Having a cyst while pregnant: Ovarian Cyst During Pregnancy | BabyCenter
Ovarian Cyst During Pregnancy | BabyCenter
An ovarian cyst during pregnancy is usually no cause for worry. Most ovarian cysts are harmless, painless, and go away on their own. Ovarian cysts don’t normally cause symptoms, either, although if a cyst ruptures it can be painful. And if a cyst twists or causes the ovary to twist (called ovarian torsion), you’ll need immediate surgery. While it’s usually not necessary, doctors can safely remove an ovarian cyst during pregnancy.
What is an ovarian cyst?
An ovarian cyst is a fluid- or tissue-filled sac or pouch in or on the ovary.
Ovarian cysts are usually harmless, painless, and disappear without treatment. They can vary in size from half an inch to four inches, and they usually develop during the childbearing years or after menopause. About 7 percent of women worldwide have an ovarian cyst at some time.
There are several types of ovarian cysts:
- Functional cysts are the most common type of cyst, and they’re related to ovulation. They don’t cause cancer. Functional cysts include follicular cysts and corpus luteum cysts. Follicular cysts form when the follicle holding the egg doesn’t open and release the egg during ovulation but instead holds onto it, forming a cyst. Corpus luteum cysts develop after ovulation. Usually, after an egg is released from the follicle the follicle shrinks. If the follicle doesn’t shrink but instead fluid collects in it, it forms a corpus luteum cyst.
- Teratoma cysts (also called dermoid cysts) contain different bodily tissues, such as skin and hair tissue. Teratoma cysts might be in the body from birth and then grow during a woman’s childbearing years. It’s rare, but these can become cancerous.
- Cystadenoma cysts grow on the outer surface of the ovary and are benign (non-cancerous). They can get quite large and are solid.
- Endometriomas might form when a woman has endometriosis (a condition where the tissue that normally lines the uterus grows outside the uterus, often on the ovaries). They are also called chocolate cysts and are filled with blood.
When the ovaries make many small cysts, it’s called polycystic ovary syndrome (PCOS). PCOS can cause fertility problems and lead to diabetes later in life.
What causes an ovarian cyst during pregnancy?
The most common type of ovarian cyst during pregnancy is a corpus luteum cyst. Rather than shrinking, the follicle that released the egg fills with fluid and remains on the ovary. These cysts usually go away on their own by the middle of the second trimester, but sometimes they stay on the ovary and – if they become large or cause symptoms – may need to be removed.
You may also have another type of cyst that you had before pregnancy. It may stay on your ovary while you’re pregnant. Other types of cysts may even grow during pregnancy and become painful, but they don’t usually cause problems for the pregnancy.
What will happen if I have an ovarian cyst during pregnancy?
Ovarian cysts usually don’t cause any problems during pregnancy, though if a cyst continues to grow it might rupture or twist or cause the ovary to twist (this twisting is called ovarian torsion). A growing cyst could cause problems during childbirth, particularly if it’s a large mass obstructing the abdomen or pelvis.
Your caregiver will do regular ultrasounds to monitor your ovaries and the cyst and make sure it doesn’t grow or threaten to cause any problems. If an ultrasound isn’t adequate for viewing a cyst that’s causing problems, you may have an MRI.
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Ovarian cyst symptoms
Ovarian cysts usually don’t cause any symptoms. Your caregiver might discover one during a routine pelvic exam or an ultrasound.
If an ovarian cyst becomes large or bleeds, breaks open, or becomes twisted or causes the ovary to twist, it can be painful.
Other possible ovarian cyst symptoms include:
- Abdominal fullness or pressure
- Pain during bowel movements
How will I know if I have ovarian torsion?
Ovarian torsion usually causes intermittent lower abdominal pain on one side. It may also cause:
- Low-grade fever
Ovarian torsion is a medical emergency. Go to the emergency department right away if you think you could have ovarian torsion.
How will I know if an ovarian cyst ruptures?
If an ovarian cyst ruptures during pregnancy, it’s most likely to happen in the first trimester or early second trimester and disappear on its own by the middle of the second trimester.
A cyst that has ruptured may cause:
- Sudden, severe pain
- Faintness or weakness
- Rapid breathing
Contact your healthcare provider right away if you think you have a ruptured ovarian cyst.
Ovarian cyst treatments
Usually ovarian cysts don’t require treatment. They go away on their own. Unless:
- You have an ovarian cyst that ruptures. In this case, you will likely need pain medication. Usually your body will absorb the ruptured cyst, but your healthcare provider will recommend rest and monitor you for signs of infection.
- You have an ovarian torsion (the cyst causes the ovary to twist). This is a medical emergency that requires surgery.
- The cyst is large or causing symptoms. Your caregiver may recommend rest and possibly surgery.
Is it safe to remove an ovarian cyst during pregnancy?
If necessary, an ovarian cyst can be safely removed during pregnancy, though your caregiver will probably avoid removal unless you’re in pain or the cyst is bleeding. If you need surgery, you may be able to have minimally invasive laparoscopic surgery through tiny incisions. In some cases, though, regular abdominal surgery is necessary.
If you have a corpus luteum cyst removed early in pregnancy (before 10 weeks), you’ll likely take progesterone supplements afterwards to support the pregnancy. (Normally, the corpus luteum provides progesterone to support the pregnancy until the placenta takes over.)
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What It Is and How to Treat
When you’re pregnant, it’s only natural to worry about every little thing that goes on in your body. After all, you want to ensure that everything is just right for that growing baby! So if you’ve been diagnosed with a corpus luteum cyst, you’re probably wondering what it is and what it means for baby. But rest assured that it’s a common condition that many women experience, whether they’re pregnant or not.
In this article:
What is a corpus luteum cyst?
Is a corpus luteum cyst dangerous?
Corpus luteum cyst symptoms
Corpus luteum cyst treatment
What Is a Corpus Luteum Cyst?
A corpus luteum cyst is simply a cyst that forms inside the corpus luteum. What’s that, you ask? Let’s review how ovulation works.
Every cycle, your body produces hormones that cause follicles—aka tiny fluid-filled sacs, each containing an immature egg—in one of your ovaries to start maturing. However, only one of the developing follicles will go on to form and then release a fully mature egg. Once it has released the egg, the empty follicle then transforms into the corpus luteum, a ball of cells that’s responsible for producing the hormone progesterone, explains Melissa R. Peskin-Stolze, MD, an ob-gyn and assistant professor of obstetrics and gynecology and women’s health at Montefiore Health System and Albert Einstein College of Medicine.
If an egg is fertilized and you become pregnant, hormones stimulate the corpus luteum to secrete progesterone until the placenta develops and takes over progesterone production for the remainder of the pregnancy, says Camaryn Chrisman Robbins, MD, a Washington University ob-gyn at the Women & Infants Center in St. Louis, Missouri.
If you don’t become pregnant that cycle, the corpus luteum breaks down and is shed along with the lining of your uterus in your next period.
Sometimes, a cyst can form in the corpus luteum, filled with fluid or blood. They can happen whether you become pregnant during the cycle or not, and happens when the corpus luteum fails to break down and instead continues to grow larger after it’s released the egg, Peskin-Stolze says.
If you’ve been diagnosed with a corpus luteum cyst, know that in the vast majority of cases, they’re completely benign and will resolve on their own. That’s the case even if you’re dealing with a corpus luteum cyst during pregnancy; they’re rarely harmful to the fetus.
Is a Corpus Luteum Cyst Dangerous During Pregnancy?
A luteal cyst is generally harmless and will usually go away on its own. “The corpus luteum works to support the early pregnancy, but if a cyst is still present on the corpus luteum by the end of the first trimester or early part of the second trimester, it usually resolves itself,” Peskin-Stolze says.
If that’s not the case, your doctor will likely just keep an eye on it and ask you questions at your regularly scheduled appointments about whether you’re experiencing any pain or discomfort. They may order an extra ultrasound now and then to monitor its size and make sure the cyst isn’t causing any issues for your ovary.
However, it’s possible (though unlikely) for a corpus luteum cyst to rupture or twist on the ovary’s blood supply, which could cause pain and, in rare cases, endanger your ovary, says Peskin-Stolze. Read on to learn more.
Corpus Luteum Cyst Rupture During Pregnancy
Though uncommon, a corpus luteum cyst can burst open, either spontaneously or because of an external factor like a pelvic exam, sex or exercise, says Robbins. In these cases, the greatest concern isn’t the impact on baby, but rather on the mom-to-be. “Usually the amount of bleeding is small, but in rare cases the cyst rupture can cause internal bleeding, requiring surgery.”
Corpus Luteum Cyst Torsion During Pregnancy
Even rarer than a corpus luteum cyst rupture is an event called torsion. This happens when an ovary with a cyst gets twisted around the artery and vein that make up its blood supply. “The heavy weight of the cyst swings around the blood supply, kind of like a tether ball game,” Peskin-Stolze explains. It’s more common in the early second trimester, as the uterus grows out of the pelvis. A torsion would also call for surgery.
Symptoms of a Corpus Luteum Cyst in Pregnancy
In many cases, there aren’t any corpus luteum cyst symptoms. In fact, most pregnant women don’t even know they have a corpus luteum cyst, especially if they skip that early ultrasound that doctors use to confirm a pregnancy. Other times they show up as part of a routine pregnancy ultrasound.
If you do experience corpus luteum cyst symptoms, the most common is typically a dull ache in your lower abdomen, says Robbins.
When to worry? If your pain suddenly becomes intense. According to Peskin-Stolze, the following are some symptoms you might experience if, in the unlikely event, you’ve had a corpus luteum cyst rupture or become twisted:
- One-sided, sharp lower abdominal/pelvic pain
- Moderate to severe pain that comes on quickly
- Shoulder pain
- Fainting and/or dizziness
If you experience any of the symptoms above, it’s important to seek medical attention. If your regular doctor is unavailable, or you experience these symptoms during off hours, it’s best to head to the Emergency Room to get checked out.
Corpus Luteum Cyst Treatment During Pregnancy
The best corpus luteum cyst treatment is often simply time, Pskin-Stolze says. Since most corpus luteum cysts resolve on their own, it doesn’t make sense to subject yourself to unnecessary medical procedures to get rid of the cyst.
If you’re experiencing minor corpus luteum cyst pain, it’s fine to take over-the-counter medication like Tylenol (ibuprofen, like Motrin and Advil, isn’t recommended during pregnancy). Heating pads and warm (not piping hot) baths can also be effective ways to reduce pain naturally. If you have a large corpus luteum cyst or take any medication that increases your likelihood of bleeding, your doctor may recommend abstaining from sex, Robbins says. But most women have no pain and don’t need to restrict their activities.
In the event of corpus luteum cyst torsion, you’d likely undergo laparoscopic surgery—but don’t worry, it can be performed safely and effectively in pregnant women. “Sometimes the ovary needs to be untwisted, with or without removal of the cyst that caused it to twist in the first place,” says Robbins. “In some cases, the blood supply has been pinched off too long and the ovary needs to be removed.” But rest assured, those cases are rare.
Updated February 2020
Melissa R. Peskin-Stolze, MD, is an ob-gyn and assistant professor of obstetrics and gynecology and women’s health at Montefiore Health System and Albert Einstein College of Medicine. She earned her medical degree from Albany Medical College.
Camaryn Chrisman Robbins, MD, MPH, is a Washington University ob-gyn at the Women & Infants Center in St. Louis, Missouri. She received her medical degree from Wake Forest University in 2004.
Please note: The Bump and the materials and information it contains are not intended to, and do not constitute, medical or other health advice or diagnosis and should not be used as such. You should always consult with a qualified physician or health professional about your specific circumstances.
Plus, more from The Bump:
What Causes Abdominal Pain During Pregnancy (and How to Find Relief)
What to Do About Dizziness During Pregnancy
The Truth About Taking Baths During Pregnancy
Ovarian cysts – what are they and what are dangerous during pregnancy
- Causes of ovarian cysts
- Types of ovarian cysts: their signs and symptoms
- Why ovarian cysts are dangerous
- Diagnosis of cysts
- Ways to treat ovarian cysts
When planning a pregnancy, women undergo various examinations, including ultrasound of the pelvic organs – the uterus and ovaries. In this case, the diagnosis of “ovarian cyst” is sometimes made. Can such cysts interfere with pregnancy and do they need to be treated or operated on to give birth to a healthy baby?
Ovarian cyst is a formation in the ovary, which is a bubble filled with fluid. The size of this formation can be different, which determines the symptoms of this disease. Small cysts are usually asymptomatic and are usually discovered incidentally during an ultrasound scan. Large ovarian cysts cause a feeling of heaviness in the lower abdomen and even pain.
Causes of ovarian cysts
Normally, in every woman, during the menstrual cycle, a dominant follicle matures in the ovary, from which in the middle of the cycle comes the germ cell – the egg. In place of the ruptured follicle, the so-called corpus luteum is formed – a formation with thick walls, which secretes the hormone progesterone into the blood, which contributes to the attachment of the fetal egg in the uterine cavity and its development until the placenta is formed. If the egg is not fertilized and pregnancy does not occur, the corpus luteum undergoes reverse development.
When follicle maturation and ovulation are disturbed, ovarian cysts may form. The mechanisms of their growth are very diverse. For example, if the follicle in the ovary reaches 20 mm in diameter, however, for some reason, ovulation (the release of the egg – the female germ cell – from the ovary) does not occur, that is, the follicle does not burst, it continues to grow further, and the so-called ovarian follicular cyst is formed.
If ovulation occurs, but hormonal imbalances lead to excessive accumulation of fluid in the lumen of the corpus luteum, a corpus luteum cyst may form.
Cysts can occur for no apparent reason, against the background of climate change, stress, hormonal disorders in the body.
Learn more about the services:
- Ultrasound of the pelvic organs
- Gynecological consultation
Types of ovarian cysts: their signs and symptoms
By their nature, ovarian cysts are functional and organic.
Functional ovarian cysts
Functional cysts include follicular cysts and cysts of the corpus luteum, most often they resolve spontaneously within several menstrual cycles. If functional cysts are small in diameter, do not compress the surrounding organs and do not cause pain, they are usually not treated.
With large sizes of cysts, hormonal treatment is carried out, most often hormonal contraceptives are prescribed, which normalize the hormonal background and promote the resorption of the cyst.
Functional cysts usually do not affect the course of pregnancy. When pregnancy occurs, they usually resolve before 16-19 weeks.
In addition, at early stages of pregnancy, the doctor very often diagnoses the presence of a corpus luteum cyst, which contributes to pregnancy due to increased production of progesterone (pregnancy hormone). Such cysts decrease in size and resolve after the formation of the placenta, that is, after 12 weeks of pregnancy.
Organic ovarian cysts
Organic cysts are cysts that do not resolve on their own and most often require surgical treatment. These include endometrioid cysts, cystadenomas, dermoid and paraovarian cysts.
These are benign organic cysts that grow slowly and are easily treated with surgery. Inside them is the tissue of the endometrium – the inner lining of the uterine cavity, which changes monthly and is rejected during menstruation.
The endometrium is a hormone-dependent tissue, respectively, all the same processes take place inside the cyst as in the uterine cavity, that is, the endometrium grows in the first phase of the menstrual cycle, matures in the second phase and is shed with bleeding during menstruation. Due to these processes, there is a gradual increase in the diameter of the endometrioid cyst.
Most often, small ovarian endometrioid cysts are asymptomatic and are found incidentally on ultrasound.
Large cysts can cause pain that gets worse during menstruation. They are often bilateral and can reach considerable sizes. Endometrioid cysts have a small risk of degeneration into a malignant ovarian cyst, most often this occurs in women after 40 years of age.
The presence of endometrioid ovarian cysts may prevent pregnancy and is an indication for surgical treatment. First, the cyst is removed, and then hormonal therapy, since endometrioid cysts are prone to reappear. Most often, hormonal contraceptives and drugs that cause artificial menopause are prescribed. In the absence of hormonal stimulation, endometrioid cells die, which prevents the recurrence of the disease. Depending on the diameter and number of endometrioid cysts, the presence of foci of endometriosis on the fallopian tubes and internal tissues of the abdominal cavity, a drug is chosen.
This is a fairly common type of ovarian cysts, most often cystadenomas are small unilateral cysts. Depending on the contents, a serous cystadenoma is distinguished, inside which there is a clear liquid of a light straw color, and a mucinous cystadenoma, with thick mucus inside.
These are benign cysts, but they can become malignant, which determines the tactics of their treatment: surgical removal of the formation.
During pregnancy, cystadenomas may increase in size and cause persistent abdominal pain.
Dermoid cyst (mature teratoma)
This is a congenital ovarian tumor, it is a round formation in the ovary and contains elements of hair, skin, nails, and fat in its structure. Such cysts can be of different sizes – from a few centimeters to giant formations. However, most often they are small and therefore do not manifest themselves clinically. Small-sized dermoid cysts, as a rule, do not affect conception and pregnancy, however, since there is a small probability of malignant degeneration of teratomas, their treatment is surgical.
This is a fluid-filled mass located between the ligaments of the uterus, next to the ovary. The paraovarian cyst is most often small and does not decrease over time or under the influence of drugs. However, it may increase. Most often this happens due to prolonged overheating – for example, if a woman likes to visit a sauna, abuses body wraps, often takes baths with water temperatures over 38 degrees C. Sunburn or in a solarium also contributes to the progression of the paraovarian cyst.
This type of formation, although small in size, usually does not affect the course of pregnancy and does not require any treatment. With the active growth of the cyst, its surgical removal is indicated.
Why are ovarian cysts dangerous? In this case, bleeding may begin, and, as a result, the need for hospitalization in a hospital. In addition, ovarian cyst torsion is possible, which is accompanied by severe abdominal pain and also requires hospital treatment.
Large ovarian cysts are a potential hazard during pregnancy, as the cyst may rupture or torsion, in which case surgery is indispensable.
In rare cases, the formation of multiple ovarian cysts causes infertility.
Diagnosis of cysts
The first stage of diagnosis of cysts is an examination by a gynecologist in the chair, the doctor can detect unilateral (rarely bilateral) enlargement of the ovary, with large cysts, pain is sometimes noted during the examination.
Ultrasound examination of the pelvic organs is widely used to diagnose ovarian cysts, which makes it possible to determine the type of cyst, since all the formations described above have their own distinctive features.
In some cases, for a correct diagnosis, it is necessary to conduct repeated ultrasound examinations during one or more menstrual cycles.
In case of controversial issues, the doctor may additionally recommend an MRI of the pelvic organs.
Methods for the treatment of ovarian cysts
Treatment of cysts is carried out in two ways – conservatively, that is, with the help of drugs, and operatively, that is, surgically.
Conservative therapy in this case is based on the use of hormonal drugs. For the treatment of cysts, hormonal contraceptives are widely used, most often prescribed MARVELON .
Hormonal contraceptives are prescribed for the treatment of functional ovarian cysts and in the postoperative period after removal of other ovarian cysts to prevent their recurrence.
With endometrioid ovarian cysts in the postoperative period, hormonal agents that cause artificial menopause are usually used to prevent recurrence.
Surgery for functional cysts is only required if there are complications such as cyst rupture or torsion. Organic cysts often require surgery.
Operations to remove ovarian cysts are performed laparoscopically (special instruments inserted into the abdomen through small incisions under the control of a video camera). Laparoscopy is also possible during pregnancy, in case of complications from the ovarian cyst. Only with large cysts is it necessary to make an incision on the anterior abdominal wall.
A feature of ovarian surgeries is the removal of a cyst or tumor within healthy tissues, that is, the ovarian tissue, which contains many follicles, must remain intact and intact, and the cyst, together with its capsule, is carefully “taken out” from the ovary. In rare cases, the so-called resection of the ovary is carried out, that is, the removal of part of it. If the size of the cysts is very large, then in some situations the ovarian tissue can hardly be found. In this case, the entire ovary is removed.
After laparoscopic surgery, the woman recovers quickly, usually a week after the operation she can already return to work.
Pregnancy management for ovarian cysts
Pregnancy planning usually depends on the type of cyst. Most often, conception is recommended 3-6 months after surgery.
During pregnancy, ovarian cysts are monitored using ultrasound and Doppler studies – the study of blood flow in the ovary and in the cyst, the control of the tumor disease marker CA-125, the concentration of which increases sharply if the cyst degenerates into a malignant tumor.
If surgery is required during pregnancy, it is safest to perform laparoscopy at 16-18 weeks.
Prevention of ovarian cysts
Timely diagnosis and treatment of thyroid diseases, as well as weight normalization are of great importance for the prevention of cysts, as this will help to avoid hormonal disorders in a woman’s body.
It is important to maintain personal hygiene and prevent inflammatory diseases of the uterus and ovaries, as well as sexually transmitted diseases.
It is not uncommon for ovarian cysts to occur after abortions.
The use of hormonal contraceptives significantly reduces the risk of any ovarian cysts.
Ovarian cyst during pregnancy. What is an ovarian cyst during pregnancy?
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.
An ovarian cyst during pregnancy is a volumetric neoplasm in the form of a cavity with liquid contents that can exist before fertilization or form after the conception of a child. With a small size of cysts, an asymptomatic course is possible, as the fetus grows, pains appear in the suprapubic region of varying intensity, radiating to the groin or sacrum, urination disorders, and constipation. For diagnosis, ultrasound of the pelvic organs is used, which is supplemented by color Doppler mapping. Conservative therapy is aimed at maintaining pregnancy and alleviating the condition. Removal of cysts is performed after the maturation of the placenta.
D27 Benign neoplasm of ovary
- Conservative therapy
- Surgical treatment
- Prognosis and prevention
- Prices for treatment
An ovarian cyst is more often detected in patients of late reproductive age, usually exists even before conception, due to hormonal and immune changes during gestation, it increases in volume. Cystic formations are diagnosed in 0.02-0.46% of women bearing a child. A direct relationship between the appearance of cysts and pregnancy has not been established. In adolescents and patients over 45 years of age, there is a risk of malignancy of the neoplasm under the influence of endocrine factors.
ovarian cyst during pregnancy
The exact causes of ovarian cysts during pregnancy are unknown. The most popular theory suggests the influence of endocrine disorders, which can be provoked by external or internal factors, or a combination of them. The development of the disease is facilitated by:
- Sexual infections. Chronic inflammatory diseases of the ovaries can cause disruption of proliferation processes in organ tissues. During pregnancy, the immune system weakens, the infection enters the active phase, which provokes the growth of the cyst.
- Hormonal changes. Associated with a decrease in estrogen production and an increase in the stimulating effect of FSH. They cause diffuse and then focal hyperplasia and proliferation of ovarian cells.
- Abortions. Termination of pregnancy causes fluctuations in the endocrine status, increases the risk of infection of the genital organs. This leads to a violation of the hormonal regulation of the sex glands and proliferative processes.
- Heredity. The likelihood of developing the disease is increased in women who have a maternal history of ovarian cysts.
- Prolonged absence of pregnancy. Regular ovulation is considered a damaging factor for ovarian tissue. If the patient does not become pregnant and does not take oral contraceptives that inhibit the ovaries and the maturation of the follicles, the risk of cyst formation increases.
The development of ovarian cysts often begins before pregnancy. Violation of neuroendocrine regulation leads to a weakening of the function of the gonads. The stimulating effect of FSH triggers proliferation processes. The source of focal hyperplasia can be normal cells that form ovarian tissues, or the remains of embryonic rudiments. In the latter case, cysts prone to malignancy appear.
With regular ovulation, ovarian tissue is damaged at the time of rupture of the follicle. The spilled liquid contains a large amount of estrogens, which increase cell proliferation. In older women, along with conventional estrogens, altered phenol steroids appear that can cause malignancy of cysts, so malignant tumors are often diagnosed in premenopausal pregnant women.
Ovarian cysts found during pregnancy can also be due to endometriosis. The pathogenesis of endometrioid cysts is associated with retrograde reflux of menstrual blood or with the remnants of embryonic tissue in the gonads. Under the influence of hormonal fluctuations, the epithelium in the cyst cavity is rejected, but does not go beyond the capsule and forms its contents.
Ovarian cysts during pregnancy are classified according to the histological structure, less often – according to the mechanism of origin. The division into types is the same as for neoplasms that have arisen outside the period of gestation. Histological classification includes:
- Epithelial. Serous, endometrioid, clear cell and mixed cysts, Brenner’s tumor.
- From the stroma of the sex cord. Thecoma, fibroma.
- Germinogenic. Dermoid cysts, chorionepitheliomas and ovarian struma.
- Tumor-like processes. Endometriosis, pregnancy luteoma, superficial epithelial and paraovarian cysts, polycystic, hyperthecosis.
Clinical manifestations do not depend on the histological structure of the ovarian cyst during pregnancy. At an early stage, there are no signs of the disease, the duration of the asymptomatic course can reach several years. Subsequently, aching dull pains in the lower abdomen are periodically disturbed, which can radiate to the groin, perineum, and lumbosacral region. Sometimes, before conception, the patient does not know about the existence of a neoplasm, the diagnosis is made during registration and a routine examination.
For the first trimester, the progression of symptoms is uncharacteristic. From 12-13 weeks, the uterus increases in size, changes the location of the appendages, can compress the cyst and cause tension in its capsule. Pain in the lower abdomen intensifies, especially with a change in body position. Acute pain indicates the development of complications – torsion of the legs of the ovarian cyst.
An ovarian cyst in 18% of cases causes a short-term abortion, the likelihood of complications is determined by the hormonal activity of the neoplasm and the existing risk factors for spontaneous miscarriage. In 12% of pregnant women, serous or dermoid cysts twist at the base. Torsion is accompanied by compression of the vessels supplying the tumor and tissue necrosis. Need emergency care and hospitalization in the gynecological department.
In the 2-3 trimester, with neoplasms of a significant size, the fetus occupies the wrong position – oblique or transverse, which makes it difficult to give birth through the natural birth canal and becomes an indication for caesarean section. If the patient gives birth on her own, at the end of the 1st stage of labor, with the appearance of attempts, there is a possibility of rupture of the cyst capsule and the addition of an acute abdomen clinic.
Large and inactive cystic masses can interfere with the advancement of the fetal head, so the preservation of the tumor before delivery increases the risk of labor anomalies and injuries in the newborn. Malignant degeneration of an ovarian cyst during pregnancy occurs in 25% of women with this pathology.
Suspicion of an ovarian cyst may occur during examination or routine examination of a pregnant woman. The diagnosis is established in cooperation with an oncogynecologist or oncologist, who exclude the malignant nature of the tumor. The following diagnostic methods are used:
- Gynecological examination. In a bimanual study over the Douglas space, a mobile tugoelastic formation is determined. The shape of a benign cyst is round or oval, the surface is smooth.
- Gynecological ultrasound. A benign ovarian cyst during pregnancy looks like a smooth-walled single-chamber formation of a rounded shape with even contours. The contents are hypoechoic or anechoic.
- CDC. Ovarian cysts are characterized by blood flow in single vessels located in the capsule. A large number of tortuous and irregularly shaped vessels testifies in favor of malignancy.
- CA-125, CA 19-9. Tumor markers are determined for differential diagnosis with a malignant tumor. The analysis is highly specific, with an increase in the rate of more than 35 mU / ml, 78-100% of pregnant women are diagnosed with ovarian cancer.
If an ovarian cyst is detected at the conception planning stage, surgical treatment is recommended before pregnancy. In other cases, tactics depend on the type of neoplasia. With follicular and luteal cysts, treatment is not always required, since in most women the formations disappear on their own within 2-3 cycles. For other types of cysts, hormonal therapy is used at the initial stage, with ineffectiveness, laparoscopic removal.
Treatment of ovarian cysts in early pregnancy is carried out by conservative methods, aimed at preserving the fetus and reducing unpleasant symptoms. A complete cure by medical methods is impossible. Hospitalization in the gynecology department is necessary in the first trimester when there is a threat of interruption of gestation. From the second trimester, women are sent to the department of pathology of pregnant women. The following groups of drugs are used:
- Gestagens. Oral or vaginal progesterone tablets are indicated for maintaining corpus luteum function and maintaining pregnancy.
- Antispasmodics. They are prescribed to reduce the tone of the myometrium. Pregnant women are allowed to take drugs based on drotaverine or papaverine in the form of tablets, rectal suppositories or injections.
- β-blockers. They are used to reduce the tone of the uterus after 24 weeks. In the early stages, they are ineffective due to the lack of appropriate receptors.
In most patients, cysts up to 10 cm in diameter accidentally discovered in the 1st trimester are luteal and regress independently after the final formation of the placenta. For other tumors, surgery is indicated. If the ovarian cyst at the beginning of pregnancy proceeds without complications, the intervention is refrained until 16 weeks of gestation. With elevated tumor markers, surgical treatment is carried out as early as possible.
Laparoscopic access is used, which reduces the risk of complications and shortens the rehabilitation period. When carrying out the operation at a later date, a laparotomy is performed. The volume of intervention is determined intraoperatively based on the results of an urgent histological examination, varies from cyst removal to ovarian resection. In severe cases, an oophorectomy is performed, which does not affect the bearing of the fetus.
Prognosis and prevention
The prognosis of ovarian cysts during pregnancy is usually favorable. Timely removal of the neoplasm allows you to bear the child and give birth on time. The reproductive function does not suffer, there are no contraindications for subsequent pregnancies. In order not to increase the risk of complications during the gestation period, cystic formations must be treated at the conception planning stage.
Specific prevention of the disease has not been developed. Unprotected sex should be abandoned, timely treatment of inflammatory diseases of the genital organs should be carried out, and abortions should be avoided. Patients who do not plan pregnancy and do not have contraindications to hormonal therapy are recommended to use oral contraceptives to prevent hyperplastic processes of the reproductive organs.
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