scholarly journals Adnexal Masses in Pregnancy: Diagnosis and Management

2007 ◽  
Vol 1 (4) ◽  
pp. 66-74 ◽  
Author(s):  
George M Graham
Keyword(s):  
Surgical Intervention ◽  
Adnexal Mass ◽  
Ultrasound Images ◽  
List Type ◽  
Management Options ◽  
Safe Alternative ◽  
Adnexal Masses ◽  
Increased Risk ◽  
Adverse Pregnancy ◽  
In Pregnancy

Abstract The widespread use of ultrasound in obstetrics has led to an increase in the diagnosis of asymptomatic adnexal masses in pregnancy. Ultrasound is an accurate and safe method for diagnosing the etiology of an adnexal mass and distinguishing benign from malignant pathology. The management of an adnexal mass in pregnancy is controversial. Historically, it was recommended that any adnexal mass be removed electively in the second trimester to exclude malignancy and prevent complications such as torsion, rupture, and obstruction of labor. More recent recommendations have limited surgical intervention in pregnancy to symptomatic adnexal masses and those that are highly suggestive of malignancy. Surgery in pregnancy is associated with an increased risk of adverse pregnancy outcomes. However, laparoscopy appears to be a safe alternative to laparotomy for benign masses when performed by experienced surgeons. Learning objectives To list the differential diagnoses of adnexal masses in pregnancy To interpret ultrasound images of adnexal masses and distinguish benign from malignant masses To describe the management options for adnexal masses in pregnancy, including the indications and options for surgical intervention.

scholarly journals Sleep disordered breathing in pregnancy

Breathe ◽  
2015 ◽  
Vol 11 (4) ◽  
pp. 268-277 ◽  
Author(s):  
Bilgay Izci Balserak
Keyword(s):  
Risk Factors ◽  
Pregnancy Outcomes ◽  
Sleep Disordered Breathing ◽  
Adverse Pregnancy Outcomes ◽  
List Type ◽  
Management Options ◽  
Fetal Outcomes ◽  
Adverse Pregnancy ◽  
In Pregnancy ◽  
Disordered Breathing

Key pointsSleep disordered breathing (SDB) is common and the severity increases as pregnancy progresses.Frequent snoring, older age and high pre-pregnancy body mass index (>25 kg⋅m−2) could be reliable indicators for SDB in early pregnancy.SDB screening tools, including questionnaires, used in the nonpregnant population have poor predictive ability in pregnancy.Accumulating evidence suggests that SDB during pregnancy may be associated with increased risk of adverse pregnancy outcomes, including gestational diabetes and pre-eclampsia. However, the results should be interpreted cautiously because several studies failed to adjust for potential maternal confounders and have other study limitations.There are no pregnancy-specific practice guidelines for SDB treatment. Many clinicians and practices follow recommendations for the treatment in the general population. Women with pre-existing SDB might need to be reassessed, particularly after the sixth month of pregnancy, because symptoms can worsen with nasal congestion and weight gain.Educational aimsTo highlight the prevalence and severity of sleep disordered breathing (SDB) in the pregnant population.To inform readers about risk factors for SDB in pregnancy.To explore the impact of SDB on adverse maternal and fetal outcomes, and biological pathways for associated adverse maternal and fetal outcomes.To introduce current management options for SDB in pregnancy, including medical and behavioural approaches.Sleep disordered breathing (SDB) is very common during pregnancy, and is most likely explained by hormonal, physiological and physical changes. Maternal obesity, one of the major risk factors for SDB, together with physiological changes in pregnancy may predispose women to develop SDB. SDB has been associated with poor maternal and fetal outcomes. Thus, early identification, diagnosis and treatment of SDB are important in pregnancy. This article reviews the pregnancy-related changes affecting the severity of SDB, the epidemiology and the risk factors of SDB in pregnancy, the association of SDB with adverse pregnancy outcomes, and screening and management options specific for this population.

Adnexal Masses in Pregnancy

2016 ◽  
Vol 10 (1) ◽  
pp. 78-82
Author(s):  
Harris Sara ◽  
Ausbeck Elizabeth ◽  
Goh William
Keyword(s):  
Obstet Gynecol ◽  
Adnexal Mass ◽  
Asymptomatic Patient ◽  
Expectant Management ◽  
First Trimester ◽  
Management Options ◽  
Adnexal Masses ◽  
Review Management ◽  
Laparoscopic Removal ◽  
In Pregnancy

ABSTRACT With the increased use of ultrasound in the first trimester, up to 4.5% of all pregnancies are diagnosed with an adnexal mass. The management of asymptomatic adnexal masses in pregnancy continues to be controversial. Potential complications include torsion and malignancy. This review will highlight the utility of ultrasound in generating a differential diagnosis for an adnexal mass based on their ultrasound characteristics. It will also review management options for the asymptomatic patient including expectant management and laparoscopic removal. How to cite this article Harris S, Ausbeck E, Goh W. Adnexal Masses in Pregnancy. Donald School J Ultrasound Obstet Gynecol 2016;10(1):78-82.

scholarly journals Maternal and Neonatal Outcomes Associated with Psychostimulant Use in Pregnancy

2020 ◽  
Vol 5 (5) ◽  
Author(s):  
Ximena Camacho ◽  
Alys Havard ◽  
Helga Zoega ◽  
Margaret Wilson ◽  
Tara Gomes ◽  
...  
Keyword(s):  
Birth Outcomes ◽  
Neonatal Intensive Care ◽  
Low Birthweight ◽  
Cohort Analysis ◽  
Neonatal Outcomes ◽  
Increased Risk ◽  
The Usa ◽  
Maternal And Neonatal Outcomes ◽  
Adverse Pregnancy ◽  
In Pregnancy

IntroductionRecent evidence from the USA and Nordic countries suggests a possible association between psychostimulant use during gestation and adverse pregnancy and birth outcomes. Objectives and ApproachWe employed a distributed cohort analysis using linked administrative data for women who gave birth in New South Wales (NSW; Australia) and Ontario (Canada), whereby a common protocol was implemented separately in each jurisdiction. The study population comprised women who were hospitalized for a singleton delivery over an 8 (NSW) and 4 (Ontario) year period, respectively, with the NSW cohort restricted to social security beneficiaries. Psychostimulant exposure was defined as at least one dispensing of methylphenidate, amphetamine, dextroamphetamine or lisdexamfetamine during pregnancy. We examined the risk of maternal and neonatal outcomes among psychostimulant exposed mothers compared with unexposed mothers. ResultsThere were 140,356 eligible deliveries in NSW and 449,499 in Ontario during the respective study periods. Fewer than 1% of these pregnancies were exposed to psychostimulants during gestation, although use was higher in Ontario (0.30% vs 0.11% in NSW). Preliminary unadjusted analyses indicated possible associations between psychostimulant use in pregnancy and higher risks of pre-term birth (relative risk [RR] 1.7, 95% confidence interval [CI] 1.4-2.0 (Ontario); RR 1.8, 95% CI 1.2-2.6 (NSW)) and pre-eclampsia (RR 2.0, 95% CI 1.5-2.6 (Ontario); RR 2.0, 95% CI 1.2-3.5 (NSW)). Similarly, psychostimulant use was associated with higher risks of low birthweight (RR 1.6, 95% CI 1.3-1.9 (Ontario); RR 2.0, 95% CI 1.3-3.0 (NSW)) and admission to neonatal intensive care (RR 2.1, 95% CI 1.9-2.3 (Ontario); RR 1.5, 95% CI 1.1-1.9 (NSW)). Conclusion / ImplicationsUnadjusted analyses indicate an increased risk of adverse maternal and birth outcomes associated with psychostimulant exposure during pregnancy, potentially representing a placental effect. We are currently refining the analyses, employing propensity score methods to adjust for confounding.

scholarly journals P116 A systematic review of the safety of non-tumour necrosis factor inhibitor and targeted synthetic drugs in rheumatic disease in pregnancy

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Hanh Nguyen ◽  
Kawser Ahmed ◽  
Julia Flint ◽  
Ian Giles
Keyword(s):  
Systematic Review ◽  
Tumour Necrosis Factor ◽  
Tumour Necrosis ◽  
Final Analysis ◽  
Tumour Necrosis Factor Inhibitor ◽  
Increased Risk ◽  
Factor Inhibitor ◽  
Adverse Pregnancy ◽  
Necrosis Factor ◽  
In Pregnancy

Abstract Background Despite increasing evidence to support safe use of tumour necrosis factor inhibitor (TNFi) drugs in pregnancy, there remains a paucity of evidence regarding non-TNFi and targeted synthetic disease modifying anti-rheumatic drugs (tsDMARDs) in pregnancy. Therefore, we conducted a systematic review to summarise use of these drugs in pregnancy and breastfeeding. Methods Systematic search of databases including; EMBASE, Pubmed (MEDLINE), and Cochrane up to December 2018 using keywords including; commonly prescribed non-TNFi and tsDMARDs, pregnancy, conception/pre-conception, lactation/breastfeeding, childhood and vaccination/infection. Results From an initial screen of 700 papers, n = 92 full text papers were included in the final analysis. A summary of findings from known outcomes of pregnancy and breastfeeding exposures as well as long-term follow-up of infants where available are shown in Table 1. Overall, this data does not identify an increased risk of adverse pregnancy outcomes with these drugs in this population of patients. Conclusion These findings do not suggest an increased risk of non-TNFi and tsDMARDs in pregnancy. Given that the total number of exposures, however, remain limited these drugs should only be considered in pregnancy if the benefit of maintaining disease control in the mother justifies any potential risk to the fetus. This body of evidence will be useful when counselling women about the potential risks of using these types of drugs during pregnancy and breastfeeding period as well as following accidental exposure to drugs at conception. Disclosures H. Nguyen None. K. Ahmed None. J. Flint None. I. Giles None.

First epidemiological data for venotonics in pregnancy from the EFEMERIS database

2015 ◽  
Vol 31 (5) ◽  
pp. 344-348 ◽  
Author(s):  
Isabelle Lacroix ◽  
Anna-Belle Beau ◽  
Caroline Hurault-Delarue ◽  
Claire Bouilhac ◽  
Dominique Petiot ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Adverse Pregnancy Outcome ◽  
Pregnancy Termination ◽  
Newborn Health ◽  
Control Group ◽  
Published Data ◽  
Intrauterine Death ◽  
Increased Risk ◽  
Adverse Pregnancy ◽  
In Pregnancy

Objective There are few published data about possible effects of veinotonics in pregnant women. The present study investigates potential adverse drug reactions of veinotonics in pregnancy. Method EFEMERIS is a database including prescribed and dispensed reimbursed drugs during pregnancy (data from Caisse Primaire d’Assurance Maladie) and outcomes (data from Maternal and Infant Protection Service and Antenatal diagnostic Centre). Women who delivered from 1 July 2004 to December 2007 in Haute-Garonne and were registered in the French Health Insurance Service have been included in the EFEMERIS database. We compared pregnancy outcomes and newborn health between women exposed to veinotonics during pregnancy and unexposed women. Results We found that 8998 women (24%) had received at least one prescription for venotonic agents during their pregnancy, corresponding to the period of organogenesis in 1200 cases. We compared data for these women with those for the 27,963 women for whom these drugs were not prescribed during pregnancy. The most widely used veinotonics were hesperidin, diosmin and troxerutin. Pregnancies led to 98.4% versus 93.6% of live births, 0.2% versus 0.2% of postnatal deaths and 1.6% versus 6.4% of pregnancy termination (miscarriage, ectopic pregnancy, medical termination, intrauterine death) in exposed and non-exposed groups, respectively. The risks of pregnancy termination (HR = 0.71 (0.60–0.84)) and prematurity (HR = 0.82 (0.73–0.93)) remained significantly lower in the women exposed to venotonics than in unexposed women. In the group of newborns whose mother had a prescription of veinotonics during organogenesis, 39 out of 1200 (3.4%) had a malformation versus 789 (3.0%) in the control group (ORa = 1.134 (0.873–1.472)). The risk of neonatal diseases was not increased by exposure to venotonic agents in the third trimester (4.9% versus 6.1% for the controls, ORa = 1.07 (0.95–1.20)). Conclusion We found no increased risk of adverse pregnancy outcome among women exposed to veinotonics compared with unexposed pregnant women.

scholarly journals Chronic hypertension in pregnancy: impact of ethnicity and superimposed preeclampsia on placental, endothelial, and renal biomarkers

2018 ◽  
Vol 315 (1) ◽  
pp. R36-R47 ◽  
Author(s):  
Louise M. Webster ◽  
Carolyn Gill ◽  
Paul T. Seed ◽  
Kate Bramham ◽  
Cornelia Wiesender ◽  
...  
Keyword(s):  
Black Women ◽  
Adverse Pregnancy Outcome ◽  
Plasma Concentrations ◽  
Chronic Hypertension ◽  
Creatinine Ratio ◽  
Hypertension In Pregnancy ◽  
Increased Risk ◽  
Pregnancy And Postpartum ◽  
Adverse Pregnancy ◽  
In Pregnancy

Black ethnicity is associated with worse pregnancy outcomes in women with chronic hypertension. Preexisting endothelial and renal dysfunction and poor placentation may contribute, but pathophysiological mechanisms underpinning increased risk are poorly understood. This cohort study aimed to investigate the relationship between ethnicity, superimposed preeclampsia, and longitudinal changes in markers of endothelial, renal, and placental dysfunction in women with chronic hypertension. Plasma concentrations of placental growth factor (PlGF), syndecan-1, renin, and aldosterone and urinary angiotensinogen-to-creatinine ratio (AGTCR), protein-to-creatinine ratio (PCR), and albumin-to-creatinine ratio (ACR) were quantified during pregnancy and postpartum in women with chronic hypertension. Comparisons of longitudinal biomarker concentrations were made using log-transformation and random effects logistic regression allowing for gestation. Of 117 women, superimposed preeclampsia was diagnosed in 21% ( n = 25), with 24% ( n = 6) having an additional diagnosis of diabetes. The cohort included 63 (54%) women who self-identified as being of black ethnicity. PlGF concentrations were 67% lower [95% confidence interval (CI) −79 to −48%] and AGTCR, PCR, and ACR were higher over gestation, in women with subsequent superimposed preeclampsia (compared with those without superimposed preeclampsia). PlGF <100 pg/ml at 20–23.9 wk of gestation predicted subsequent birth weight <3rd percentile with 88% sensitivity (95% CI 47–100%) and 83% specificity (95% CI 70–92%). Black women had 43% lower renin (95% CI −58 to −23%) and 41% lower aldosterone (95%CI −45 to −15%) concentrations over gestation. Changes in placental (PlGF) and renal (AGTCR/PCR/ACR) biomarkers predated adverse pregnancy outcome. Ethnic variation in the renin-angiotensin-aldosterone system exists in women with chronic hypertension in pregnancy and may be important in treatment selection.

scholarly journals Lingual thyroid gland: it’s time for awareness

2020 ◽  
Vol 2020 ◽  
Author(s):  
Nicolás Cruz-Dardíz ◽  
Nadyeschka Rivera-Santana ◽  
Marina Torres-Torres ◽  
Héctor Cintrón-Colón ◽  
Shayanne Lajud ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Hormone Replacement ◽  
Thyroid Tissue ◽  
Size Reduction ◽  
Ectopic Thyroid ◽  
Lingual Thyroid ◽  
List Type ◽  
Management Options ◽  
Ectopic Thyroid Tissue ◽  
Ectopic Tissue

Summary Lingual thyroid (LT) gland is the most common type of ectopic thyroid tissue, but it is an extremely rare presentation. We present a case of a 41-year-old Hispanic female patient complaining of dysphonia and dysphagia. As part of the evaluation, fiber optic flexible indirect laryngoscopy (FIL) was performed which revealed a mass at the base of the tongue. The morphological examination was highly suspicious for ectopic thyroid tissue and the diagnosis was confirmed with neck ultrasound and thyroid scintigraphy. Although the patient presented subclinical hypothyroidism, levothyroxine therapy was initiated with a favorable response which included resolution of symptoms and mass size reduction. Our case portrays how thyroid hormone replacement therapy (THRT) may lead to a reduction in the size of the ectopic tissue and improvement of symptoms, thus avoiding the need for surgical intervention which could result in profound hypothyroidism severely affecting the patients’ quality of life. Learning points: Benign LT and malignant LT are indistinguishable clinically and radiographically for which histopathology is recommended. THRT, radioactive iodine 131 (RAI) therapy, and surgical excision are potential management options for LT. THRT may lead to size reduction of the ectopic tissue and resolution of symptoms avoiding surgical intervention.

scholarly journals Ovarian cyst mimicking acute appendicitis in pregnancy: A case report

2021 ◽  
Vol 8 (3) ◽  
pp. 431-433
Author(s):  
Vijay Verma ◽  
Supriya ◽  
Ravi Verma
Keyword(s):  
Acute Appendicitis ◽  
Ovarian Cyst ◽  
Surgical Intervention ◽  
Ovarian Cysts ◽  
Adnexal Masses ◽  
Emergency Intervention ◽  
Large Ovarian Cyst ◽  
Asymptomatic Women ◽  
Ovarian Masses ◽  
In Pregnancy

Ovarian cysts, also known as ovarian masses or adnexal masses are fluid filled sacs or pockets in an ovary or on its surface. These are found incidentally in asymptomatic women. Ovarian cysts are considered large in size when they are over 5 cm and giant when they are over 15 cm. Acute appendicitis is the most common surgical problem encountered during pregnancy. Pregnancy is associated with various anatomic and physiologic changes that may disguise and delay the diagnosis of acute appendicitis. Antibiotic treatment does not always improve the outcome and emergency intervention is required. Early diagnosis and surgical intervention is mandatory for the eventful outcome of pregnancy. Here we present a case of a primigravida patient with a large ovarian cyst mimicking acute appendicitis.

scholarly journals Investigation and Management of Adnexal Masses in Pregnancy

Scientifica ◽  
2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
João Cavaco-Gomes ◽  
Cátia Jorge Moreira ◽  
Anabela Rocha ◽  
Raquel Mota ◽  
Vera Paiva ◽  
...  
Keyword(s):  
Tumor Markers ◽  
Low Risk ◽  
Second Trimester ◽  
Adnexal Masses ◽  
Increased Risk ◽  
Risk Of Malignancy ◽  
Safe Technique ◽  
Epithelial Neoplasms ◽  
Medical Approach ◽  
In Pregnancy

Adnexal masses can be found in 0.19 to 8.8% of all pregnancies. Most masses are functional and asymptomatic and up to 70% resolve spontaneously in the second trimester. The main predictors of persistence are the size (>5 cm) and the imagiological morphocomplexity. Those that persist carry a low risk of malignancy (0 to 10%). Most malignant masses are diagnosed at early stages and more than 50% are borderline epithelial neoplasms. Ultrasound is the preferred method to stratify the risk of complications and malignancy, allowing medical approach planning. Pregnancy and some gestational disorders may modify the levels of tumor markers, whereby their interpretation during pregnancy should be cautious. Large masses are at increased risk of torsion, rupture, and dystocia. When surgery is indicated, laparoscopy is a safe technique and should ideally be carried out in the second trimester of pregnancy.

Adnexal mass in pregnancy

2021 ◽  
Vol 10 (3) ◽  
pp. 1154
Author(s):  
Marilia Lima Freixo ◽  
Elisa Soares ◽  
Maria Liz Coelho ◽  
Fernanda Costa ◽  
Ana Rita Pinto
Keyword(s):  
Best Management Practices ◽  
Management Practices ◽  
Total Abdominal Hysterectomy ◽  
First Trimester ◽  
Abdominal Hysterectomy ◽  
Adnexal Masses ◽  
Best Management ◽  
Increased Risk ◽  
The Right ◽  
In Pregnancy

Adnexal masses in pregnancy are a rare finding. The majority of these masses are discovered incidentally during routine follow-up. The differential diagnosis of adnexal masses discovered during pregnancy is broad and the management of such lesions has been a subject of debate for years with no consensus regarding the best management plan. We report a case of a 38 year-old pregnant woman who was diagnosed at the time of the first trimester ultrasound with a multilocular solid arising form the right ovary. A laparoscopy followed by left oophorectomy was performed at 22 weeks and the definitive histology revealed a borderline ovarian cyst/proliferative mucinous atypical cyst. The patient delivered via vaginal at 38 weeks of gestation. This case was discussed and a secondary staging surgery (peritoneal washing, total abdominal hysterectomy, salpingo-oophorectomy, omentectomy, appendectomy, and peritoneal biopsies) was performed with no evidence of disease found. The surgical approach is controversial due to the increased risk of complications. In the absence of large prospective randomized trials it is difficult to know which are the best management practices and especially to determine the right moment during pregnancy to perform surgery in these patients. 

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