Abstract

Introduction: The widespread use of ultrasound in obstetrics has led to an increase in the diagnosis of asymptomatic adnexal masses in pregnancy. Ultrasound is an accurate and safe method for diagnosing the etiology of an adnexal mass and distinguishing benign from malignant pathology. The aim of this study was to determine the frequency of adnexal pathology detected in the first trimester in women presenting for early pregnancy care, follow-up of these masses in the second trimester in order to observe their natural history; and assess their obstetric outcomes.

Methods: This is a prospective observational study of women attending for early pregnancy care between 1st July 2017 and 30th June 2018, in a private outpatient clinic in Aden. All women up to 14 weeks’ gestation had both ovaries visualized by transvaginal or transabdominal sonography. All the ultrasonic examinations were done and followed up by the same observer with standard sonographic definitions. They were followed with ultrasound scans every 4–6 weeks during the second trimester until either resolution of the ovarian cyst occurred, intervention was required or the pregnancy was aborted.

Result: During the 1-year study period, dating scans were performed in 505 women, 12% of them were incidentally found to have adnexal masses. The frequency of adnexal mass in the study group was 12% in the first trimester, and spontaneous regression occurred in 88.5% of the cases, leaving only 3.3% beyond the second trimester. Torsion occurred in 4.9% and rupture in 1.6%. Operative interventions were required in 8.2% of women (four of them because of pain and one because of suspicious mass which appeared to be big mature cystic teratoma. Nine women (14.8%) had spontaneous abortion in the first trimester.

Conclusion: The current findings support conservative management for asymptomatic small simple cysts diagnosed during pregnancy. The need for subsequent follow-up scans in this group during the antenatal period is minimal due to their benign nature and minimal risk of complications or adverse outcomes.

Keywords: Adnexa, Mass, Pregnancy, Ultrasound, Diagnosis.

• PDF