Surgical Management of Adnexal Masses in Pregnancy: A Systematic Review and Meta-analysis

Cagino, Kristen; Xuan, Ling; Thomas, Charlene; Delgado, Diana; Christos, Paul J.; Acholonu, Uchenna C.

doi:10.1016/j.jmig.2021.01.020

Cited by 19 publications

(19 citation statements)

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“…These cysts are typically found at prenatal ultrasound check‐ups and operated on if symptoms occur or tumour grows; sometimes, morphology in imaging studies or doctor's and patient's attitudes also encourage surgery 11,12 . In a recent meta‐analysis of ovarian masses operated during pregnancy, the odds ratio (OR) for postoperative spontaneous abortion was similar after elective or emergency surgery (OR 0.26; 95% CI 0.06, 1.02), but OR for preterm delivery was lower (OR 0.13; 95% CI 0.04, 0.48) after elective ovarian surgery than after emergency surgery 13 . This highlights appropriate preoperative evaluation when any surgical interventions are planned in pregnant women.…”

Section: Discussionmentioning

confidence: 99%

“…11,12 In a recent meta-analysis of ovarian masses operated during pregnancy, the odds ratio (OR) for postoperative spontaneous abortion was similar after elective or emergency surgery (OR 0.26; 95% CI 0.06, 1.02), but OR for preterm delivery was lower (OR 0.13; 95% CI 0.04, 0.48) after elective ovarian surgery than after emergency surgery. 13 This highlights appropriate preoperative evaluation when any surgical interventions are planned in pregnant women.…”

Section: Discussionmentioning

confidence: 99%

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Nonobstetric surgery during pregnancy in Finland during a 21‐year period: A register‐based study

Haataja

Gissler

Kokki

et al. 2022

Repro Female Child Health

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To assess how much and on which specialities nonobstetric surgery was performed for pregnant women in Finland during a 21-year period, between 1997 and 2017 and the effect of Finnish guideline about preoperative evaluation affected the amount of surgery during pregnancy. Design: Register-based observational study. Setting: Finnish Medical Birth Register. Population: 1 175 677 pregnancies ending with a singleton birth 1997−2017. Methods: Amount of nonobstetric surgeries, and pregnancy foetal and maternal outcomes in Finland between 1997 and 2017 were searched. Main Outcome Measures: The prevalence of nonobstetric surgery, and proportions of elective and emergency nonobstetric surgery performed during the three trimesters. Results: The prevalence of nonobstetric surgery before the guideline was 0.39%, after the guideline 0.28% and after the first revision 0.39%. The prevalence of elective surgery decreased after the guideline (before 0.15%, after the guideline 0.10% and 0.07% after the first revision), but the prevalence of emergency surgery was highest after the first revision (0.24%, 0.21% and 0.29%). The guideline and the first revision had no impact on the timing of elective surgery; 35% of elective surgery was performed during the second trimester before the guideline, 36% after it and 36% after its first revision. The preterm delivery rate, 9.1%−9.4% of pregnancies with nonobstetric surgery was twofold higher than that of pregnancies without surgery. Conclusion:The prevalence of nonobstetric surgery during pregnancy is low in Finland. The national guideline decreases the prevalence of elective surgery during pregnancy but does not impact the timing of nonobstetric surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Nonobstetric surgery during pregnancy in Finland during a 21‐year period: A register‐based study

Haataja

Gissler

Kokki

et al. 2022

Repro Female Child Health

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“…The effect of surgery during pregnancy on the risk of miscarriage is unclear and the maternal condition necessitating surgery could be the main factor associated with risk of miscarriage and preterm labour ( Cohen-Kerem et al , 2005 ; de Bakker et al , 2011 ; Silvestri et al , 2011 ; Ball et al , 2019 ). The advantages of laparoscopic treatment over open procedures are the reduced risk of postoperative adverse events ( Liu et al , 2017 ) and a shorter hospital stay ( Cagino et al , 2021 ). However, a significantly higher risk of adverse foetal outcomes has been reported following laparoscopic versus open surgery for acute appendicitis ( McGory et al , 2007 ; Wilasrusmee et al , 2012 ; Winter et al , 2017 ).…”

Section: Discussionmentioning

confidence: 99%

The risk of miscarriage following surgical treatment of heterotopic extrauterine pregnancies

Solangon

Otify

Gaughran

et al. 2022

Human Reproduction Open

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Study Question What is the risk of loss of a live normally sited (eutopic) pregnancy following surgical treatment of the concomitant extrauterine ectopic pregnancy? Summary Answer In women diagnosed with heterotopic pregnancies, minimally invasive surgery to treat the extrauterine ectopic pregnancy does not increase the risk of miscarriage of the concomitant live eutopic pregnancy. What Is Known Already Previous studies have indicated that surgical treatment of the concomitant ectopic pregnancy in women with live eutopic pregnancies could be associated with an increased risk of miscarriage. The findings of our study did not confirm that. Study Design, Size, Duration A retrospective observational case-control study of 52 women diagnosed with live eutopic and concomitant extrauterine pregnancies matched to 156 women with live normally sited singleton pregnancies. The study was carried out in three London Early Pregnancy Units covering a twenty-year period between November 2019 and April 2000. Participants/Materials, Setting, Methods All women attended early pregnancy units because of suspected early pregnancy complications. The diagnosis of heterotopic pregnancy was made on ultrasound scan and women were subsequently offered surgical or expectant management. There were three controls per each case who were randomly selected from our clinical database and were matched for maternal age, mode of conception and gestational age at presentation. Main Results And The Role Of Chance In the study group 49/52 (94%) women had surgery and 3/52 (6%) were managed expectantly. There were 9/52 (17%, 95% CI 8.2-30.3) miscarriages <12 weeks’ gestation and 9/49 (18%, 95% CI 8.7-32) miscarriages in those treated surgically. In the control group there were 28/156 (18%, 95% CI 12.2-24.8) miscarriages <12 weeks’ gestation, which was not significantly different from heterotopic pregnancies who were treated surgically (OR 1.03 95% CI 0.44-2.36). There was a further second trimester miscarriage in the study group and one in the control group. The live birth rate in the study group was 41/51 (80%, 95% CI 66.9-90.2) and 38/48 (79%, 95% CI 65-89.5) for those who were treated surgically. These results were similar to 127/156 (81%, 95% CI 74.4-87.2) live-births in the control group (OR 0.87, 95% CI 0.39-1.94). Limitations, Reasons For Caution This study is retrospective, and the number of patients is relatively small, which reflects the rarity of heterotopic pregnancies. Heterotopic pregnancies without a known outcome were excluded from analysis. Wider Implications Of The Findings This study demonstrates that in women diagnosed with heterotopic pregnancies, minimally invasive surgery to treat the extrauterine pregnancy does not increase the risk of miscarriage of the concomitant live eutopic pregnancy. This finding will be helpful to women and their clinicians when discussing the options for treating heterotopic pregnancies. Study Funding/Competing Interest(s) This work did not receive any funding. None of the authors has any conflict of interest to declare. Trial Registration Number Research Registry: researchregistry6430.

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“…Nowadays, more and more studies show that laparoscopy is a safe and effective surgical approach in pregnancy, providing several advantages over laparotomy, including reduced postoperative pain, analgesic use, and hospitalization time (14). Cagino et al (15) investigated the optimal approach to surgical management of adnexal masses in pregnancy based on a meta-analysis of previous studies. They found that laparoscopy was a safe and effective approach for the surgical management of adnexal masses in pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Laparoendoscopic single-site surgery for adnexal disease during pregnancy: A single-center preliminary experience

et al. 2022

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PurposeThis study aimed to evaluate the safety and efficacy of laparoendoscopic single-site surgery (LESS) in treating adnexal disease during pregnancy.MethodsMedical records of included patients were retrospectively reviewed and follow-ups of all the patients were performed until the delivery of the fetus. The clinical characteristics, surgical interventions, postoperative complications, and pregnancy outcomes were analyzed.ResultsSix cases were included, with the gestational age ranging from 19 to 31 weeks 1 day. Procedures included salpingo-oophorectomy (n = 3), ovarian or paratubal cystectomy with detorsion (n = 2), and adnexal detorsion (n = 1). The median duration of surgery was 35 min (range, 20–60 min), and the estimated blood loss ranged from 5 to 50 ml. No major intraoperative or postoperative complications were noted. The final pathologic results included high-grade serous ovarian carcinoma, ovarian borderline serous cystadenoma, ovarian simple cyst, endometrioma, and mesosalpinx cyst. Five patients had a spontaneous vaginal delivery at full-term, and one patient had a cesarean section preterm followed by comprehensive staging surgery of ovarian cancer.ConclusionBased on the data we included, LESS performed by experienced surgeons appeared to be a safe and feasible alternative to multiport laparoscopic surgery for the management of selected patients with adnexal disease during pregnancy. More studies with large sample sizes at multiple centers are warranted.

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Surgical Management of Adnexal Masses in Pregnancy: A Systematic Review and Meta-analysis

Cited by 19 publications

References 44 publications

Nonobstetric surgery during pregnancy in Finland during a 21‐year period: A register‐based study

Nonobstetric surgery during pregnancy in Finland during a 21‐year period: A register‐based study

The risk of miscarriage following surgical treatment of heterotopic extrauterine pregnancies

Laparoendoscopic single-site surgery for adnexal disease during pregnancy: A single-center preliminary experience

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