Risk analysis of torsion and malignancy for adnexal masses during pregnancy

Objective To find the risk factors of torsion and malignancy for adnexal tumors during pregnancy. Design Retrospective, historical cohort study. Setting University hospital. Patient(s) Patients from 1990 to 2004 with adnexal tumors ≥4 cm during pregnancy. Intervention(s) Surgery undertaken antepartum, concurrently with cesarean delivery, or postpartum. Main Outcome Measure(s) Tumor size, progression, pathology, incidence of malignancy, and torsion. Result(s) Almost all 213 managements analyzed had good surgical and obstetric outcomes. In 174 patients who were followed through pregnancy with known tumor existence, 14.84% ± 3.05% encountered tumor torsion. Adnexal masses with sizes between 6 and 8 cm had a significantly higher risk of torsion compared with other sizes (22.41% vs. 9.48%; odds ratio 2.8, 95% confidence interval [CI], [1.1, 6.6]). Sixty percent of the torsion happened between the 10th and 17th weeks of gestation, and only 5.9% happened after 20 weeks. The incidence of malignancy was 3.4%, while that of ovarian cancer was 2.3%. Tumor diameters ≥10 cm at initial diagnosis had a higher risk of malignancy versus smaller sizes (8.77% vs. 0.85%; odds ratio 11.2, 95% CI, [1.3, 97.9]), and tumor growth rates ≥3.5 cm/week also had a significantly higher risk of malignancy versus lower rates (8.33% vs. 0.88%; odds ratio 10.2, 95% CI, [1.0, 101.2]). Conclusion(s) Adnexal tumors bearing higher risks for torsion and malignancy should be strongly considered for an aggressive strategy of management during pregnancy.