What are the adnexa (adnexa of the uterus, including the ovaries, fallopian tubes, and supporting structures)?

From the Guidelines

The adnexa of the uterus, including the ovaries, fallopian tubes, and supporting structures, are essential for female reproductive function and can be affected by various pathologies, such as ovarian cysts, ectopic pregnancy, and ovarian cancer, which can be diagnosed and managed using ultrasound imaging and surgical intervention, as discussed in a recent study published in the American Journal of Obstetrics and Gynecology 1.

Definition and Function of Adnexa

The adnexa refer to the structures adjacent to an organ, most commonly used in reference to the uterine adnexa, which include the fallopian tubes, ovaries, and supporting ligaments. These structures are crucial for female reproductive function, with the ovaries producing eggs and hormones like estrogen and progesterone, while the fallopian tubes serve as the pathway for egg transport and fertilization.

Clinical Significance and Diagnostic Evaluation

Adnexal pathology often presents with pelvic pain, irregular bleeding, or infertility. Diagnostic evaluation typically involves pelvic examination, ultrasound imaging, and sometimes blood tests for tumor markers or hormones. According to a recent study 1, ultrasound is the mainstay of evaluation of adnexal masses in pregnancy because of accuracy, safety, and availability.

Management and Treatment

Treatment depends on the specific condition identified and may range from observation for benign cysts to surgical intervention for more serious conditions. Laparoscopic surgery is preferred over open surgery when possible because of consistently demonstrated shorter hospital length of stay and less postoperative pain, as noted in the study 1. The best practices for laparoscopic surgery during pregnancy include left lateral decubitus positioning after the first trimester of pregnancy, port placement with respect to uterine size and pathology location, and appropriate mechanical and chemical thromboprophylaxes.

Key Points to Consider

• The adnexa are essential for female reproductive function and can be affected by various pathologies.
• Ultrasound imaging is a crucial diagnostic tool for evaluating adnexal masses in pregnancy.
• Laparoscopic surgery is preferred over open surgery for managing adnexal masses in pregnancy.
• Regular gynecological examinations are important for early detection of adnexal abnormalities, particularly in women with risk factors or symptoms.

From the Research

Definition of Adnexa

• The adnexa of the uterus, also known as the adnexa, refers to the structures surrounding the uterus, including the ovaries, fallopian tubes, and supporting structures 2, 3, 4, 5, 6.

Components of Adnexa

• The adnexa includes:
  • Ovaries: responsible for producing eggs and hormones 4, 5.
  • Fallopian tubes: tubes that connect the ovaries to the uterus, allowing eggs to travel from the ovaries to the uterus 2, 3.
  • Supporting structures: such as ligaments and blood vessels that support the ovaries and fallopian tubes 6.

Clinical Significance of Adnexa

• Adnexal masses or torsion can cause symptoms such as pelvic pain, abdominal bloating, and nausea 2, 3, 4, 5.
• Adnexal masses can be benign or malignant, and timely evaluation and management are crucial to exclude malignancy 4, 5, 6.
• Adnexal torsion is a gynecological emergency that requires prompt surgical intervention to prevent complications such as ovarian necrosis and fetal loss 2, 3.