management of a persistent adnexal mass in pregnancy

Our purpose was to evaluate the pathologic features and outcome of pregnancy. Complicated by a persistent adnexal mass that was managed conservatively or with surgical intervention. A review was performed of patients who were seen with an adnexal mass in pregnancy from January 1999 to June 2003. We included patients with simple or complex masses >/= 6m that were persistent on ultrasonographic evolution. We excluded cysts that spontaneously resolved by 16 weeks gestation and those diagnosed after delivery. Thirty one patients of 43.372 delivery were identified with persistent adnexal masses that met the above criteria. Nineteen [59%] of these patients had operative intervention, whereas 12[41%] were managed conservatively. Of the patient who had surgery, nine had functional cysts, six had mature cystic teratomas, and four had other benign cysts. Twelve patients were managed nonsurgically. Seven patients had conservative management, whereas five patients had percutaneous drainage of simple cysts [negative results on cytology study] that were symptomatic. Although the incidence of ovarian cancer in pregnancy is low, the incidental finding of an adnexal mass in pregnancy is becoming more common. Because complications of abdominal surgery are increased in pregnancy, surgical management of this prenatal complication needs to be reconsidered. Our data support a randomized clinical study to determine optimal management of an adnexal mass in pregnancy

Cervical ripening with intravaginal prostaglandins E2 gel

Ripening of the cervix by intravaginal application of a prostaglandin containing gel was evaluated. Thirty patients with an unfavorable cervix needing labor induction were studied in a double-blind prospective fashion. The prostaglandin gel proved superior to placebo in ripening the cervix [p<0.5], reducing induction failure [p<0.25] diminishing the oxytocin dosage necessary for induction [p<0.5]. and lowering the rate of cesarean section [p<0.1]. One hundred fifty additional patients with varying Bishop scores and differing clinical situation were also studied. There were 35 cesarean sections [23.3%], nine failed inductions [6%], a spontaneous labor rate of 46% and an average Bishop score change of 2.5. Twenty patients with premature rupture of the membranes and an unfavorable cervix received a modified gel containing 2.5mg of prostaglandin E2. Average Bishop score change was 2.9, and there was 55% incidence of spontaneous labor

Estrogenic action of tamoxifen in women treated with leutinizing hormone releasing-hormone agonist goserelin [zoladex]: lack of shrinkage of uterine fibroids

Six premenopausal women with uterine fibroids were treated with a combination of tamoxifen 20mg/d and Zoladex 3.6mg every 28 days for a total of 24 weeks. Results were compared with those from six women matched for pretreatmented uterine volume who had been treated with zoladex alone. During combined therapy, plasma and urinary estrogen concentrations were significantly lower than during Zoladex alone, whereas sex hormone binding globulin concentrations were significantly higher. Plasma LH and FSH concentration were both suppressed in contrast with results during Zoladex alone when FSH levels remained with the pretreatment range. None of the women on combined therapy bled in response to the endocrine change of the internal treatment cycle. Despite this profound pituitary-ovarian suppression. There was no significant change in uterine volume during combined therapy. The results suggest that tamoxifen is acting as an estrogen agonist in women rendered hypoestrogenic with luteinizing releasing hormone agonist. We failed to demonstrate any decrease in size of uterine fibroids when the antiestrogen tamoxifen was administered continuosly as a single agent. However, this lack of response was attributable to significant elevation of estrogen concentration during tamoxifen therapy