Torsion of ovarian cyst during pregnancy: a case report

,¹,¹,¹ and ¹

Vasavi Kolluru

¹Department of Obstetrics and Gynaecology, Kamineni Institute of Medical Sciences, Narketpally, Andhrapradesh, India-508254

Rekha Gurumurthy

¹Department of Obstetrics and Gynaecology, Kamineni Institute of Medical Sciences, Narketpally, Andhrapradesh, India-508254

Venkatasujatha Vellanki

¹Department of Obstetrics and Gynaecology, Kamineni Institute of Medical Sciences, Narketpally, Andhrapradesh, India-508254

Deshpande Gururaj

¹Department of Obstetrics and Gynaecology, Kamineni Institute of Medical Sciences, Narketpally, Andhrapradesh, India-508254

¹Department of Obstetrics and Gynaecology, Kamineni Institute of Medical Sciences, Narketpally, Andhrapradesh, India-508254

Corresponding author.

Received 2009 Nov 6; Accepted 2009 Dec 31.

Copyright ©2009 Kolluru et al; licensee BioMed Central Ltd.This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.This article has been cited by other articles in PMC.

Abstract

In this case we report a 23 -year-old primigravida with 30 weeks presenting with torsion of the ovarian cyst. She presented to the antenatal clinic with acute pain abdomen. She was diagnosed to have torsion of ovarian cyst during pregnancy and a cystecomy was carried out. Her histopathology report showed a benign serous cystadenoma. Her pregnancy was followed up. She delivered a healthy female baby at term. Although the safety of antepartum surgical intervention has been accepted, abdominal surgery nevertheless carries some risks to a pregnant woman and unborn fetus, and so the choice of management necessitates a weighing of risks based on characterization of the adnexal mass and gestational age.

Introduction

Torsion of ovary is the total or partial rotation of the adnexa around its vascular axis or pedicle. Moderate size, free mobility and long pedicle are predisposing factors. The exact etiology is obscure. Most commonly seen are dermoid and serous cystadenomas. Complete torsion causes venous and lymphatic blockade leading to stasis and venous congestion, haemorrhage and necrosis. The cyst becomes tense and may rupture. Patient usually presents with acute severe pain abdomen and pelvic examination may reveal a tender cystic mass separate from the uterus. The risk of ovarian torsion rises by 5 fold during pregnancy. Incidence is 5 per 10,000 pregnancies[1]. Torsion of ovarian tumors occurred predominantly in the reproductive age group. The majority of the cases presented in pregnant (22.7%) than in non-pregnant (6.1%) women[2].

Case Report

23 year old primigravida presented to the antenatal clinic with 7 months amenorrhoea and pain abdomen and 3 episodes of vomitings, since one day. Her menstrual cycles were regular. She described the pain as sharp non-radiating type of pain in the right iliac fossa with sudden onset, with no relieving factors. She gave no history of vaginal bleeding or discharge. There was no history of diarrhoea, constipation, fever, urinary complaints or any recent illness. She conceived spontaneously. She had regular antenatal checkups. Her first & second trimesters were uneventful. No significant past medical and surgical history noted.

On examination, patient was conscious, coherent with pulse 82/min, blood pressure 130/80 mm of hg, temperature normal, cardiovascular and respiratory systems normal. Abdominal examination revealed fundal height corresponding to 30 weeks gestation. Uterus was irritable. There was a single fetus in longitudinal lie with breech presentation. Fetal heart rate was good & regular. There was severe tenderness in right iliac fossa. On vaginal examination, cervix was posterior, 50% effaced, 2 cm dilated, and breech presentation.

All her blood and urine investigations were within normal limits. Ultrasonography revealed a 10 × 5 cm single anechoic cystic lesion in right iliac fossa with single thin septation and no solid components. It also showed a single intrauterine live fetus in longitudinal lie with breech presentation of 30 wks gestational age. Estimated fetal weight-1629 gms, Amniotic fluid adequate, placental position posterior upper segment with grade 2 maturity. No evidence of free fluid in the abdomen.

MRI showed extended breech presentation of the fetus and a large hyper intense mass lesion on the right side of the abdomen, outside the uterus measuring 10.4 × 5.0 cms suggestive of right ovarian cyst. (Figure , )

Showing MRI image of ovarian cyst with fetus in utero.

MRI image of fetus with ovarian cyst.

With the provisional diagnosis of twisted ovarian cyst, emergency laparotomy was done under regional anaesthesia. A 10 × 5 cm right ovarian cyst was found to be twisted around its pedicle by 3 rotations. After untwisting, cystectomy was done by carefully enucleating the cyst and separating it from the capsule. The cyst was sent for histopathological examination. (Figure )

Ovarian cyst showing torsion around its pedicle.

Patient recovered with an uneventful postoperative period and was discharged on 9^th post operative day. Her histopathology report showed benign serous cystadenoma of the ovary. She was followed up, her pregnancy continued unremarkably and she delivered an alive female baby of birth weight 2.75 kg at term gestation by caesarean section.

Discussion

The commonest type of ovarian tumours encountered in pregnancy are cystic teratoma, paraovarian cyst, serous cystadenoma, corpus luteal cysts, luteomas etc[2]. Serous cystadenomas are thin walled, translucent cysts usually unilocular, may have few daughter cysts, varying between 20-30 cms in size. They are often unilateral can be bilateral.10-15% of them are borderline malignant while 20- 40% are malignant.

Differential diagnosis includes: uterine leiomyomas, non preganant horn of bicornuate uterus, appendiceal abscess, diverticular abscess, pelvic kidney, retroperitoneal tumours, ectopic pregnancy and retroverted gravid uterus[2].

Complications of the cysts associated with pregnancy are torsion of the cyst, rupture, infection, malignancy, impaction of cyst in pelvis causing retention of urine, obstructed labour and malpresentations of the fetus[2]. Some studies have suggested surgical intervention for concerns of malignancy, tumor torsion. Tumor rupture, or obstruction of labor[3,4]. Other studies have recommended the principle of observation, finding that most ovarian masses can either remain uneventful or resolve throughout pregnancy and that the incidence of the above risks was actually low[3,5]. Its most common cause in pregnancy is a corpus luteum cyst, which usually regresses spontaneously by the second trimester[6]. Ovarian torsion, therefore, occurs most frequently in the first trimester, occasionally in the second, and rarely in the third[7].

Management

Cysts less than 6 centimetres in diameter and appearing benign on ultrasound are generally treated conservatively as they may undergo spontaneous resolution. Corpus luteal cysts regress by 12 to 16 weeks. Cysts more than 10 centimetres in size are usually resected due to increased risk of malignancy, rupture or torsion. Management of cysts between 5 to 10 centimetres is controversial. If the cysts contain septae, nodules, papillary excrescences or solid components then resection is recommended. Those with simple cystic appearance may be managed expectantly with serial ultrasound surveillance. However they may require emergency exploratory laparotomy for rupture, torsion or infarction in as many as 50% cases [3]. With the advent of imaging techniques like high resolution ultrasound, MRI and transvaginal colour Doppler, the expectant management has become much more common.

If the ovarian cyst is diagnosed in the first trimester, it is better to wait till 16 wks when the implantation of pregnancy is more secure and also the cyst may disappear spontaneously. Persisting tumours are treated by cystectomy or ovariotomy as indicated. Ovarian tumour or cyst can be easily removed till 28 wks of gestation thereafter it is not readily accessible and may precipitate preterm labour. Ovarian cyst which ruptures, or undergoes torsion or if it shows evidence of malignancy, requires immediate surgery, irrespective of the period of gestation [3].

A simple cystectomy can be performed in the absence of overt malignancy. Previously untwisting of the pedicle was avoided to prevent emboli and toxic substances related to hypoxia, from entering peripheral circulation. but recently, re-establishing ovarian circulation by untwisting, has shown to result in viable ovarian tissue with no systemic complications[1].

Conclusion

Ovarian torsion is relatively uncommon in the second trimester of pregnancy. Diagnosis can usually be made on the basis of the characteristic clinical presentation in conjunction with ultrasound evidence of a unilaterally enlarged adnexal mass. Treatment options are limited to surgery, either by laparoscopy or laparotomy, but the former becomes more difficult after second trimester.

Consent

Written informed consent was obtained from the patient for publication of this case report. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

The case was managed and operated by RG, VK, and VVS. The authors have read and approved the final manuscript.

Acknowledgements

I would like to thank Dr. (Col). C.G. Wilson, Principal Kamineni Institute of Medical Sciences, Narketpally A.P for permitting me to use hospital data.

I am grateful to Dr. Rajesh Kaul, Professor and Head of the Department, OBGYN for her support and encouragement.

References

• Ventolini G, Hunter L, Drollinger D, Hurd WW. Ovarian torsion during pregnancy. http://www.residentandstaff.com/issues/articles/2005-09_04.asp
• Lee CH, Raman S, Sivanesaratnam V. Torsion of ovarian tumors: a clinicopathological study. Int J Gynaecol Obstet. 1989;28:21–25. doi: 10.1016/0020-7292(89)90539-0. [PubMed] [CrossRef] [Google Scholar]
• Yen CF, Lin SL, Murk W, Wang CJ, Lee CL, Soong YK, Arici A. Risk analysis of torsion and malignancy for adnexal mases during pregnancy. Fertil Steril. 2009;91(5):1895–902. doi: 10.1016/j.fertnstert.2008.02.014. [PubMed] [CrossRef] [Google Scholar]
• Whitecar MP, Turner S, Higby MK. Adnexal masses in pregnancy: A review of 130 cases undergoing surgical management. Am J Obstet Gynecol. 1999;181(1):19–24. doi: 10.1016/S0002-9378(99)70429-1. [PubMed] [CrossRef] [Google Scholar]
• Schmeler KM, Mayo-smith WW, Peipert JF, Weitzen S, Manuel MD, Gordinier ME. Adnexal masses in pregnancy: surgery compared with observation. Obstet Gynecol. 2005;105:1098–103. [PubMed] [Google Scholar]
• Duic Z, Kukura V, Ciglar S. Adnexal masses in pregnancy: a review of eight cases undergoing surgical management. Eur J Gynaecol Oncol. 2002;23:133–134. [PubMed] [Google Scholar]
• Hibbard LT. Adnexal torsion. Am J Obstet Gynecol. 1985;152:456–461. [PubMed] [Google Scholar]

Ovarian cysts and infertility: A connection?

Is there a link between ovarian cysts and infertility?

Answer From Tatnai Burnett, M.D.

Some ovarian cysts can be associated with decreased fertility. However, it depends on the type of ovarian cyst you have.

Ovarian cysts that can affect your fertility include:

• Endometriomas. Endometriomas (en-doe-me-tree-O-muhs) are cysts caused by endometriosis, a condition in which the tissue normally lining your uterus (endometrium) grows outside the uterus. These ovarian cysts may be associated with fertility problems.
• Ovarian cysts resulting from polycystic ovary syndrome. Polycystic ovary syndrome (PCOS) is a condition marked by many small cysts on your ovaries, irregular periods and high levels of certain hormones. PCOS is associated with irregular ovulation, which may contribute to problems with fertility in some women.

These types of ovarian cysts generally don’t affect fertility:

• Functional cysts. Functional cysts — such as follicular cysts or corpus luteum cysts — are the most common type of ovarian cyst. Functional cysts form during a normal menstrual cycle and don’t cause or contribute to infertility. In fact, functional cysts actually indicate that the necessary functions leading to fertility are taking place.
• Cystadenomas. Cystadenomas (sis-tad-uh-NO-muhs) are growths in the ovary that arise from the surface of the ovaries. Although they may require treatment, they don’t affect fertility.
• Dermoid cysts. These solid cysts contain tissue — such as skin, hair or even teeth — instead of fluid. Dermoid cysts aren’t associated with infertility.

If you’ve been diagnosed with an ovarian cyst and are concerned about becoming pregnant, talk to your doctor. Your doctor will discuss treatment options that may improve your chances of pregnancy.

With

Tatnai Burnett, M.D.

Get the latest health information from Mayo Clinic’s experts.

Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health.

Learn more about Mayo Clinic’s use of data.

To provide you with the most relevant and helpful information, and understand which
information is beneficial, we may combine your email and website usage information with
other information we have about you. If you are a Mayo Clinic patient, this could
include protected health information. If we combine this information with your protected
health information, we will treat all of that information as protected health
information and will only use or disclose that information as set forth in our notice of
privacy practices. You may opt-out of email communications at any time by clicking on
the unsubscribe link in the e-mail.

Subscribe!

Thank you for subscribing

Our Housecall e-newsletter will keep you up-to-date on the latest health information.

Sorry something went wrong with your subscription

Please, try again in a couple of minutes

Retry

Dec. 04, 2020

Show references

1. Lobo RA, et al. Benign gynecologic lesions: Vulva, vagina, cervix, uterus, oviduct, ovary, ultrasound imaging of pelvic structures. In: Comprehensive Gynecology. 7th ed. Philadelphia, Pa.: Elsevier; 2017. https://www.clinicalkey.com. Accessed Oct. 17, 2018.
2. Levy BS, et al. Endometriosis: Management of ovarian endometriomas. https://www.uptodate.com/contents/search. Accessed Oct. 17, 2018.
3. Barbieri RL, et al. Clinical manifestations of polycystic ovary syndrome in adults. https://www.uptodate.com/contents/search. Accessed Oct. 17, 2018.
4. Hoffman MS, et al. Differential diagnosis of the adnexal mass. https://www.uptodate.com/contents/search. Accessed Oct. 24, 2018.
5. Frequently asked questions. Gynecologic problems FAQ075. Ovarian cysts. American College of Obstetricians and Gynecologists. https://www.acog.org/Patients/FAQs/Ovarian-Cysts. Accessed Oct. 24, 2018.
6. Legendre G, et al. Relationship between ovarian cysts and infertility: What surgery and when? Fertility and Sterility. 2014;101:608.

See more Expert Answers

Products and Services

1. Newsletter: Mayo Clinic Health Letter — Digital Edition
2. Book: Mayo Clinic Family Health Book, 5th Edition

.

Can ovarian cysts affect your ability to get pregnant

There are two types of ovarian cysts. Here’s everything you need to know about them from the signs, treatment and whether you should worry if they will cause infertility.

Ovarian cysts are simply fluid-filled sacs on, or within, the ovaries. Though they might not come up in conversation, they’re actually very common—many, if not most, women will experience a cyst at some point during their lives. But not all ovarian cysts are the same—while some are harmless, others can affect your ability to get pregnant. Here’s what you need to know.

Functional cysts

   
   

   How uterine fibroids can wreak havoc on your health

“Functional cysts are the most common type and they form during a normal menstrual cycle,” says Danielle Derrington, head of service family medicine obstetrics at St. Joseph’s Healthcare in Hamilton, Ont. Every month, your body grows a cyst-like structure, called a follicle, in which an egg develops. When the egg is released, the follicle should break down on its own, but sometimes it keeps growing and filling with fluid, forming a functional cyst. These cysts are typically harmless, rarely cause symptoms and should resolve on their own within a few menstrual cycles. However, they can contribute to infertility if they grow very large.

Symptomatic cysts
There are three other types of cysts that are unrelated to the menstrual cycle, and are more likely to cause pain or other uncomfortable symptoms. Dermoid cysts can contain human bone fragments, tissue, hair and even teeth (this happens because they develop from the cells that create ova). They sound scary, but they are usually benign. Cystadenomas, meanwhile, are fluid- or mucus-filled sacs that develop out of ovarian tissue. In some cases, these can be cancerous, but they’re usually not.  Both dermoid cysts and cystadenomas can grow large, sometimes shifting the position of the ovary and causing it to twist—a painful condition known as ovarian torsion. Finally, an endometrioma is a cyst related to endometriosis. These cysts are sometimes called “chocolate cysts” because of their dark colour. They grow out of endometrial tissue on the outside of the uterus, and can attach themselves to surrounding areas and organs, which can be extremely painful.

Getting a diagnosis
So what are the telltale signs you have a cyst and should see your doctor? Pelvic pain that may radiate to your lower back and thighs, pressure on your bowels (sometimes extreme, and especially during bowel movements), increased urination (caused by pressure on the bladder), nausea or vomiting, breast tenderness, and pain during intercourse are all symptoms of cysts. If any of the symptoms become severe—especially abdominal or pelvic pain, potentially with a fever or vomiting—you should head to the emergency room. These symptoms may indicate ectopic pregnancy (an embryo implanted in the fallopian tubes), ovarian torsion or a ruptured cyst.

To have a cyst diagnosed, you’ll have a series of tests, including ultrasound and bloodwork. “Ultrasound is a relatively easy imaging option and can usually confirm the diagnosis,” Derrington says. “In a small number of patients where the ultrasound doesn’t give enough information, an MRI is generally the next step.”

Cysts and fertility
A cyst’s influence on your long-term health and your ability to get pregnant depends on many factors, including the cyst type and size, your age and your overall fertility. “Functional cysts don’t usually affect fertility, unless they’re very large,” says Derrington, noting that women who have polycystic ovarian syndrome can experience fertility challenges, too. Endometriomas may also affect your ability to conceive (they can distort the anatomy of your pelvis and cause inflammation and scarring), and you may require treatment—usually laparoscopic surgery if you’re trying to become pregnant, in order to preserve as much of your uterus and ovaries as possible. Dermoid cysts and cystadenomas aren’t associated with infertility.

Treating ovarian cysts
The best treatment depends on the type and size of the cyst, but options include careful monitoring, birth control pills to help slow the growth, or surgery. If the cyst is particularly large, looks concerning on imaging or doesn’t respond to treatment, it may need to be removed. In extreme cases, your doctor may recommend removing the entire ovary, or, if the cyst is cancerous, removing the uterus, ovaries and fallopian tubes.

Read more:
Problems getting pregnant? It could be PCOS
How uterine fibroids can wreak havoc on your health

See more on Getting Pregnant

//

Vaginal Bleeding During Early Pregnancy – Women’s Health Issues

If a home pregnancy test indicates pregnancy but pregnancy has not been confirmed by a health care practitioner, doctors do a pregnancy test using a urine sample.

Once pregnancy is confirmed, several tests are done:

• Blood type and Rh status (positive or negative)

• Usually blood tests to measure a hormone (human chorionic gonadotropin, or hCG) produced by the placenta during early pregnancy

If bleeding is substantial (more than about a cup), doctors also do a complete blood cell count (CBC) and tests to check for abnormal antibodies or to cross-match blood (to determine whether the woman’s blood type is compatible with a donor’s in case blood transfusion is needed). If blood loss is substantial or shock develops, blood tests are done to determine whether blood can clot normally.

Typically, ultrasonography is done using an ultrasound device inserted into the vagina. Ultrasonography can detect a pregnancy in the uterus and can detect a heartbeat after about 6 weeks of pregnancy. If no heartbeat is detected after this time, a miscarriage is diagnosed. If a heartbeat is detected, miscarriage is much less likely but may still occur.

Ultrasonography can also help identify the following:

• A miscarriage that is incomplete, is infected, or has been missed

• Any parts of the placenta or other pregnancy-related tissues that remain in the uterus

• A ruptured corpus luteum cyst

• A hydatidiform mole or other form of gestational trophoblastic disease

• Sometimes an ectopic pregnancy, depending on where it is located and how big it is

Measuring hCG levels helps doctors interpret ultrasonography results and distinguish a normal pregnancy from an ectopic pregnancy. If the likelihood of a ruptured ectopic pregnancy is low, hCG levels are measured frequently and ultrasonography is repeated as needed. If the likelihood of a ruptured ectopic pregnancy is moderate or high, doctors may make a small incision just below the navel and insert a viewing tube (laparoscope) to directly view the uterus and surrounding structures (laparoscopy) and thus determine whether an ectopic pregnancy is present.

Ovarian Cyst While Pregnant: Types, Reasons & Treatment

Last Updated on September 5, 2019

A cyst, in general, is a fluid-filled sac that forms in some of the organs of the body. An ovarian cyst is similarly one such fluid filled pocket that grows in one or both of the ovaries. Ovarian cysts can occur in a significant number of women at some point without affecting their health or ability to conceive. They develop and resolve on their own. However, some types of cysts cause infertility or troubling symptoms when they rupture or grow too much in size.

What Is An Ovarian Cyst?

Ovaries are two almond-sized structures in the female reproductive system, which are responsible for the production of eggs. During the menstruation cycle, the ovaries release one egg every month in a process called ovulation. During each cycle, several egg-containing follicles, inside the ovary, ripen as they get filled with nourishing fluids that envelop each egg. The largest follicle, then, bursts to release the egg. Sometimes, the egg continues to develop but the process isn’t complete, and the follicle remains as a cyst in the ovary for some time before disappearing. Most of the time, ovarian cysts are harmless and present little or no discomfort, some, however, can rupture causing internal bleeding. In rare cases, the cysts develop into cancer.

Types of Ovarian Cysts

There are different types of ovarian cysts that can be classified as either functional cysts or pathological cysts.

Functional Cysts:

Functional cysts occur due to the natural processes during the menstrual cycle and are very common. They affect women who have an active menstrual cycle and haven’t had a menopause. They are often benign (non-cancerous) and harmless and disappear on their own in a few months without treatment. In rare cases, they may cause symptoms such as pelvic pain.

Functional cysts occur mainly in two types:

1. Follicular Cysts: These are the most commonly occurring type of cysts in women and develop in either of the following ways:

• The follicle develops in the ovary but the egg is not released, and it continues to grow.
• The follicle bursts after ripening to release the egg but stays filled with fluid

Follicular cysts are usually small, but some may grow to sizes up to 5 or 6 cm across. They usually disappear on their own in a few months without treatment.

2. Luteal Cysts: They form when the follicle which has burst to release an egg remains as a shell (corpus luteum). Sometimes, the shell reseals and may get filled up with fluid or blood. Luteal cysts can grow up to 6cm in size and take a few months to go away. In some cases, they can burst and release blood in the abdomen which can be painful and dangerous.

Pathological Cysts:

Pathological cysts are caused by abnormal growth of cells and aren’t related to the menstrual cycle. They can develop in all women before or after menopause. These cysts can develop from the cells that make up the outer part of the ovary or from the cells used to create eggs. Pathological cysts can grow large and block blood supply to the ovaries or even burst. They are rarely cancerous and are removed surgically when they are.

Pathological cysts are classified as:

1. Dermoid Cysts: These cysts, also called teratomas, form from embryonic cells and can contain tissues within them such as skin, hair or teeth. They are mostly benign.
2. Cystadenomas: They form on the surface of the ovary and are filled with watery or mucous-like fluids.
3. Endometriomas: These cysts grow due to a condition called endometriosis where uterine endometrial cells grow outside the uterus. Some of this tissue can attach to the ovary and form a growth.

Symptoms

In most women, ovarian cysts do not cause any noticeable symptoms. In some, however, when the cysts grow to a large size and are blocking the blood supply or pressing on surrounding organs or are leaking blood, there can be clear symptoms such as:

• Change in the menstrual cycle where the periods are irregular, heavier or lighter
• Need to urinate frequently
• Feeling excessively tired
• Difficult or pain when emptying the bowels
• Feeling bloated, full or suffer indigestion
• Inability to conceive

Diagnosis of Ovarian Cysts

Ovarian cysts can be found during a pelvic exam. Depending on the nature of the cysts and their type, the doctor will recommend different tests to determine the cyst type. Some of the tests include:

• Pregnancy Test: A positive on this test suggests that you have a corpus luteum cyst.
• Pelvic Ultrasound: An ultrasound transducer that sends and receives high-frequency sound signals is used to create an image of the uterus. The scans give insight into the location, type and contents of the cyst.
• CA 125 Blood Test: Cysts that are partly solid are at high risk of being cancerous. The test looks for a protein called cancer antigen 125 which shows up in elevated levels in women with ovarian cancer.

Does Ovarian Cyst Affect Your Chance of Getting Pregnant?

Most of the ovarian cysts do not lead to infertility. However, there are two types that make it difficult to get pregnant.

• Polycystic Ovarian Syndrome (PCOS): The condition leads to the formation of multiple small cysts in the ovaries and interferes with ovulation by making it rare or irregular. PCOS leads to irregular menstrual periods and hormonal imbalance. It is also the most common type of cyst that leads to infertility.
• Endometriosis: These types of cysts can block the fallopian tubes or damage the ovaries causing infertility.

Risks of Ovarian Cyst while Pregnant

Can ovarian cyst affect pregnancy? Yes and no. The risks associated depend on the type and size of the cyst during pregnancy. Ovarian cysts that grow to large sizes take up space and apply pressure on the urinary bladder, or the cysts burst and pour its contents into the abdominal cavity. In some cases, the cyst pedicle gets twisted, and the blood supply is cut off. Such a cyst might die and elevate the risk of severe peritonitis which is an inflammation of the lining of the abdominal cavity that is dangerous to both the mother and the child.

Ruptured Or Twisted Cyst In Pregnancy

Ovarian Torsion:

When cysts grow to large sizes, they cause the ovaries to move out of place. Sometimes the forces due to displacement can cause the ovary to get twisted in a condition called ovarian torsion. It can decrease or cut off blood flow to the ovaries and cause symptoms such as severe pelvic pain, nausea and vomiting.

Rupture:

Cysts that contain blood and fluids can rupture when they overgrow and cause internal bleeding and severe pain. The larger the cyst, the greater its chance of rupturing. Vigorous activities and exercises that affect the pelvis can cause a large cyst to rupture.

Treatment

The treatment of ovarian cysts depends on the risk it poses and the discomfort felt by the woman during pregnancy. Watchful waiting is the first approach when a cyst is discovered in an ultrasound scan. With follow up scans, it is possible to tell if the cyst has resolved on its own or is growing in size, posing a risk.

If the cyst grows large enough to cause pain or other risks such as a rupture, it may be surgically taken out. A keyhole surgery or laparoscopy is normally done in early pregnancy. If the cyst is large or develops late in pregnancy, it will be removed through a cut in the tummy (laparotomy).

Removing ovarian cyst during pregnancy is done in two ways:

• Operation After 20 Weeks: A troublesome cyst will need to be removed surgically but only after 20 weeks of the pregnancy. A surgery to remove it before 20 weeks increases the chances of a miscarriage, and therefore, is avoided.
• Operation At Any Stage: Sometimes a large cyst could develop on a stem from an ovary causing it to twist (Ovarian torsion). This could damage the ovary and make the woman very sick. In such cases, doctors operate immediately, no matter what stage the pregnancy is in.

Preventive Measures

There is no way to prevent ovarian cysts from forming. However, regular pelvic exams can ensure they can be detected as early as possible. Changes in the menstrual cycles and unusual symptoms that persist for many cycles are, usually, an indicator and should be reported to the doctor.

When Should You Call the Doctor?

Ovarian cyst and pregnancy can co-exist as long as the cyst is benign and monitored on a regular basis to check if there are indications of trouble on the horizon. If you feel a sudden abdominal pain accompanied by vomiting and fever, it’s time to call the doctor. Some of the other symptoms can include cold and clammy skin along with weakness and lightheadedness. These are signs of an emergency and should not be ignored.

Having an ovarian cyst is not always a cause for worry, chances are that the cyst you have is benign and will resolve on its own in months. It is important, however, to get it examined on a regular basis to be on the safer side.

Also read: Irregular Periods After Pregnancy: Should You Worry?

Fetal Abdominal Cyst (for Parents)

What Is a Fetal Abdominal Cyst?

A fetal abdominal

cystis a bubble of fluid in a balloon-like bag in an unborn baby’s belly.

What Happens With a Fetal Abdominal Cyst?

A fetus can have one fetal abdominal cyst, or more. The most common types include:

• enteric (en-TARE-ik) duplication cysts: these form when the digestive tract splits as it’s forming
• mesenteric (mez-en-TARE-ik) cysts: these form in the mesentery. The mesentery (MEZ-en-tare-ee) attaches to the intestines and contains the blood vessels that supply them.
• genitourinary (jen-ih-toe-YUR-ih-nair-ee) cysts: these form on a kidney, a
  ureter(urine-carrying tube), or the bladder
• choledochal (KOLE-uh-dok-ul) cysts: these form from the bile ducts in or near the liver

In a female fetus, the most common type of a fetal abdominal cyst is an ovarian cyst.

A cyst can cause problems if it:

• blocks the digestive tract
• makes an organ twist until its blood vessels are squeezed shut. This is called torsion (TOR-shun). An organ with blocked blood vessels doesn’t get enough oxygen, so part or all of it can die.

Fetal abdominal cysts usually don’t cause problems unless they get very large. A big cyst can put pressure on the baby’s developing lungs and other organs. This can cause problems such as:

• too much fluid in the womb (uterus)
• fluid build-up in the belly
• blockage of the intestines

What Are the Signs & Symptoms of a Fetal Abdominal Cyst?

The cysts usually don’t cause any symptoms during the pregnancy.

Sometimes doctors can feel the cyst in the baby’s belly after birth. Other symptoms of a fetal abdominal cyst after birth include:

• trouble feeding
• crying and fussiness due to pain
• yellow-tinted skin and eyes (jaundice)
• vomiting
• trouble pooping
• trouble peeing

Cysts that are more than 2 inches (5 cm) across may also cause:

• a difficult delivery because of the cyst’s size
• trouble breathing if the cyst presses on the
  diaphragmso the baby’s lungs can’t expand well

What Causes a Fetal Abdominal Cyst?

Most fetal abdominal cysts happen when an accidental slip in the normal growth process makes an extra layer or bubble that fills with fluid. Doctors don’t know why it happens. There is nothing the baby’s parents can do to keep a fetal abdominal cyst from forming.

Ovarian cysts often happen because the unborn baby is exposed to the mother’s hormones. There is nothing the baby’s mother can do to prevent one.

A fetal abdominal cyst is not a cancer.

How Is a Fetal Abdominal Cyst Diagnosed?

A routine ultrasound scan of an unborn baby usually will find a fetal abdominal cyst. An imaging specialist (a radiologist) will study the cyst’s:

• location
• size
• movement
• contents

By studying the images of the cyst and how it changes with gentle pressure, the radiologist might be able to tell what kind it is. Knowing the type of cyst helps the baby’s doctors know what kind of special care, if any, is needed at birth or in the first few weeks of life.

If the screening prenatal ultrasound doesn’t show what kind of cyst the baby has, the radiologist may:

How Is a Fetal Abdominal Cyst Treated?

Doctors make a plan for treating a fetal abdominal cyst based on:

• its size
• the type of cyst
• how the cyst changes and grows during the pregnancy

The obstetrician (pregnancy specialist) and radiologist will check the cyst with ultrasound scans every few weeks until birth. The doctors work as a team to decide if a C-section delivery is best. But most babies with fetal abdominal cysts are delivered through the vagina.

Surgery to remove a cyst (cystectomy) is sometimes needed to keep it from blocking the digestive tract or to prevent torsion. Pediatric surgeons usually use minimally invasive surgery (laparoscopy) to remove cysts.

Ovarian Cysts

After birth, a baby isn’t exposed to the mother’s hormones. So an ovarian cyst usually goes away on its own within a few months. The baby’s doctor checks ultrasound scans regularly to be sure the cyst goes away.

A large fetal ovarian cyst — one that is more than about 2 inches (5 cm) across — can twist on its stem and squeeze off the blood vessels that carry blood to and from the ovary. To prevent this, doctors usually:

• do an ultrasound scan soon after birth
• recommend surgery to drain or remove the cyst

For a smaller fetal ovarian cyst, the baby’s doctor will order an ultrasound scan during the first few weeks after birth to:

• confirm the type of cyst
• guide treatment

If the cyst doesn’t go away on its own, the doctor may recommend a cystectomy to remove it.

What Else Should I Know?

Sometimes, treating an ovarian cyst requires removal of the ovary it grew from. The ovary on the other side can release enough hormones and eggs for normal sexual development and pregnancy later in life.

An 11-year experience with ovarian surgery during pregnancy

https://doi.org/10.1016/j.jcma.2013.04.008Get rights and content

Abstract

Background

The management of ovarian tumors during pregnancy can be challenging because of the risk of fetal wastage and the possibility of surgery-related complications, or a delayed diagnosis of a possibly lethal disease or malignancy. The aim of this study was to study the characteristics and outcomes of pregnant women undergoing surgical intervention for ovarian tumors during pregnancy.

Methods

We reviewed the data of 102 pregnant women who underwent ovarian surgery between 2000 and 2010 at Taipei Veterans General Hospital, Taiwan. Data subject to analysis included gestational age at the time of surgery, complications, surgical and pathological findings, and the outcome of pregnancy.

Results

Fifty-two women who underwent surgery were excluded, whether by cesarean section, during the postpartum period or during simultaneous abortion surgery. Ultimately, the data of 50 patients were analyzed. Almost all patients (n = 46, 92%) were asymptomatic and underwent elective surgery. Frequently, this surgery was done in the second trimester (n = 35, 70%). We determined that teratoma (26%), mucinous cystadenomas (20%), and endometriomas (16%) were the three most common pathological findings. Nonspecific ovarian tumors were common (28%), including seven corpus luteum cysts, six simple cysts, and one paratubal cyst. Two women were diagnosed with malignant ovarian tumors, but both were metastatic and the primary site was the colon. Ten women underwent laparoscopic surgery. General anesthesia was used in four patients, and all underwent emergency exploratory laparotomy. There was no surgery-related complication or instance of preterm labor.

Conclusion

In our study cohort, surgical intervention during pregnancy was safe, since neither surgical approach, such as exploratory laparotomy or laparoscopic surgery, nor anesthesia methods, for example general anesthesia or spinal anesthesia showed negative impact on the pregnancy outcomes. Reported cases of malignant ovarian tumor are still rare, thus, the possibility of metastatic tumor should be considered first.

Keywords

laparoscopy

laparotomy

ovarian tumor

pregnancy

Recommended articlesCiting articles (0)

Copyright © 2013 Published by Elsevier B.V.

Recommended articles

Citing articles

Ovarian cyst during pregnancy: is it dangerous for a baby and how is it treated in Israel

The word “cyst” comes from the Greek word “kystis”, which means “bubble”. What is an ovarian cyst? It is a benign mass with fluid inside, which is located in the left or right ovary. Cysts can develop in a woman’s body both before and during pregnancy. There are several types of “bubbles”: some of them are not dangerous for the fetus and the expectant mother and usually disappear on their own, while the detection of others may become an indication for their prompt removal.

There are several reasons for the appearance of cysts in the body. But most often the “dog is buried” in the changes in hormonal levels. Among them:

• Diseases of the endocrine system.
• Earlier onset of the first menstruation.
• “Jumping” dates of the beginning of monthly menstruation.
• Stress.

Types of cysts

Ovarian cysts are organic and functional.

Let’s start with the functional ones. These are follicular and luteal cysts.According to gynecologists, functional cysts most often develop against the background of various changes in a woman’s hormonal system. When the so-called “imbalance” of hormones occurs or an inflammatory process develops.

Ovarian follicular cyst is formed from the follicle, which, after the release of the egg, normally turns into a yellow body. But if there is no ovulation, and the follicle continues to grow, this may mean that it is transformed into a follicular cyst, up to 5-6 cm in size. This type of cyst, as a rule, can develop before pregnancy.In addition, it often happens that it is discovered after the onset of an “interesting situation”. In most cases, this type of cyst disappears without a doctor’s prescription.

As for luteal cyst – it is she who in most cases forms during pregnancy. This is a “bubble” up to 8 cm in size, which is also called a “corpus luteum” cyst. The reason for its appearance can be violations of blood circulation and lymph flow in the female genital organs, stress, pathology of the endocrine system.

A luteal cyst usually does not require medical intervention (removal). It disappears on its own as soon as the placenta begins to form and the hormone progesterone is actively produced. This usually occurs by 14-16 weeks of gestation.

Unlike functional cysts, organic cysts can be dangerous even during pregnancy. They do not dissolve without medical intervention, and can also degenerate into malignant neoplasms. Their appearance, as a rule, is associated with various lesions of the ovaries (including inflammatory and infectious diseases).

Organic cysts are:

1. Endometrioid . Such a cyst is a “bubble” of cells of the uterine mucosa, filled with a dark liquid (mixed with blood). It occurs, as a rule, as a consequence of a disease – endometriosis.
2. Ovarian cystadenoma. May enlarge and become cancerous. Therefore, it is recommended to delete it. Ovarian cystadenoma is a bladder filled with serous or mucinous fluid.

These two types of cysts are dangerous during pregnancy. This is primarily manifested in their proliferation.

According to experts, ovarian cystadenoma and endometrioid cyst can be up to 30 cm in size, causing constant painful sensations in a pregnant woman.

In addition, there is a high probability of rupture of such cysts, as a result of which their contents (fluid, mucus, blood) enter the abdominal cavity. Then an immediate operation is indicated, regardless of the gestational age.

1. Dermoid. These are cysts consisting of particles of hair, skin, nails. They can appear in the female body due to various disorders of the embryonic development of the fetus even during the period of its gestation. The size of such a cyst is up to 15 cm. Dermoid cysts are indicated for mandatory surgical removal, since they can transform into malignant tumors.
2. Paraovarian cysts do not degenerate into cancer. The walls of such a “bubble” do not divide, but stretch.Therefore, it can grow in size. But despite the seemingly harmlessness, this type of cyst, they do not dissolve without the help of medical prescriptions. Paraovarian cysts, as a rule, do not form in the ovary itself, but next to it.

How do ovarian cysts manifest during pregnancy

According to gynecology specialists, quite often cysts do not manifest themselves symptomatically, including during pregnancy. As a rule, they “make themselves felt” only if there is a torsion, rupture of the pedicle of the formation, and also if the cyst has transformed into cancer.How exactly?

• Aching and cutting pains in the lower abdomen, which intensify during intercourse.
• Unpleasant sensations (disturbances) when urinating.

INTERCUT: By the way, according to experts, large cysts are a direct indication for a planned Caesarean section, as they can cause complications:

• Torsion of the cyst leg. This complication can be caused by the growth of the uterus, which displaces the cyst from its usual place.It manifests itself as symptoms of an “acute” abdomen (constant sharp pain in the lower abdomen, forced position (lying on the side, with legs bent at the knees), fever.

• Ovarian cyst rupture. Characterized by severe internal bleeding. Its symptoms:

• sharp pain
• pallor of the skin,
• weakness (up to loss of consciousness),
• decrease in blood pressure, increased heart rate.

If a cyst ruptures, immediate surgical intervention is required.

Is a normal pregnancy possible with cysts

Since cysts often interfere with the appearance of new follicles during ovulation, their presence in the ovaries can cause infertility. If pregnancy has occurred, Israeli gynecologists recommend regular examinations of the body (including ultrasound), carefully monitoring the “behavior” of the cysts. Then the chance to bear and give birth to a healthy baby is quite high.

For the treatment of cysts during pregnancy in Israel, a comprehensive individual approach is used.The leading gynecologists of the First Tel Aviv Medical Center, first of all, analyze in detail each case in accordance with international protocols, using modern diagnostic equipment. Ultrasound and laboratory tests are performed, including a blood test for hormonal profile, tumor markers.

For drug treatment of ovarian cysts, oral contraceptives are prescribed, as well as pain relievers and anti-inflammatory drugs.

If necessary, cysts are removed laparoscopically (minimally invasive) without incision using abdominal wall punctures.This happens, as a rule, if they have reached a size of 7-8 cm or more. The operation is carried out no earlier than 14-16 weeks of gestation.

“In order to prevent danger to the fetus, as well as the expectant mother, you need to be regularly monitored and examined by a gynecologist who leads the pregnancy,” says Gennady Bitman, senior physician at the Department of Gynecology at Tel Aviv First Medical Center. For more than 25 years, Dr. Bitman has been fruitfully engaged in the diagnosis and treatment of various pathologies during pregnancy, including the presence of cysts in the ovaries.

“The fact is that large cysts, as well as“ bubbles ”on the legs, can provoke complications both during pregnancy and during childbirth,” the doctor continues. It is important to understand that it is very difficult to predict how the cyst will behave during gestation. Therefore, the doctor must be ready at any time to carry out urgent surgery and remove it. ”

Israeli doctors also prescribe conserving therapy and preventive courses to patients at critical stages of pregnancy.Physical activity, sharp bends, turns are strongly not recommended.

Post-term pregnancy – causes, symptoms, management in the Intime clinic

Post-term pregnancy occurs when the fetus is not born until 42 weeks. Such births are called belated, they carry a number of complications for both the baby and the woman in labor. Overburdening is observed in women in 2% of cases.

The duration of a standard pregnancy is 40 weeks from the start of extreme menstruation.This period is sufficient for the normal development of the fetus. Doctors judge about the presence of pathology in terms of the condition of the placenta. While maintaining the integrity of the placenta and the absence of signs of aging, such a pregnancy is called prolonged. If aging and violation of the integrity of the placenta are observed, as well as a number of other characteristic signs, then they speak of a post-term pregnancy.

Causes of post-term pregnancy

• Irregularity of the menstrual cycle;
• Pathological changes in the fetus;
• Infectious diseases carried over in childhood;
• Disruption of the endocrine system;
• Diseases of the liver, gastrointestinal tract;
• Uterine fibroids, preeclampsia, termination of pregnancy;
• Psychological trauma, sedentary lifestyle;
• Hormonal disorders.

Send a request
for a free consultation

We provide the first free consultation for new patients.
Just leave your contact details and we will contact
with you during the working day.

If you have already been our client, you can
use this form to order a call back.

Thank you!

Your application has been accepted.
We will contact you within business hours.

Symptoms of post-term pregnancy

Such a pregnancy is characterized by a sharp reduction in the volume of the abdomen, weight loss, which indicates a decrease in amniotic fluid.Milk is emitted from the nipples, and false contractions may also appear. However, the main symptom is the aging of the placenta and the absence of labor at the appointed time.

Treatment of post-term pregnancy

Regardless of the cause of the post-term pregnancy, the main task of the doctor is to induce labor with the help of medications. A pregnant woman is hospitalized and monitored without fail at 41 weeks.

After a thorough analysis of the causes of post-term pregnancy and delayed labor, the duration of pregnancy and the state of the mother’s body, the method of delivery is determined.

The induction of labor begins 2-3 weeks after the expected onset of their normal onset with the help of special hormonal drugs. Then, activities begin to stimulate the contraction of the uterus.

If there is a threat to the life of the fetus or a discrepancy in the size of the head to the mother’s pelvis, the caesarean section is used.

Consequences of post-term pregnancy

The main danger of a post-term pregnancy is that the baby begins to starve.Due to the aging of the placenta, it can no longer receive nutrients, and hence developmental problems, oxygen starvation begin.

Post-term pregnancy is dangerous for the nervous system of the fetus; increased dryness and wrinkling of the skin can also be observed. In the future, such children have reduced immune protection, and, accordingly, the risk of various diseases increases.

It is important to note that post-term pregnancy does not have the best effect on the health of the mother.Injuries to the birth canal, hormonal imbalance, problems with the uterus are just a few of the consequences that a woman may face. After childbirth, doctors prescribe the patient and the child the necessary recovery course in order to avoid the unpleasant consequences of a post-term pregnancy.

Ministry of Health

Cysts
during pregnancy complicate its course and can lead to operational
childbirth by cesarean section.To maintain pregnancy, doctors
the gynecological department of UOKTSSVMP carry out special treatment with the help of
high-precision equipment.

Cyst
– This is a formation in the form of a cavity filled with liquid. This pathology occurs
in one in a thousand pregnant women. If the cyst reaches a large size, then
it can rupture, torsion of the leg of the ovarian cyst, which leads to intra-abdominal
bleeding, accompanied by unbearable pain and can cause miscarriage and premature
childbirth.Large (over 6-8 cm in diameter) cysts are usually removed with surgery
by, mainly laparoscopically, through small incisions. During pregnancy
the most suitable time for surgery is 14-16 weeks. Few people take up treatment
such patients surgically.

home
the task of the department of gynecology of UOKTSSVMP is to provide surgical medical
care for gynecological diseases in a short time, as much as possible
efficiently, painlessly and with minimal side effects.Work
is built in accordance with the standards of evidence-based medicine practiced
among foreign colleagues. In conditions
the gynecological department has been conducting an active surgical
treatment of ovarian formations during
during pregnancy. Gynecologists-surgeons have extensive experience, modern equipment,
which is used by gynecologists of the most popular clinics around the world.

V
their practice during operations, doctors – gynecological department
actively use special equipment that contributes to stopping
bleeding during surgery, prevents the formation of adhesions, reduces the time
operations.Using endoscopic technologies and small approaches,
surgical treatment of women during pregnancy from 10 to 18 weeks, with
the size of the cysts is from 6 to 12 cm. The scope of the operation is to remove the cyst.
The operation time varies from 30 to 45 minutes. Already for 3-4 days the patient
are discharged home in satisfactory condition.

“In our practice, there was a 25 – year – old patient with her first pregnancy;
consultations.At 8 weeks, she was first diagnosed with a cyst
the right ovary measuring 10×10 centimeters. To the gynecological department
was admitted at 15 weeks of pregnancy with complaints of bleeding, pulling pains
lower abdomen. First, we treated the threat of premature birth,
pregnancy-preserving therapy was prescribed. All this time the woman was
under the constant supervision of qualified medical personnel. After
removal of all symptoms of the threat of termination of pregnancy, the patient was successfully operated
by laparoscopy using modern equipment.We removed her
cyst of the right ovary, the operation lasted 35 minutes, blood loss was minimal.
In the postoperative period, it was not required to prescribe an antibacterial
therapy. The patient was discharged home on the fourth day. Further pregnancy
proceeded without complications. A healthy baby was born at 39 weeks. Fortunately,
we live in the age of modern technologies and we can identify and cure in time
almost any disease. For many years, our department has been helping women with
to maintain your women’s health, carry and give birth to various diseases
healthy babies, regardless of those complications and conditions that may
accompany their pregnancy.Through the efforts of the entire team of our hospital,
with the support of the health care system of the Ulyanovsk region, in our power
to bring the methods of treating those diseases to a qualitatively new level during
pregnancies that until recently seemed beyond the realm of possibility, ”-
noted the head of the gynecological department of the UOCTsSVMP Sergey Zakharevsky.

.