Morphological changes of endometriomas during pregnancy and after delivery detected using ultrasound
Orlov, Sofie LU
; Sladkevicius, Povilas
LU
; Rivano Eckerdal, Isis
and Jokubkiene, Ligita
LU
(2025)
In Fertility and Sterility
123(2).
p.211-220
- Abstract
- Objective: To assess changes in morphology and size of endometriomas during pregnancy and after delivery.
Design: This was a prospective observational cohort study performed during 2013 - 2024 at a tertiary care center (Ultrasound Unit, Department of Obstetrics and Gynecology, Skane University Hospital, Malmo, Sweden). Women were offered repeated ultrasound examinations every month during pregnancy and thereafter 3 and 12 months after delivery. Ultrasound examinations were performed either transvaginally or transabdominally depending on the gestational week and assessability of the ovaries.
Subjects: Pregnant women with an ovarian cyst suggestive of endometrioma based on subjective assessment were eligible and those with... (More) - Objective: To assess changes in morphology and size of endometriomas during pregnancy and after delivery.
Design: This was a prospective observational cohort study performed during 2013 - 2024 at a tertiary care center (Ultrasound Unit, Department of Obstetrics and Gynecology, Skane University Hospital, Malmo, Sweden). Women were offered repeated ultrasound examinations every month during pregnancy and thereafter 3 and 12 months after delivery. Ultrasound examinations were performed either transvaginally or transabdominally depending on the gestational week and assessability of the ovaries.
Subjects: Pregnant women with an ovarian cyst suggestive of endometrioma based on subjective assessment were eligible and those with the pregnancy that continued beyond gestational age of 22 weeks were included. In total, 57 women were included.
Exposure: Pregnancy.
Main outcome measures: Changes in morphology (cyst type, cyst content and signs of decidualization) and size of the endometrioma and the largest solid component were assessed during follow-up ultrasound examinations.
Results: During pregnancy, endometriomas changed in morphology in 42/57 women (74%, 95% CI 60 - 84) and decreased in size in 42/57 women (74%, 95% CI 60 - 84). Decidualization of endometrioma was observed in 33/57 women (58%, 95% CI 44 - 71) and was detected first time at gestational age of 17 weeks (median, IQR 15 - 22, range 6 - 29). Size of endometriomas decreased while size of solid components increased from gestational age of 22+0 weeks. Signs of decidualization disappeared after delivery.
Conclusion: Three out of four endometriomas undergo morphological changes during pregnancy. Decidualized endometrioma may mimic borderline malignancy, however, changes regress after delivery. Knowing natural behavior of endometriomas during pregnancy is crucial to reduce the risk of misclassification of endometriomas as malignant masses. Follow-up ultrasound examination after delivery helps to reassure the benign nature of the cyst.
(Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/5aed9186-396f-4d9f-9720-3afe6f90901e
- author
- Orlov, Sofie
LU
; Sladkevicius, Povilas
LU
; Rivano Eckerdal, Isis
and Jokubkiene, Ligita
LU
- organization
- publishing date
- 2025
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- endometrioma, endometriosis, pregnancy, decidualization, ultrasound
- in
- Fertility and Sterility
- volume
- 123
- issue
- 2
- pages
- 211 - 220
- publisher
- Elsevier
- external identifiers
-
- scopus:85205322912
- pmid:39243849
- ISSN
- 1556-5653
- DOI
- 10.1016/j.fertnstert.2024.08.355
- language
- English
- LU publication?
- yes
- id
- 5aed9186-396f-4d9f-9720-3afe6f90901e
- date added to LUP
- 2024-09-27 09:13:17
- date last changed
- 2025-04-04 15:02:45
@article{5aed9186-396f-4d9f-9720-3afe6f90901e,
abstract = {{Objective: To assess changes in morphology and size of endometriomas during pregnancy and after delivery.<br/><br/>Design: This was a prospective observational cohort study performed during 2013 - 2024 at a tertiary care center (Ultrasound Unit, Department of Obstetrics and Gynecology, Skane University Hospital, Malmo, Sweden). Women were offered repeated ultrasound examinations every month during pregnancy and thereafter 3 and 12 months after delivery. Ultrasound examinations were performed either transvaginally or transabdominally depending on the gestational week and assessability of the ovaries.<br/><br/>Subjects: Pregnant women with an ovarian cyst suggestive of endometrioma based on subjective assessment were eligible and those with the pregnancy that continued beyond gestational age of 22 weeks were included. In total, 57 women were included.<br/><br/>Exposure: Pregnancy.<br/><br/>Main outcome measures: Changes in morphology (cyst type, cyst content and signs of decidualization) and size of the endometrioma and the largest solid component were assessed during follow-up ultrasound examinations.<br/><br/>Results: During pregnancy, endometriomas changed in morphology in 42/57 women (74%, 95% CI 60 - 84) and decreased in size in 42/57 women (74%, 95% CI 60 - 84). Decidualization of endometrioma was observed in 33/57 women (58%, 95% CI 44 - 71) and was detected first time at gestational age of 17 weeks (median, IQR 15 - 22, range 6 - 29). Size of endometriomas decreased while size of solid components increased from gestational age of 22+0 weeks. Signs of decidualization disappeared after delivery.<br/><br/>Conclusion: Three out of four endometriomas undergo morphological changes during pregnancy. Decidualized endometrioma may mimic borderline malignancy, however, changes regress after delivery. Knowing natural behavior of endometriomas during pregnancy is crucial to reduce the risk of misclassification of endometriomas as malignant masses. Follow-up ultrasound examination after delivery helps to reassure the benign nature of the cyst.<br/>}},
author = {{Orlov, Sofie and Sladkevicius, Povilas and Rivano Eckerdal, Isis and Jokubkiene, Ligita}},
issn = {{1556-5653}},
keywords = {{endometrioma; endometriosis; pregnancy; decidualization; ultrasound}},
language = {{eng}},
number = {{2}},
pages = {{211--220}},
publisher = {{Elsevier}},
series = {{Fertility and Sterility}},
title = {{Morphological changes of endometriomas during pregnancy and after delivery detected using ultrasound}},
url = {{http://dx.doi.org/10.1016/j.fertnstert.2024.08.355}},
doi = {{10.1016/j.fertnstert.2024.08.355}},
volume = {{123}},
year = {{2025}},
}