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Adnexal mass in pregnancy

Carolyn D Runowicz, MD
Molly Brewer, DVM, MD, MS
Section Editor
Barbara Goff, MD
Deputy Editor
Sandy J Falk, MD, FACOG


The liberal use of prenatal ultrasound for evaluation of the fetus has also resulted in increased detection of asymptomatic adnexal masses during pregnancy. Although the vast majority of these masses are benign, the possibility of cancer must be considered.

This topic will discuss management of the adnexal mass in pregnancy, with an emphasis on women with suspected malignancy. Detailed reviews on the evaluation and management of the nonpregnant woman with an adnexal mass can be found separately:

(See "Approach to the patient with an adnexal mass".)

(See "Management of an adnexal mass".)

(See "Differential diagnosis of the adnexal mass".)

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Literature review current through: Nov 2017. | This topic last updated: Jun 03, 2016.
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  1. Leiserowitz GS, Xing G, Cress R, et al. Adnexal masses in pregnancy: how often are they malignant? Gynecol Oncol 2006; 101:315.
  2. Schmeler KM, Mayo-Smith WW, Peipert JF, et al. Adnexal masses in pregnancy: surgery compared with observation. Obstet Gynecol 2005; 105:1098.
  3. Smith LH, Dalrymple JL, Leiserowitz GS, et al. Obstetrical deliveries associated with maternal malignancy in California, 1992 through 1997. Am J Obstet Gynecol 2001; 184:1504.
  4. Webb KE, Sakhel K, Chauhan SP, Abuhamad AZ. Adnexal mass during pregnancy: a review. Am J Perinatol 2015; 32:1010.
  5. Palmer J, Vatish M, Tidy J. Epithelial ovarian cancer in pregnancy: a review of the literature. BJOG 2009; 116:480.
  6. Shim MH, Mok CW, Chang KH, et al. Clinical characteristics and outcome of cancer diagnosed during pregnancy. Obstet Gynecol Sci 2016; 59:1.
  7. Giuntoli RL 2nd, Vang RS, Bristow RE. Evaluation and management of adnexal masses during pregnancy. Clin Obstet Gynecol 2006; 49:492.
  8. Machado F, Vegas C, Leon J, et al. Ovarian cancer during pregnancy: analysis of 15 cases. Gynecol Oncol 2007; 105:446.
  9. Baser E, Erkilinc S, Esin S, et al. Adnexal masses encountered during cesarean delivery. Int J Gynaecol Obstet 2013; 123:124.
  10. Goff BA, Mandel LS, Melancon CH, Muntz HG. Frequency of symptoms of ovarian cancer in women presenting to primary care clinics. JAMA 2004; 291:2705.
  11. Goff BA, Mandel LS, Drescher CW, et al. Development of an ovarian cancer symptom index: possibilities for earlier detection. Cancer 2007; 109:221.
  12. Yen CF, Lin SL, Murk W, et al. Risk analysis of torsion and malignancy for adnexal masses during pregnancy. Fertil Steril 2009; 91:1895.
  13. Sarandakou A, Protonotariou E, Rizos D. Tumor markers in biological fluids associated with pregnancy. Crit Rev Clin Lab Sci 2007; 44:151.
  14. Chiang G, Levine D. Imaging of adnexal masses in pregnancy. J Ultrasound Med 2004; 23:805.
  15. Bakri YN, Ezzat A, Akhtar, et al. Malignant germ cell tumors of the ovary. Pregnancy considerations. Eur J Obstet Gynecol Reprod Biol 2000; 90:87.
  16. Kumar S, Shah JP, Bryant CS, et al. The prevalence and prognostic impact of lymph node metastasis in malignant germ cell tumors of the ovary. Gynecol Oncol 2008; 110:125.
  17. Young RH, Dudley AG, Scully RE. Granulosa cell, Sertoli-Leydig cell, and unclassified sex cord-stromal tumors associated with pregnancy: a clinicopathological analysis of thirty-six cases. Gynecol Oncol 1984; 18:181.
  18. Mooney J, Silva E, Tornos C, Gershenson D. Unusual features of serous neoplasms of low malignant potential during pregnancy. Gynecol Oncol 1997; 65:30.
  19. Wang PH, Chao HT, Yuan CC, et al. Ovarian tumors complicating pregnancy. Emergency and elective surgery. J Reprod Med 1999; 44:279.
  20. Lee GS, Hur SY, Shin JC, et al. Elective vs. conservative management of ovarian tumors in pregnancy. Int J Gynaecol Obstet 2004; 85:250.
  21. Leiserowitz GS. Managing ovarian masses during pregnancy. Obstet Gynecol Surv 2006; 61:463.
  22. Bernhard LM, Klebba PK, Gray DL, Mutch DG. Predictors of persistence of adnexal masses in pregnancy. Obstet Gynecol 1999; 93:585.
  23. Whitecar MP, Turner S, Higby MK. Adnexal masses in pregnancy: a review of 130 cases undergoing surgical management. Am J Obstet Gynecol 1999; 181:19.
  24. Yakasai IA, Bappa LA. Diagnosis and management of adnexal masses in pregnancy. J Surg Tech Case Rep 2012; 4:79.
  25. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin. Management of adnexal masses. Obstet Gynecol 2007; 110:201.
  26. Hoffman MS, Sayer RA. Adnexal masses in pregnancy. OBG Management 2007; 19:27.
  27. Zanetta G, Mariani E, Lissoni A, et al. A prospective study of the role of ultrasound in the management of adnexal masses in pregnancy. BJOG 2003; 110:578.
  28. Sherard GB 3rd, Hodson CA, Williams HJ, et al. Adnexal masses and pregnancy: a 12-year experience. Am J Obstet Gynecol 2003; 189:358.
  29. Agarwal N, Parul, Kriplani A, et al. Management and outcome of pregnancies complicated with adnexal masses. Arch Gynecol Obstet 2003; 267:148.
  30. Caspi B, Levi R, Appelman Z, et al. Conservative management of ovarian cystic teratoma during pregnancy and labor. Am J Obstet Gynecol 2000; 182:503.
  31. Perera DS, Prabhakar HB. Imaging of the adnexal mass. Clin Obstet Gynecol 2015; 58:28.
  32. Hoffman MS. Primary ovarian carcinoma during pregnancy. Clin Consul Obstet Gynecol 1995; 7:237.
  33. Birchard KR, Brown MA, Hyslop WB, et al. MRI of acute abdominal and pelvic pain in pregnant patients. AJR Am J Roentgenol 2005; 184:452.
  34. Telischak NA, Yeh BM, Joe BN, et al. MRI of adnexal masses in pregnancy. AJR Am J Roentgenol 2008; 191:364.
  35. ACOG Committee on Obstetric Practice. ACOG Committee Opinion. Number 299, September 2004 (replaces No. 158, September 1995). Guidelines for diagnostic imaging during pregnancy. Obstet Gynecol 2004; 104:647.
  36. Harvey EB, Boice JD Jr, Honeyman M, Flannery JT. Prenatal x-ray exposure and childhood cancer in twins. N Engl J Med 1985; 312:541.
  37. Frederiksen MC, Casanova L, Schink JC. An elevated maternal serum alpha-fetoprotein leading to the diagnosis of an immature teratoma. Int J Gynaecol Obstet 1991; 35:343.
  38. Nawa A, Obata N, Kikkawa F, et al. Prognostic factors of patients with yolk sac tumors of the ovary. Am J Obstet Gynecol 2001; 184:1182.
  39. Elit L, Bocking A, Kenyon C, Natale R. An endodermal sinus tumor diagnosed in pregnancy: case report and review of the literature. Gynecol Oncol 1999; 72:123.
  40. Horbelt D, Delmore J, Meisel R, et al. Mixed germ cell malignancy of the ovary concurrent with pregnancy. Obstet Gynecol 1994; 84:662.
  41. Buller RE, Darrow V, Manetta A, et al. Conservative surgical management of dysgerminoma concomitant with pregnancy. Obstet Gynecol 1992; 79:887.
  42. Demir SC, Evruke C, Ozgunen FT, et al. Factors that influence morbidity and mortality in severe preeclampsia, eclampsia and hemolysis, elevated liver enzymes, and low platelet count syndrome. Saudi Med J 2006; 27:1015.
  43. Schumer ST, Cannistra SA. Granulosa cell tumor of the ovary. J Clin Oncol 2003; 21:1180.
  44. Luisi S, Florio P, Reis FM, Petraglia F. Inhibins in female and male reproductive physiology: role in gametogenesis, conception, implantation and early pregnancy. Hum Reprod Update 2005; 11:123.
  45. Moore RG, Miller MC, Eklund EE, et al. Serum levels of the ovarian cancer biomarker HE4 are decreased in pregnancy and increase with age. Am J Obstet Gynecol 2012; 206:349.e1.
  46. Gucer F, Kiran G, Canaz E, et al. Serum human epididymis protein 4 can be a useful tumor marker in the differential diagnosis of adnexal masses during pregnancy: a pilot study. Eur J Gynaecol Oncol 2015; 36:406.
  47. Eichelberger KY, Cantrell LA, Balthazar U, et al. Robotic resection of adnexal masses during pregnancy. Am J Perinatol 2013; 30:371.
  48. Rajendran S, Hollingworth J, Scudamore I. Endodermal sinus tumour of the ovary in pregnancy. Eur J Gynaecol Oncol 1999; 20:272.
  49. Méndez LE, Mueller A, Salom E, González-Quintero VH. Paclitaxel and carboplatin chemotherapy administered during pregnancy for advanced epithelial ovarian cancer. Obstet Gynecol 2003; 102:1200.
  50. Picone O, Lhommé C, Tournaire M, et al. Preservation of pregnancy in a patient with a stage IIIB ovarian epithelial carcinoma diagnosed at 22 weeks of gestation and treated with initial chemotherapy: case report and literature review. Gynecol Oncol 2004; 94:600.
  51. Sood AK, Shahin MS, Sorosky JI. Paclitaxel and platinum chemotherapy for ovarian carcinoma during pregnancy. Gynecol Oncol 2001; 83:599.
  52. Ferrandina G, Distefano M, Testa A, et al. Management of an advanced ovarian cancer at 15 weeks of gestation: case report and literature review. Gynecol Oncol 2005; 97:693.
  53. Csapo AI, Pulkkinen MO, Ruttner B, et al. The significance of the human corpus luteum in pregnancy maintenance. I. Preliminary studies. Am J Obstet Gynecol 1972; 112:1061.
  54. Csapo AI, Pulkkinen MO, Wiest WG. Effects of luteectomy and progesterone replacement therapy in early pregnant patients. Am J Obstet Gynecol 1973; 115:759.
  55. Grimm D, Woelber L, Trillsch F, et al. Clinical management of epithelial ovarian cancer during pregnancy. Eur J Cancer 2014; 50:963.
  56. Zhao XY, Huang HF, Lian LJ, Lang JH. Ovarian cancer in pregnancy: a clinicopathologic analysis of 22 cases and review of the literature. Int J Gynecol Cancer 2006; 16:8.
  57. Stensheim H, Møller B, van Dijk T, Fosså SD. Cause-specific survival for women diagnosed with cancer during pregnancy or lactation: a registry-based cohort study. J Clin Oncol 2009; 27:45.