Comparison of Laparoscopic Surgery and Expectant Management in Patients with Adnexal Masses During Pregnancy in A High-Volume Tertiary Center.

Objective: To describe the characteristics of pregnant women diagnosed with adnexal masses and review our experience with diagnosis, management and treatment modalities in this area for which there are no definitive treatment guidelines. Methods: All women with adnexal masses during pregnancy whose management and follow-up was completed at a large tertiary referral center between January 2018 and September 2023 were retrospectively evaluated. After applying the exclusion criteria, a total of 19 women who underwent antepartum laparoscopic adnexal surgery (group 1) and 34 women who underwent expectant management (group 2) were included. Results: Gestational age at birth, cesarean section rates, birthweight and APGAR-5 scores were similar, while the largest mass diameter and CA-125 levels were significantly higher in group 1 (p<0.001 and p=0.014, respectively). Of the patients in group 1, 15 (78.9%) had unilateral complex cysts and 4 (21.1%) had unilateral simple cysts, while there were no bilateral masses. Emergency laparoscopy was performed in 6 (31.6%) of patients for adnexal torsion and in 7 (36.8%) for cyst rupture, while elective laparoscopy was performed in 6 (31.6%) asymptomatic patients with suspected malignancy. While functional cyst was the most common histopathologic finding, malignancy was found in 2 cases (granulosa cell tumor and endometrioid adenocarcinoma). Preterm births occurred in 8 (41.1%) women, of whom 5 (26.3%) gave birth before 34 weeks' gestation and 3 (15.7%) between 34-36 weeks and 6 days. Conclusion: Parallel to the increase in ultrasound examinations in early pregnancy, both the overdiagnosis and early detection of adnexal masses during pregnancy have increased. Given the high rate of spontaneous regression in most lesions and the fact that bleeding in ruptured cases is usually self-limiting, an expectant approach would be appropriate in cases without hemodynamic instability, acute abdomen and/or suspected malignancy. Laparoscopy is a safe and efficient surgical approach for surgery. [ABSTRACT FROM AUTHOR]