Management of adnexal masses in pregnancy

Key content Adnexal masses are commonly identified in pregnancy but they are rarely malignant. Most adnexal masses either resolve spontaneously or can be managed conservatively during pregnancy. Pregnancy may alter the serum levels of tumour markers, making the interpretation of results difficult. Surgery in pregnancy is indicated in cases of an acute abdomen and high suspicion of malignancy. In cases where there is a high suspicion of malignancy, a multidisciplinary approach is required taking into account the woman's age, gestation, parity, desire for fertility and the likely stage of disease. Learning objectives To be aware of the clinical presentation and ultrasound characteristics of clinically significant adnexal masses in pregnancy. To understand the limitations of investigations in pregnancy and the importance of a multidisciplinary approach in the management of complex adnexal masses. To be aware of the indications for surgery and evaluate the appropriateness, mode and timing of surgery in pregnancy.