Although less efective than surgery, uterine artery embolization of myomas has also been used to treat infertility or symptoms (Mara, 2008). Women so treated have higher rates of miscarriage, cesarean delivery, and postpartum hemorrhage (Homer, 2010). he Society of Interventional Radiology considers myoma embolization relatively contraindicated in women who plan future pregnancies (Stokes, 2010).
Finally, outside the United States, ulipristal-a selective progesterone-receptor modulator-can be used for myoma regression. Successful subsequent pregnancies without tumor regrowth have been reported (Luycx, 2014).
Occasionally, endometriosis can develop after delivery from otomy scars (Bumpers, 2002). Here, they form a palpable mass and can cause cyclic localized pain. Endometriomas within an ovary are discussed in the next section.
Adenomyosis is traditionally found in late reproductive life and beyond. Its acquisition may be at least partially related to disruption of the endometrial-myometrial border during sharp curettage for abortion (Curtis, 2002). In a case-control study, associated rates of second-trimester abortion, preeclampsia, fetal malposition, and preterm delivery.
Endometrial carcinoma is an estrogen-dependent neoplasia also usually found in women older than 40 years. hus, it is seen only rarely with pregnancy. Of 27 cases that were identi fied during pregnancy or within the irst 4 months postpartum, nuna, 2009). These are usually early-stage, well-diferentiated adenocarcinomas for which treatment consists primarily of tomy. Much less commonly, to preserve future fertility, curet tage with or without postprocedural progestational therapy has been used for the rare patient with cancer identified in a miscar riage curettage specimen (Schammel, 1998).
Many more studies describe a conservative approach for well-selected nonpregnant women diagnosed with endometrial cancer who wish to preserve fertility. One study followed 13 women treated with progestins for early-stage, well-diferentiated adenocarcinoma who then later conceived after apparent remission (Godieb, 2003). Nine had liveborn neonates, and four of six women with a recurrence responded to another course of therapy. Similar outcomes were described in 12 women by Niwa (2005) and in 21 women by Signorelli (2009), each with their coworkers. Despite these acceptable pregnancy rates, recurrences and death have been reported, and conservative management is not considered standard (Erkanli, 2010).
Ovarian masses found during pregnancy are relatively common. Among studies, incidences vary depending on the frequency of prenatal sonography, the ovarian size threshold used to define a clinically signiicant "mass," and whether the study site is tertiary or primary care. Thus, the incidence of ovarian masses not surprisingly ranges from 1 in 100 to 2000 pregnancies (Whitecar, 1999; Zan etta, 2003). Of ovarian malignancies, the absolute incidence in the California Cancer Registry was 1 in 19,000 pregnancies (Smith, 2003).
The most frequent types of ovarian masses are corpus luteum cysts, endometriomas, benign cystadenomas, and mature cystic teratomas. Because pregnant women are usually young, malignant tumors and those of low malignant potential are proportionately uncommon. Our experiences from Parkland Hospital are similar to those of Leiserowitz and associates (2006), who