TOG - Adnexal masses in pregnancy and Appendicitis in Pregnancy

Question 1

what is the overall incidence of adnexal masses identified at USS in pregnancy?

Answer 1

4%

Question 2

what is the incidence of ovarian pathology detected at caesarean section?

Answer 2

0.5%

Question 3

what is the overall incidence of ovarian canver in pregnancy

Answer 3

0.004-0.04%

Question 4

what is the most common type of ovarian mass diagnosed in pregnancy?

Answer 4

Simple.

If complex-looking= Benign teratomas, endometriomas

Question 5

what is the incidence of complex/ persistent cysts measuring >6cm in pregnancy? what percentage of these are complex?

Answer 5

0.07%.

75% of them are complex looking on USS

Question 6

If ovarian cancer is diagnosed in pregnancy, what type of tumour is commonly identified?

Answer 6

early stage borderline tumours

Question 7

How do endometriotic cysts and dermoid cysts appear differently on MRI?

Answer 7

endometriotic: high signal, homogenous on T1, low signal intensity on T2
dermoid: high fat and sebum content easily identified.High signal intensity on T1, Low signal intensity on fat signal suppressed images.

Question 8

if a simple ovarian cyst, <5cm is identified in pregnancy, what is the management?

Answer 8

no further investigation. Re-scanning only necessary if clinical indication

Question 9

if a complex ovarian cyst is found in pregnancy- eg. solid and cystic elements of 3cm size, what is the management?

Answer 9

needs further evaluation irrespective of size.

further uss assessment every 4 weeks to see if its getting bigger.

Question 10

what type of adnexal masses are more likely to undergo torsion?

Answer 10

dermoid, cystadenoma

Question 11

if adnexal mass undergoes torsion in pregnancy, when and which side is this likely to occur?

Answer 11

torsion likely in first trimester, or immediate puerperium.

More commonly occurs on right side.

Question 12

if a woman presents with dermoid cyst in pregnancy (seen on USS) <6cm, what is the management

Answer 12

dermoids <6cm unlikely to grow significantly in pregnancy.

Rescan in post-natal period to determine management if hasn’t resolved spontaneously

Question 13

if woman presents with 10cm simple ovarian cyst in pregnancy, which is causing pain/ affecting position of baby or obstructing labour, what is management?

Answer 13

USS guided aspiration- TV or TA using needle >20 gauge (fine).

Question 14

what percentage of simple cysts, aspirated in pregnancy, will recur?

Answer 14

33-50%

Question 15

at what gestation should simple ovarian cyst aspiration be done?

Answer 15

after 14/40 to avoid disturbance to corpus luteum

Question 16

what percentage of ovarian cysts can under go torsion?

Answer 16

up to 5%

Question 17

what are the main complications of ovarian cysts in pregnancy

Answer 17

cyst rupture, cyst haemorrhage, torsion, obstructed labour, fetal malpresentation

Question 18

if a simple ovarian cyst less than 5 cm is identified at caesarean section, what is the management?

Answer 18

leave alone.

Question 19

if an ovarian cyst that looks bigger than 5cm, or appears complex, seen at caesarean section, what is the management?

Answer 19

cystectomy

Question 20

if malignant looking ovarian cyst is seen at caesarean section, what is the management?

Answer 20

after cyst removal inspect contents- if any signs of malignancy- eg solid excrescences(abnormal outgrowth); remove ovary
examine contralateral ovary thoroughly +/- biopsy

Question 21

What is the fetal loss rate in appendicitis?

Answer 21

Simple - 1.5%
Generalised peritonitis - 6%
Perforation - 36%

Question 22

Up to what % of laparscopies for suspected appendicitis will be negative?

Answer 22

35%

Question 23

What are the risks of GA in a pregnant patient?

Answer 23

x 17-fold
3.3% failed intubation
Mendelssohn syndrome
Hypoxia

Question 24

What is the rate of preterm delivery if operated on for appendicities in second and third trimesters?

Answer 24

1% T2, 9% T3