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Ovarian Tumors and Pregnancy
Title:Ovarian tumors that complicate pregnancy
Author:P. Wang et al.
Address: Taipei, Taiwan
Source: Journal of Reproductive Medicine 44:279-287 (March) 1999
Summary: The discovery of an ovarian tumor during pregnancy produces anxiety in the patient and physician alike. The optimal time for surgery is in the second trimester but emergency situations can not be planned for. This study retrospectively analyzes 16 years of surgical intervention. The review searches for the risk factors contributing to emergency ovarian surgery during pregnancy and evaluates the different effects and characteristics of ovarian surgery performed electively or under emergency conditions. The study sample consisted of 174 women. 32 of these women underwent emergency surgery (Group A, and 142 (Group B) underwent elective surgery. 4 patients had an ovarian tumor with a resistance index (doppler ultrasound) of less than 0.40 but none was malignant. Benign cystic teratoma was the most common tumor during pregnancy (35.6% of patients in study) malignant ovarian tumor occurred in 3.4% of the study patients and 27 patients had bilateral ovarian masses.
The results showed that:
1. Emergency surgeries accounted for 75% of fetal wastage (9/12) and 85% of spontaneous fetal loss(6/7).
2.Ovarian tumor size was significantly larger in the emergency surgery group (11.1+ 4.cm vs 8.3 + 3.76cm)
3. More than half of the emergency surgeries occurred in the 1st trimester.
4. Tumors less than 5 cm never caused symptoms requiring emergency surgery.
5. An increasing incidence of extirpative surgery and general anesthesia was noted.
The authors suggest that tumors greater than 10 cm be removed at earlier stages in gestation (but after 7 weeks) because of the risk of malignancy and surgical complications associated with the increased size. There was no evidence of increasing risk of fetal loss when surgery was performed after the seventh week of gestation.
Comment: I am skeptical about the gasless concept, but the laparoscopy versus laparotomy comparison may have merit .
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