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Fertil Steril. 2009 May;91(5):1895-902. doi: 10.1016/j.fertnstert.2008.02.014. Epub 2008 Mar 21.

Risk analysis of torsion and malignancy for adnexal masses during pregnancy.

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  • 1Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and University, Tao-Yuan, Taiwan.

Abstract

OBJECTIVE:

To find the risk factors of torsion and malignancy for adnexal tumors during pregnancy.

DESIGN:

Retrospective, historical cohort study.

SETTING:

University hospital.

PATIENT(S):

Patients from 1990 to 2004 with adnexal tumors >or=4 cm during pregnancy.

INTERVENTION(S):

Surgery undertaken antepartum, concurrently with cesarean delivery, or postpartum.

MAIN OUTCOME MEASURE(S):

Tumor size, progression, pathology, incidence of malignancy, and torsion.

RESULT(S):

Almost all 213 managements analyzed had good surgical and obstetric outcomes. In 174 patients who were followed through pregnancy with known tumor existence, 14.84% +/- 3.05% encountered tumor torsion. Adnexal masses with sizes between 6 and 8 cm had a significantly higher risk of torsion compared with other sizes (22.41% vs. 9.48%; odds ratio 2.8, 95% confidence interval [CI], [1.1, 6.6]). Sixty percent of the torsion happened between the 10th and 17th weeks of gestation, and only 5.9% happened after 20 weeks. The incidence of malignancy was 3.4%, while that of ovarian cancer was 2.3%. Tumor diameters >or=10 cm at initial diagnosis had a higher risk of malignancy versus smaller sizes (8.77% vs. 0.85%; odds ratio 11.2, 95% CI, [1.3, 97.9]), and tumor growth rates >or=3.5 cm/week also had a significantly higher risk of malignancy versus lower rates (8.33% vs. 0.88%; odds ratio 10.2, 95% CI, [1.0, 101.2]).

CONCLUSION(S):

Adnexal tumors bearing higher risks for torsion and malignancy should be strongly considered for an aggressive strategy of management during pregnancy.

PMID:
18359024
[PubMed - indexed for MEDLINE]
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