The outcome of laparoscopic management of adnexal pathology complicating pregnancies

Nagendra Prasad, Sarojamma Chunchiah, R. Nagarathnamma, Nirmala Chandrashekar, Nirupama Y. Shivananjappa, Sherin A. Thampan


Background: Adnexal pathology found during pregnancy is relatively common and the reported incidences are population and investigation dependent. The most frequent types of adnexal masses are corpus luteum cysts, endometriomas, benign cystadenomas and mature cystic teratomas. The objective was to study the feasibility of laparoscopic management of adnexal pathology in pregnancy, maternal complications and fatal outcome. We have reported 25 cases of adnexal pathology complicating pregnancy, managed successfully laparoscopically with no maternal and fetal complications.

Methods: The study is based on the outcome of laparoscopic management of adnexal pathology in 25 pregnant women over period of eight years. Laparoscopy was done using three port technique, 10 mm umbilical or supra umbilical port for optics and two lateral ports for instrumentation. Cystectomy was the most common procedure.

Results: There was no intra or post-operative complication observed in the study. Successful obstetric outcome in all the patients with no complications was observed.

Conclusions: Laparoscopy is preferred for exploration and treatment of adnexal masses especially between 14 to 25 weeks of gestation.


Adnexal pathology, Pregnancy, Laparoscopy, Heterotropic pregnancy

Full Text:



Hess LW, Peaceman A, O’Brien WF, Winkel CA, Cruikshank DP, Morrison JC. Adnexal mass occurring with intrauterine pregnancy: report of fifty-four patients requiring laparotomy for definitive management. Am J Obstet Gynecol. 1988;158:1029-34.

Nezhat CR, Nezhat FR, Luciano AA, Siegler AM, Metzger DA, Nezhat CH, eds. Operative Gynecologic Laparoscopy: Principles and Techniques. New York: McGraw-Hill;1995:507.

Dimitry ES, Subak SR, Mills M, Margara R, Winston R. Nine cases of heterotopic pregnancies in 4 years of in-vitro fertilization. Fertil Steril. 1990;53(1):107-10.

David S, Yuval Y, Daniel SS, Mordechai G, Shlomo M, et al. Laparotomy vs Laparoscopy in the management of adnexal masses during pregnancy. Fertil Steril. 1999;71(5):955-60.

Platek DN, Henderson CE, Goldberg GL, Anderson CT, Boynton CJ, Peoples JB, et al. The management of a persistent adnexal mass in pregnancy. Am J Obstet Gynecol.1995;173:1236-40.

Mckellar DP, Anderson CT, Boynton CJ, Peoples JB. Cholecystectomy during pregnancy without fetal loss. Surg Gynecol Obstet. 1992;174:465-8.

Alexander GD, Brown EM. Physiologic alterations during pelvic laparoscopy. Am J Obstet Gynecol. 1969;105:1078-81.

Motew M, Ivankovich AD, Bieniarz J, Albrecht RF, Zahed B, Scommegna A. Cardiovascular effects and acid-base and blood gas changes during laparoscopy. Am J Obstet Gynecol. 1973;115:1002-12.

Fahim M, Rojansky N. Laproscopic surgery during pregnancy Obstet Gynecol. 2001;56:50-9.

Nezhat C, Sidman, Vernan HJ. The risk of carbon monoxide poisoining after prolonged laparoscopic surgery. Obstet Gynecol. 1996:85:771-4.