Abstract
PURPOSE: To investigate the clinical characteristics and prognosis of surgically treated ovarian endometrioma (OMA) in pregnant women. METHODS: This retrospective cohort study analyzed 30 patients with pathologically confirmed ovarian endometrioma during pregnancy and delivery. Clinical characteristics and follow-up data were summarized. RESULTS: Among the 30 patients, 21 underwent laparoscopic surgery during pregnancy. A total of 24 OMAs were identified in 21 patients and exhibited various changes during pregnancy: 13 did not show significant changes, 10 increased in size and 1 decreased in size. The indications for surgery included suspicion of malignancy (16/21), large and progressive growth (3/21), and ovarian cyst torsion (2/21). The postoperative pathology results showed that decidualization occurred in 7 cases, while only 1 case was diagnosed with malignancy, and there appears to be a lack of specific clinical characteristics to distinguish between malignant cysts and de ci du a l I zed cysts. Of the 21 patients, 19 underwent successful follow-up. Among them, 2 cases were preterm births, 1 experienced recurrence, and 2 developed adenomyosis during long-term follow-up. Besides, 9 patients underwent cystectomy during the cesarean section. All the ultrasound findings showed regular and smooth-walled unilocular cysts, with diameters smaller than 6 cm and no apparent growth during pregnancy. Postoperative pathology revealed decidualization in 3 cases, and 1 case experienced recurrence during follow-up. CONCLUSIONS: OMA presents various changes during pregnancy and caution should also be taken for recurrence after delivery. Surgical intervention is prompted mainly by suspected malignancies which is difficult to distinguish with decidualization, and laparoscopic surgery is relatively safe during mid-pregnancy.