for the performance of standard diagnostic obstetric ultrasound examinations. J Ultrasound Med 2018;9999:1–12.
Bromley B, Benacerraf B. Adnexal masses during pregnancy: accuracy of sonographic diagnosis and outcome. J Ultrasound Med. 1997;16(7):447–52.
Smith LH, Dalrymple JL, Leiserowitz G, et al. Obstetrical deliveries associated with maternal malignancy in California 1992 through 1997. Am J Obstet Gynecol. 2001;184:1504–12.
American Congress of Obstetricians and Gynecologists. Practice Bulletin No. 174: Evaluation and management of adnexal masses. Obstet Gynecol. 2016;128(5):e320–226.
Elhalwagy H. Management of ovarian masses in pregnancy. Trends Urol Gynecol Sex Health. 2009;14(1):14–8.
Fleischer A, Manning F, Jeanty P, Romero R, editors. Sonography in obstetrics and gynecology: principles and practice. 6th ed. McGraw-Hill Professional: China; 2001.
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, Part 1):1098–103.
Wheeler TC, Fleischer AC. Complex adnexal mass in pregnancy: predictive value of color Doppler sonography. J Ultrasound Med. 1997;16(6):425–8.
Abramowicz J. Fetal Doppler: how to keep it safe? Clin Obstet Gynecol. 2010;53(4):842–50.
American Institute of Ultrasound in Medicine: Official Statements. Prudent use and safety of diagnostic ultrasound in pregnancy. 2021. http://www.aium.org/officialStatements/79.
Steart EA, Cookson CL, Gandolfo RA, Schulze-Rath R. Epidemiology of uterine fibroids: a systematic review. BJOG. 2017;124:1501–12.
Lee H, Norwitz E, Shaw J. Contemporary management of fibroids in pregnancy. Rev Obstet Gynecol. 2010;3(1):20–7.
Smith LH, Dalrymple JL, Leiserowitz GS, Danielsen B, Gilbert WM. Obstetrical deliveries associated with maternal malignancy in California, 1992 through 1997. Am J Obstet Gynecol. 2001;184(7):1504–12; discussion 1512–3.
Webb KE, Sakhel K, Chauhan SP, Abuhamad AZ. Adnexal mass during pregnancy: a review. Am J Perinatol. 2015;32(11):1010–6. https://doi.org/10.1055/s-0035-1549216. Epub 2015 May 22. PMID: 26007316
Aggarwal P, Kehoe S. Ovarian tumours in pregnancy: a literature review. Eur J Obstet Gynecol Reprod Biol. 2011;155(2):119–24.
Kumari I, Kaur S, Mohan H, Huria A. Adnexal masses in pregnancy: a 5-year review. Aust N Z J Obstet Gynaecol. 2006;46(1):52–4.
Bernhard L, Klebba P, Gray D, Mutch D. Predictors of persistence of adnexal masses in pregnancy. Obstet Gynecol. 1999;93(4):585–9.
Chiang G, Levine D. Imaging of adnexal masses in pregnancy. J Ultrasound Med. 2004;23(6):805–19.
Levine D, Brown D, Andreotti R, Benacerraf B, Benson C, Brewster W, et al. Management of asymptomatic ovarian and other adnexal cysts imaged at US: Society of Radiologists in Ultrasound Consensus Conference Statement. Radiology. 2010;256(3):943–54.
Blaivas M, Lyon M. Reliability of adnexal mass mobility in distinguishing possible ectopic pregnancy from corpus luteum cysts. J Ultrasound Med. 2005;24(5):599–603.
Ku CW, Shang X, Zhang VR, Allen JC, Tan NS, et al. Gestational age-specific normative values and determinants of serum progesterone through the first trimester of pregnancy. Sci Rep. 2021;11(1):4161.
Benacerraf B, Goldstein S, Groszmann Y. Corpus luteum and hemorrhagic cyst. In: Benacerraf B, Goldstein S, Groszmann Y, editors. Gynecologic ultrasound: a problem-based approach. 1st ed. Philadelphia: Saunders; 2014. p. 43.
Pateman K, Moro F, Mavrelos D, Foo X, Hoo W, Jurkovic D. Natural history of ovarian endometrioma in pregnancy. BMC Womens Health. 2014;14:128.
Groszmann Y, Howitt B, Bromley B, Feltmate C, Benacerraf B. Decidualized endometrioma masquerading as ovarian cancer in pregnancy. J Ultrasound Med. 2014;33(11):1909–15.
Sokalska A, Timmerman D, Testa A, Van Holsbeke C, Lissoni A, Leone F, Jurkovic D, Valentin L. Diagnostic accuracy of transvaginal ultrasound examination for assigning a specific diagnosis to adnexal masses. Ultrasound Obstet Gynecol. 2009;34(4):462–70.
Runowica CD, Brewer M. Adnexal masses in pregnancy. In: Godd B, Chakrabarti A, editors. UpToDate; 2021. https://www.uptodate.com/contents/adnexal-mass-in-pregnancy#H11.
Spitzer M, Kaushal N, Benjamin F. Maternal CA-125 levels in pregnancy and the puerperium. J Reprod Med. 1998;43(4):387–92.
Myers E, Bastian L, Havrilesky L, Kulasingam S, Terplan M, Cline K, et al. Evidence Report No. 130: Management of adnexal mass. 2006. http://archive.ahrq.gov/downloads/pub/evidence/pdf/adnexal/adnexal.pdf.
Timmerman D, Ameye L, Fischerova D, Epstein E, Melis G, Guerriero S, et al. Simple ultrasound rules to distinguish between benign and malignant adnexal masses before surgery: prospective validation by IOTA group. Br Med J. 2010;341:c6839.
Cao L, Wei M, Liu Y, Fu J, Zhang H, Huang J, Pei X, Zhou J. Validation of American College of Radiology Ovarian-Adnexal Reporting and Data System Ultrasound (O-RADS US): analysis on 1054 adnexal masses. Gynecol Oncol. 2021;162(1):107–12.
Ball E, Waters N, Cooper N, Talati C, Mallick R, Rabas S, Mukherjee A, Sri Ranjan Y, Thaha M, Doodia R, Keedwell R, Madhra M, Kuruba N, Malhas R, Gaughan E, Tompsett K, Gibson H, Wright H, Gnanachandran C, Hookaway T, Baker C, Murali K, Jurkovic D, Amso N, Clark J, Thangaratinam S, Chalhoub T, Kaloo P, Saridogan E. Evidence-based guideline on laparoscopy in pregnancy: commissioned by the British Society for Gynaecological Endoscopy (BSGE) Endorsed by the Royal College of Obstetricians & Gynaecologists (RCOG). Facts Views Vis Obgyn. 2019;11(1):5–25.
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Phillips, C.H., Carpenter, L., Sacks, G., Fleischer, A.C. (2023). Sonography of Pelvic Masses Associated with Early Pregnancy. In: Abramowicz, J.S., Longman, R.E. (eds) First-Trimester Ultrasound. Springer, Cham. https://doi.org/10.1007/978-3-031-24133-8_26
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DOI: https://doi.org/10.1007/978-3-031-24133-8_26
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