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The value of routine ultrasound screening for adnexal masses at the 11–14 weeks early anomaly scan
Author(s) -
Salim R.,
Woelfer B.,
Aslam N.,
Elson J.,
Jurkovic D.
Publication year - 2001
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1046/j.1469-0705.2001.0180s1009.x
Subject(s) - medicine , asymptomatic , gestation , ovary , cyst , pregnancy , ovarian cyst , obstetrics , malignancy , ultrasound , products of conception , radiology , gynecology , prospective cohort study , surgery , pathology , genetics , biology
Purpose: To investigate the feasibility and possible advantages of routine screening for ovarian pathology in asymptomatic pregnant women at 11–14 weeks' gestation. Methods: Pregnant women attending for a routine early anomaly scan at 11–14 weeks' gestation were invited to participate in this prospective study. In all cases, an attempt was made to visualize the ovaries on transabdominal ultrasound scan. The presence of all visible cysts was recorded. Small simple cysts <5 cm in diameter were all managed expectantly with no follow up. All women with a simple cyst >5 cm in diameter or a complex ovarian cyst had a detailed gynecological scan including color Doppler blood flow studies and serum tumor markers. Surgical intervention was offered only to women with clinical symptoms suggestive of cyst complications or those with ultrasound findings suggestive of malignancy. All other women were management expectantly until six weeks after delivery, when they were either discharged from follow up or were offered a definitive surgical intervention. Results: A total of 2925 women were included into the study. Both ovaries were seen in 1755 (60%) of women, only one ovary was seen in 614 (21%) and neither ovary was seen in 556 (19%). The presence of an ovarian cyst was recorded in 728 (25%) women. A total of 400 (55%) of these were small simple cysts which did not warrant further follow up, whilst 328 (45%) had further scans. Two hundred and seventy‐eight of these cysts resolved spontaneously during pregnancy, two required surgical intervention in pregnancy, four were removed at cesarean section and 40 were still present on the postpartum scan. At postpartum scan, 11 women opted for further expectant management. The ultrasound diagnosis in these cases was dermoid cyst (8), endometrioma (2) and peritoneal pseudocyst (1). Histological diagnoses in 33 women who had surgery were: dermoid cyst (12) and endometrioma (8) benign ovarian cystadenoma (5), luteoma of pregnancy (1), corpus luteum cyst (1), hydrosalpinx (3) and fimbrial cyst (3). Six women were lost to follow up. Conclusions: Asymptomatic ovarian cysts detected at routine ultrasound screening in the first trimester are unlikely to be malignant or cause clinical symptoms later in pregnancy. The policy of routine examination of the ovaries in pregnancy should therefore be discouraged.