MATERNO-FETAL MEDICINE Incidental adnexal masses removed at laparoscopic ligation and caesarean section Nupur Gupta • Vatsla Dadhwal • Deepika Deka • Suneeta Mittal Received: 14 August 2009 / Accepted: 15 September 2009 / Published online: 29 September 2009 Ó Springer-Verlag 2009 Dear Editors, The use of routine obstetrical ultrasound has made the detection of ovarian masses in pregnancy increasingly common. The accurate management of these masses at the time of surgery is an important clinical dilemma. The study aimed to evaluate the occurrence rates and the pathologic features of incidental adnexal masses removed at the time of laparoscopic ligation and caesarean section. This was a retrospective study of 15 adnexal masses that were diagnosed incidentally and removed during laparo- scopic ligation and caesarean section at All India Institute of Medical Sciences, New Delhi from the year July 1999 to January 2009. Exclusion criteria were women with a pre- operative diagnosis of an adnexal mass. The mean age of the study population was 25 years. Demographic characteristics were similar in both the groups (Table 1). During the study period, there were 10,800 laparoscopic ligations and 7,200 deliveries/30% caesarean sections (n = 2,160). Patients with laparoscopic ligation with or without pregnancy termination did not undergo a routine ultrasound scan in the preoperative per- iod except in one patient with specific symptoms of pain. In the second group with caesarean section, ultrasound was done in all patients in first and second trimester but not in third trimester. The incidence of adnexal masses removed at the time of laparoscopic ligation (n = 6) was 1 in 1,800 and at cae- sarean section (n = 9) was 1 in 233. During the study period, all the masses diagnosed at the time of operation were not removed. Cyst aspiration was performed in 3 patients, ovarian cystectomy in 10, ovariotomy in one and salpingectomy in one patient with tubal ectopic pregnancy. The three common pathological findings were simple cyst (8, 53.3%), dermoid cyst (4, 26.6%) and serous cystade- noma (1, 6.6%); ectopic pregnancy (tubal) and corpus luteal cyst were diagnosed in one patient each (6.6% each) (Table 1). The reported incidence of adnexal masses associated with pregnancy ranges from 1:80 to 1:2,200 deliveries [1]. In the literature, there are few studies describing incidental adnexal masses at caesarean section. Koonings reported one adnexal neoplasm for every 197 caesarean sections [2], Ustunyurt et al. 1 in 447 caesarean sections [3], Dede et al. 1 in 125 (0.8%) [4]. In our study, the incidence was 1 in 233 caesarean sections. The incidence has fallen over the years due to increase in prenatal care and widespread use of ultrasonography that has led to an earlier diagnosis of adnexal masses antenatally. In our study, the mean cyst size was 5.7 cm (range 3–7.5). One study by Ballard reported ovarian tumours associated with pregnancy ter- mination patients [5]. There were 93 adnexal masses among a total of 55,278 pregnancy terminations i.e. 1 in every 594 terminations (0.17%). Most common lesion was benign cystic teratoma. In our study, we have included patients undergoing laparoscopic ligation with or without pregnancy termination and the incidence was 1 in 1,800. To conclude, adnexa should be routinely inspected vig- ilantly during laparoscopic ligation and caesarean section. N. Gupta Á V. Dadhwal Á D. Deka Á S. Mittal Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India N. Gupta (&) Department of Obstetrics and Gynaecology, Fortis La Femme, Greater Kailash-2, New Delhi, India e-mail: nupurkothari2000@yahoo.com 123 Arch Gynecol Obstet (2010) 281:775–776 DOI 10.1007/s00404-009-1237-3