Course of labor and condition of the newborn in women affected by benign ovarian tumors

Keywords: ovarian tumors and pregnancy, fetal distress, miscarriage.

Abstract

Annotation. According to various estimations, the incidence of adnexal neoplasms during pregnancy makes up from 0.19% to 8.8%. Most of cases are diagnosed in the first trimester and their incidence gradually decreases as the period of pregnancy grows. Depending on their size and location, ovarian tumors may be related to an adverse obstetrical result caused by mechanical influence. They increase the risk of abortion (from 0 to 6%), preterm labor (from 5.8% to 10.4%) and mechanical impediment to labor. Aim – studying the peculiarities of the course of labor and the condition of the newborn of women affected by benign ovarian tumors. We have conducted a complex examination of 67 pregnant women with benign ovarian tumors and tumor-like growths found before pregnancy or in the first trimester of gestation (basic group) and 50 women presenting no ovarian neoplasms or any other severe gynecological or somatic pathology (reference group). To identify the risk factors, the basic group was divided into 2 subgroups. The condition of fetuses was assessed with the use of automated cardiotocography analysis based on the Dawes/Redman criteria, with the calculation of the short-term variability (STV). The mean and standard deviation (M ± m) were evaluated at a significance level of p <0.05. Categorical variables are presented as the absolute number of cases in the group and the frequency in percent – n (%). Tests for differences between independent samples in the case of quantitative variables were performed using Student’s t test, the Mann-Whitney rank test, and in the case of categorical variables using Fisher’s exact test. The obtained results suggest that the course of labor in women affected by benign ovarian neoplasms is characterized by an increased incidence of complications. A significant difference has been established in the incidence of cesarean sections (35.8% vs 8.0% in the reference group, р<0.05), preterm labor (28.4% vs. 6.0%, р<0.05), fetal distress (19.4% vs. 8.0%, р<0.05) and preterm rupture of membranes (17.9% vs. 6.0%, р<0.05). The incidence of almost all complications of labor in Subgroup 1 significantly exceeds the figures from the reference group and the incidence of preterm labor and fetal distress is also higher in comparison with Subgroup 2. The presence of extragenital pathology is a well-known risk factor for perinatal complications, which is also confirmed by our research. A high level of comorbidity of benign ovarian neoplasms with various extragenital diseases also accounts to a certain degree for gestational complications. Thus, pregnancy in women affected by ovarian tumors implies an increased risk of obstetrical and perinatal complications, in particular, threats of miscarriage and preterm labor. The studies of this issue lack systematization, are often controversial and fragmentary. There has been practically no research on the risk factors for such complications and the ways of their prognostication and prevention.

Downloads

Download data is not yet available.

References

[1] Arena, S., Canonico, S., Luzi, G., Epicoco, G., Brusco, G., & Affronti, G. (2009). Ovarian torsion in in vitro fertilization-induced twin pregnancy: combination of Doppler ultrasound and laparoscopy in diagnosis and treatment can quickly solve the case. Fertil. Steril., 92(4), 1496.e9-13. doi:0.1016/j.fertnstert.2009.06.029
[2] Benaglia, L., Bermejo, A., Somigliana, E., Somigliana, E., Scarduelli, C., Ragni, G., … & Garcia-Velasco, J. A. (2012). Pregnancy outcome in women with endometriomas achieving pregnancy through IVF. Hum. Reprod., 27(6), 1663-1667. doi: 10.1093/humrep/des054
[3] Benaglia, L., Somigliana, E., Calzolari, L., Busnelli, A., Cardellicchio, L., Ragni, G., & Fedele, L. (2013). Thevanishing endometrioma: the intriguing impact ofpregnancy on small endometriotic ovarian cysts. Gynecol. Endocrinol., 29(9), 863-866. doi: 10.3109/09513590.2013.813476
[4] Chiang, G., & Levine, D. (2004). Imaging of adnexal masses in Pregnancy. J Ultrasound Med., 23(6), 805-819. doi: 10.7863/jum.2004.23.6.805
[5] Condous, G., Khalid, A., Okaro, E., & Bourne, T. (2004). Shouldwe be examining the ovaries in pregnancy? Prevalence and natural history of adnexal pathologydetected at first-trimester sonography. Ultrasound Obstet. Gynecol., 24(1), 62-66. doi: 10.1002/uog.1083
[6] Fruscella, E., Testa, A. C., Ferrandina, G., Manfredi, R., Zannoni, G. F., Ludovisi, M., … & Scambia, G. (2004). Sonographic features of decidualized ovarianendometriosis suspicious for malignancy. Ultrasound Obstet. Gynecol., 24(5), 578-580. doi: 10.1002/uog.1736
[7] Glanc, P., Salem, S., & Farine, D. (2008). Adnexal masses in pregnant patient: a diagnostic and management challenge. Ultrasound Q, 24(4), 225-240. doi: 10.1097/RUQ.0b013e31819032f
[8] Groszmann, Y., Howitt, B. E., Bromley, B., Feltmate, C. M., & Benacerraf, B. R. (2014). Decidualized endometrioma masquerading as ovarian cancer in pregnancy. J. Ultrasound Med., 33(11), 1909-1915. doi: 10.7863/ultra.33.11.1909
[9] Guerriero, S., Ajossa, S., Piras, S., Parodo, G., & Melis, G. B. (2005). Serial ultrasonographic evaluation of a decidualized endometrioma in pregnancy. Ultrasound Obstet. Gynecol., 26(3), 304-306. doi: 10.1002/uog.1986
[10] Hermans, R. H. M., Fischer, D.-C., van der Putten, H. W. H. M., van de Putte, G., Einzmann, T., Vos, M. C., & Kieback, D. G. (2003). Adnexal Masses in Pregnancy. Oncologie, 26(2), 167-172. doi: 10.1159/000069838
[11] Hua, D., Zhao, P., & Jiang, L. (2019). Torsion of ovarian endometrioma in pregnancy: a case report and review of the literature. Trop Doct., 49(3), 221-223. doi: 10.1177/0049475519847327
[12] Katulski, K., Czyzyk, A., Podfigurna-Stopa, A., Genazzani, A. R., & Meczekalski, B. (2015). Pregnancy complications in polycystic ovary syndrome patients. Gynecol Endocrinol., 31(2), 87-91. doi: 10.3109/09513590.2014.974535
[13] Krivokulsky, B. D, & Zhulkevich, I. V. (2018). Ризик адаптовані підходи до профілактики тромботичних ускладнень при гістеректомії [Risk adapted approaches to prophylaxis of thrombotic complications at gisterectomy]. Шпитальна хірургія. Журнал імені Л. Я. Ковальчука – Kovalchuk Magazine, 2, 78-83.
[14] Krivokulsky, B. D., Krivokulsky, D. B., & Zhulkevich, I. V. (2014). Динаміка змін гемостатичного потенціалу на операційному етапі лікування пацієнтів з пухлинними захворюваннями жіночої статевої системи [Dynamics of changer of memostatic potential on the operational phase of the treatment of patients with malignant diseases of the female reproductive system]. Шпитальна хірургія – Hospital surgery, 4, 92-96.
[15] Rehmer, J. M., Flyckt, R. L., Goodman, L. R., & Falcone, T. (2019). Management of Endometriomas. Obstet. Gynecol Surv., 74(4), 232-240. doi: 10.1097/OGX.0000000000000660
[16] Schmeler, K., Mayo-Smith, W., Peipert, J. F., Weitzen, S., Manuel, M. D., Gordinier, M. E. (2005). Adnexal masses in pregnancy: Surgery compared with observation. Obstet. Gynecol., 105(5, 1), 1098-1103. doi: 10.1097/01.AOG.0000157465.99639.e5
[17] Sherard, G. B. 3rd, Hodson, C. A., Williams, H. J., Semer, D. A., Hadi, H. A., & Tait, D. L. (2003). Adnexal masses andpregnancy: a 12-year experience. Am. J. Obstet. Gynecol., 189(2), 358-362. doi: 10.1067/s0002-9378(03)00731-2
[18] Tamura, H., Takasaki, A., Taniguchi, K., Matsuoka, A., Shimamura, K., & Sugino, N. (2008). Changes in blood-flow impedance of the human corpus luteum throughout the luteal phase and during early pregnancy. Fertil Steril., 90(6), 2334-2339. doi: 10.1016/j.fertnstert.2007.10.056
[19] Timmerman, D., Testa, A. C., Bourne, T., Ameye, L., Jurkovic, D., Van Holsbeke, C., … & Valentin, L. (2008). Simple ultrasound-based rules for the diagnosis of ovariancancer. Ultrasound Obstet Gynecol., 31(6), 681-690. doi: 10.1002/uog.5365
[20] Timmerman, D., Valentin, L., Bourne, T. H., Collins, W. P., Verrelst, H., & Vergote, I. (2000). Terms, definitions and measurements to describethe sonographic features of adnexal tumors:a consensus opinion from the International OvarianTumor Analysis (IOTA) Group. Ultrasound Obstet Gynecol., 16(5), 500-505. doi: 10.1046/j.1469-0705.2000.00287.x
[21] Timor-Tritsch, I. E., Monteagudo, A., Santos, R., & Holcomb, K. (2006). Decidualized hypervascularized ovarian endometrioma in pregnancy: can it be distinguished fromcancer to avoid surgery? Ultrasound Obstet Gynecol., 28(4), 508. DOI:10.1002/uog.3376
[22] Yu, H.-F., Chen, H.-S., Rao, D.-P., & Gong, J. (2016). GongAssociation between polycystic ovary syndrome and the risk of pregnancy complications: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore), 95(51), e4863. doi: 10.1097/MD.0000000000004863
Published
2021-09-23
How to Cite
Hulii, D. Y., & Boichuk, O. H. (2021). Course of labor and condition of the newborn in women affected by benign ovarian tumors. Reports of Vinnytsia National Medical University, 25(3), 413-418. https://doi.org/10.31393/reports-vnmedical-2021-25(3)-11