Management of Adnexal Masses Encountered at Cesarean Section

Yıl 2018, Yıl: 2018 Ek Sayı: 1, 45 - 51, 01.01.2018

Berna Aslan Çetin , Pınar Kadiroğulları Nadiye Köroğlu Pınar Yalçın Bahat Aysu Akça Gökçe Turan

https://doi.org/10.5505/kjms.2017.85057

Öz

Aim: In this study; it was aimed to study the characteristics and pathology results of adnexal masses encountered during cesarean section in a tertiary hospital. 
Material and Method: Operating room and pathology department data for adnexal masses encountered during cesarean delivery between January 2014 and December 2016 were retrospectively reviewed. Clinical features, pathology results, maternal and neonatal outcomes were evaluated. 
Results: 17,210 (41% of all deliveries) of 41,672 deliveries were performed with cesarean section and 32 (0.18%) of the adnexal masses requiring surgical intervention during the operation were detected. The mean adnexal mass dimension was 6.59 ± 1.31 (5-9 cm). 29 patients (90.6%) underwent cystectomy and 3 (9.4%) patients had oopherectomy. Most of these masses were pathologically simple serous cysts and it was seen that the additional operation did not increase morbidity during cesarean section.
Conclusion: Adnexal masses encountered during the cesarean section should be removed taking the possibility of torsion, rupture and malignancy into consideration and in order to eradicate the risk of additional surgery after cesarean section,. These masses usually have no negative effect in terms of maternal and fetal prognosis.

Anahtar Kelimeler

Adnexial mass, cesarean section, ovarian cyst

Sezaryen Sırasında Saptanan Adneksiyel Kitlelerin Yönetimi

Öz

Giriş: Bu çalışmada; tersiyer bir sağlık merkezinde sezaryen sırasında tespit edilen adneksiyel kitlelerin özelliklerini ve patoloji sonuçlarını n ortaya konulması amaçlandı. 
Materyal ve Metot: Ocak2014-Aralık 2016 tarihleri arasında ameliyathane ve patoloji bölümü verileri, sezaryen doğum sırasında saptanan adneksiyel kitleler için retrospektif olarak gözden geçirildi. Klinik özellikler, patoloji sonuçları, maternal ve neonatal sonuçlar değerlendirildi. Bulgular: 41.672 doğumun 17.210 tanesi (tüm doğumların % 41’i) sezaryen ile gerçekleştirilmiş olup bunların 32 (%0,18) tanesinde operasyon esnasında cerrahi müdahale gerektirecek adneksiyel kitle saptandı. Ortalama adneksiyel kitle boyutu 6.59±1.31 (5-9 cm) olarak görüldü. 29 (%90.6) hastaya kistektomi yapıldı. 3(%9.4) hastaya ise ooferektomi yapıldı. Bu kitlelerin büyük kısmının patoloji sonucu basit seröz kist olarak saptanmış olup yapılan ek ameliyatın sezaryen sırasında morbiditeyi arttırmadığı görüldü. 
Sonuç: Sezaryen sırasında saptanan adneksiyel kitleler torsiyon, rüptür ve malignite olasılığı göz önüne alınarak ve sezaryen sonrası ek cerrahi işlem riskini ortadan kaldırmak için çıkarılmalıdır. Saptanan bu kitleler genellikle maternal ve fetal prognoz açısından olumlu sonuçlara sahiptir.

Anahtar Kelimeler

Adneksiyel kitle, sezaryen, over kisti

Kaynakça

• 1- Nelson MJ, Cavalieri R, Sanders RC. Cysts in pregnancy discovered by sonography. J Clin Ultrasound 1986; 14: 509–512.
• 2- Bernard LM, Klebba PK, Gray DL et al. Predictors of persistence of adnexial masses in pregnancy. Obstet Gynecol 1999; 93:585–589.
• 3- Usui R, Minakami H, Kosuge S, Iwasaki R, Ohwada M, Sato I.A retrospective survey of clinical, pathologic, and prognosticfeatures of adnexal masses operated on during pregnancy. J Obstet Gynaecol Res 2000; 26: 89–93.
• 4- Leiserowitz GS. Managing ovarian masses during pregnancy. Obstet Gynecol Surv2006;61(7):463–70.
• 5- Thornton JG,Wells M. Ovarian cysts in pregnancy: does ultrasound make traditional management inappropriate? Obstet Gynecol 1987;69(5):717–21.
• 6- Bignardi T, Condous G. The management of ovarian pathology in pregnancy. Best Pract Res Clin Obstet Gynaecol 2009;23(4):539–48.
• 7-Whitecar MA, Turner S, Higby MK. Adnexal masses inpregnancy: A rewiev of 130 cases undergoing surgical management. Am J Obstet Gynecol 1999;181:19‑24.
• 8- Cengiz H, Kaya C, Ekin M, Yeşil A, Yaşar L. Management of incidental adnexal masses on caesarean section. Niger Med J 2012;53(3):132-34.
• 9- Horowitz NS. Management of adnexal masses in pregnancy. Clin Obstet Gynecol 2011;54(4):519–27.
• 10- Condous G, Khalid A, Okaro E, Bourne T. Should we be examining the ovaries in pregnancy? Prevalence and natural history of adnexal pathology detected at first-trimester sonography. Ultrasound Obstet Gynecol 2004;24(1):62–6.
• 11- Başer E, Erkilinc S, Esin S, Togrul C, Biberoglu E, Karaca MZ, Gungör T, Danısman N. Adnexal masses encountered during cesarean delivery. Int J Gynecol Obstet 2013;123: 124–126.
• 12- Schmeler KM, Mayo-Smith WW, Peipert JF, Weitzen S, Manuel MD, Gordinier ME. Adnexal masses in pregnancy:Surgery compared with observation. Obstet Gynecol 2005; 105(5): 1098–1103.
• 13- Ulker V, Gedikbasi A, Numanoglu C, Saygı S, Aslan H,Gulkilik A. Incidental adnexal masses at cesarean sectionand review of the literature. J Obstet Gynecol Res 2010;36:502‑5.
• 14- Yen CF, Lin SL, Murk W, Wang CJ, Lee CL, Soong YK, et al. Risk analysis of torsion and malignancy for adnexal massesduring pregnancy. Fertil Steril 2009;91:1895‑902.
• 15- Dede M, Yenen MC, Yilmaz A, Goktolga U, Baser I.Treatment of incidental adnexal masses at cesarean section:A retrospective study. Int J Gynecol Cancer 2007;17:339‑41.
• 16- Koonings PP, Platt LD, Wallace R. Incidental adnexal neoplasmsat cesarean section. Obstet Gynecol 1988;72:767‑9.
• 17- Ustunyurt E, Ustunyurt BO, Iskender TC, Bilge U. Incidentaladnexal masses removed at cesarean section. Int J Gynecol Obstet 2007;96:33‑4.
• 18- Stein AL, Koonings PP, Schlaerth JB, Grimes DA, d’Ablaing G3rd. Relative frequency of malignant paraovarian tumors:Should paraovarian tumors be aspirated? Obstet Gynecol 1990;75: 1029– 1031.
• 19- Blencowe H, Cousens S, OestergaardMZ, Chou D,Moller AB, Narwal R, et al. National,regional, and worldwide estimates of preterm birth rates in the year 2010 with time, trends since 1990 for selected countries: a systematic analysis and implications. Lancet 2012;379:2162–72.