What are complex ovarian cysts. How do they differ from simple cysts. What symptoms can complex ovarian cysts cause. What are the potential risks and complications of complex ovarian cysts. How are complex ovarian cysts diagnosed and treated. When should you see a doctor for ovarian cyst symptoms.

Understanding Complex Ovarian Cysts: A Comprehensive Overview

Ovarian cysts are small sacs that form in or on an ovary. While many women experience simple cysts as part of their regular menstrual cycle, complex ovarian cysts are less common and may require more attention. Complex cysts contain either blood or solid substances, distinguishing them from their fluid-filled counterparts.

Complex ovarian cysts are not typically related to the menstrual cycle and may arise from various causes. While most ovarian cysts are benign, complex cysts have a higher likelihood of requiring treatment or further investigation.

Types of Complex Ovarian Cysts

There are several types of complex ovarian cysts, each with unique characteristics:

• Endometriomas: These cysts develop when uterine lining cells grow in or around the ovaries or on the uterus. They contain a thick brown fluid.
• Dermoids: Composed of skin, hair, fat, or teeth cells, dermoid cysts are an interesting variant of complex ovarian cysts.
• Cystadenomas: These cysts are made of ovarian tissue and contain mucus or fluid.

Recognizing the Symptoms of Complex Ovarian Cysts

Many women with complex ovarian cysts may not experience any symptoms at all. In some cases, these cysts are discovered incidentally during medical exams for other conditions. However, when symptoms do occur, they can include:

• Pressure or bloating in the abdomen
• General pain in the lower abdomen
• Vomiting or nausea if the cyst causes the ovaries to bend or twist
• An urgent or frequent need to urinate if the cyst pushes on the bladder
• Severe pain that comes on rapidly if the cyst bursts

Do complex ovarian cysts cause specific symptoms? In the case of endometriomas, additional symptoms may include constipation, diarrhea, fatigue, pain during sex or periods, fertility issues, and pain during bowel movements or urination.

Causes and Risk Factors for Complex Ovarian Cysts

The exact causes of complex ovarian cysts are often unknown. However, certain factors may increase the risk of developing these cysts:

• Ovulation: Women who ovulate are at the highest risk for developing ovarian cysts.
• Age: After menopause, ovarian cysts are more likely to develop into ovarian cancer, although this is still rare.
• Endometriosis: This condition causes endometriomas, a type of complex ovarian cyst.

Is there a link between hormonal imbalances and complex ovarian cysts? While research is ongoing, some studies suggest that hormonal fluctuations may play a role in the development of certain types of ovarian cysts.

Diagnosing Complex Ovarian Cysts: Medical Procedures and Tests

When a complex ovarian cyst is suspected, healthcare providers typically follow a systematic approach to diagnosis:

1. Pelvic Examination: This is often the first step in identifying potential ovarian cysts.
2. Ultrasound Scan: This imaging technique helps determine the type, size, and location of the cyst.
3. Blood Tests: These may be conducted to look for proteins that might indicate the presence of cancer, although cancerous cysts are rare.

How accurate are these diagnostic methods for complex ovarian cysts? While these tests are generally reliable, the definitive diagnosis often requires a combination of clinical assessment, imaging studies, and sometimes surgical exploration.

Potential Complications and Risks of Complex Ovarian Cysts

While most complex ovarian cysts are benign and cause minimal issues, some potential complications may arise:

• Ovarian Torsion: The cyst may cause the ovary to twist, leading to severe pain.
• Fertility Issues: Cysts on the ovaries may impact fertility in some cases.
• Rupture or Hemorrhage: In rare cases, a cyst may rupture, causing severe symptoms such as pain, nausea, and dizziness.
• Ovarian Cancer: Although rare, some complex cysts may develop into ovarian cancer, particularly in postmenopausal women.

What percentage of complex ovarian cysts turn out to be cancerous? According to the Office of Women’s Health, between 13-21% of ovarian cysts that require surgery are found to be cancerous. However, it’s important to note that this represents a small fraction of all ovarian cysts, as only 5-10% of women with ovarian cysts require surgery.

Treatment Options for Complex Ovarian Cysts

The treatment approach for complex ovarian cysts depends on various factors, including the size of the cyst, its characteristics, and the presence of symptoms. Treatment options may include:

• Watchful Waiting: For asymptomatic cysts, doctors may recommend monitoring the cyst over time to see if it resolves on its own.
• Medication: Hormonal treatments may be prescribed in some cases to manage symptoms or prevent new cyst formation.
• Surgery: When a cyst is large, causing symptoms, or suspected to be cancerous, surgical removal may be necessary.

What type of surgery is typically used for removing complex ovarian cysts? Laparoscopy is often the preferred surgical method for removing ovarian cysts. This minimally invasive procedure involves making small incisions and using specialized instruments to remove the cyst while preserving the ovary when possible.

Living with Complex Ovarian Cysts: Management and Lifestyle Considerations

For women diagnosed with complex ovarian cysts, certain lifestyle modifications and management strategies may be helpful:

• Regular Follow-ups: Keeping scheduled appointments with healthcare providers for monitoring is crucial.
• Pain Management: Over-the-counter pain relievers may help manage discomfort associated with cysts.
• Healthy Lifestyle: Maintaining a balanced diet and regular exercise routine can support overall reproductive health.
• Stress Reduction: Practicing stress-management techniques may help alleviate symptoms and improve overall well-being.

Can dietary changes impact the development or progression of complex ovarian cysts? While there’s no definitive evidence that diet directly affects ovarian cysts, maintaining a healthy lifestyle may support overall reproductive health and potentially reduce the risk of complications.

When to Seek Medical Attention for Ovarian Cyst Symptoms

It’s important to be aware of symptoms that may indicate a more serious condition related to ovarian cysts. Seek immediate medical attention if you experience:

• Sudden, severe abdominal or pelvic pain
• Pain accompanied by fever or vomiting
• Signs of shock, such as cold, clammy skin, rapid breathing, or weakness
• Heavy vaginal bleeding

How quickly should you seek medical care if you suspect a ruptured ovarian cyst? If you experience sudden, severe pain that you suspect might be from a ruptured cyst, it’s crucial to seek medical attention immediately or go to the nearest emergency room.

Complex ovarian cysts, while less common than simple cysts, require attention and proper management. Understanding the symptoms, risks, and treatment options associated with these cysts can empower women to make informed decisions about their reproductive health. Regular check-ups and open communication with healthcare providers are key to managing complex ovarian cysts effectively and minimizing potential complications.

As research in the field of gynecology continues to advance, new insights into the causes, prevention, and treatment of complex ovarian cysts may emerge. Staying informed about these developments and maintaining a proactive approach to reproductive health can contribute to better outcomes for women affected by this condition.

Remember, while complex ovarian cysts can be concerning, most are benign and manageable with proper care. If you experience symptoms or have concerns about ovarian cysts, don’t hesitate to consult with a healthcare professional for personalized advice and treatment options.

Complex ovarian cyst: Symptoms, risks, pictures, surgery

Ovarian cysts can be simple or complex. Complex ovarian cysts are those that contain either blood or a solid substance. They are more likely to require treatment.

Simple cysts are relatively common and usually clear on their own. Complex cysts are more likely to need treatment.

Most ovarian cysts are benign, meaning that they are noncancerous.

In this article, we take a close look at complex ovarian cysts, including their causes, symptoms, and treatments.

Ovarian cysts are small sacs that form in or on an ovary. Ovarian cysts can be simple or complex, depending on the substances that are inside them.

Simple cysts are filled with fluid. Monthly ovulation will often include the formation of cysts, and they are not usually a cause for concern. When they cause no problems, they are called functional cysts.

Complex cysts are less common than simple cysts. Either blood or a hard substance fills complex cysts. Unlike simple cysts, complex cysts are not related to the typical menstrual cycle.

Most cysts are not harmful. According to the Office of Women’s Health (OWH), cancerous cysts are rare and more common in older women.

The different types of complex ovarian cyst include:

• Endometriomas. This type occurs when the cells of the uterine lining grow in or around the ovaries or on the uterus. Endometriomas contain a thick brown fluid.
• Dermoids. Skin, hair, fat, or teeth cells make up dermoid cysts.
• Cystadenomas. These cysts are made of ovarian tissue and contain mucus or fluid.

A person with complex ovarian cysts may not experience any symptoms. People may only discover them during medical exams for other conditions or symptoms.

If complex ovarian cysts do cause symptoms, people may notice the following:

• pressure or bloating in the abdomen
• general pain in the lower abdomen
• vomiting or nausea if the cyst causes the ovaries to bend or twist
• an urgent or frequent need to urinate if the cyst pushes on the bladder
• a severe pain that comes on rapidly if the cyst bursts

If a person has endometriomas, they may have additional symptoms that include:

• constipation
• diarrhea
• fatigue
• nausea
• pain during sex
• pain during periods
• issues with fertility
• pain during bowel movements or urination

People should see their doctor if they experience severe pain in the abdomen, a fever, and vomiting.

In many cases, medical experts do not know what causes complex ovarian cysts.

A condition called endometriosis causes endometriomas. Endometriosis is when the cells of the uterine lining grow outside of the uterus.

Women who ovulate are most at risk for developing an ovarian cyst. Meanwhile, after menopause, ovarian cysts are more likely to develop into ovarian cancer.

In many cases, a cyst will clear on its own without treatment. However, if a doctor suspects that someone has an ovarian cyst, they will typically conduct a pelvic examination.

A doctor may perform an ultrasound scan to identify the type and location of any cysts. They may take blood samples to look for proteins that might indicate if a person has cancer.

Most complications from complex ovarian cysts are minor, but some may be more severe.

Complications of complex ovarian cysts may include the following:

• If a cyst grows too large, it can press against the bladder, causing a frequent need to urinate.
• An enlarged cyst may also push the ovary out of its usual position in the body.
• An ovarian cyst can cause ovarian torsion, where the ovary twists. This action may be very painful.
• A person may develop fertility issues because of cysts on the ovaries.
• In rare cases, ovarian cysts can develop into ovarian cancer.

If a cyst ruptures or hemorrhages, a person may experience severe symptoms, including:

• nausea and vomiting
• severe pain
• fast breathing
• abnormal vaginal bleeding
• fever
• dizziness

Complex cysts are more likely to need treatment than simple cysts.

According to the OWH, between 5–10 percent of women with ovarian cysts will have surgery. Of that number, between 13–21 percent are cancerous.

A doctor may recommend surgery when a cyst is becoming too large, interfering with the ovary or other organs, or is painful.

A surgeon will often use laparoscopy to remove an ovarian cyst. Here, the medical team places the individual under general anesthesia, and the surgeon performs keyhole surgery, using small entry points, to remove the cyst.

Most complex ovarian cysts are benign and may not cause any symptoms. A person may experience pain or discomfort if the cyst grows too large.

An enlarged cyst may push against the bladder, cause abdominal pain, or interfere with fertility. Full recovery is usual when a person requires surgery.

If someone suspects that they have an ovarian cyst, they should speak to their doctor to find out the best course of action.

Complex ovarian cyst: Symptoms, risks, pictures, surgery

Ovarian cysts can be simple or complex. Complex ovarian cysts are those that contain either blood or a solid substance. They are more likely to require treatment.

Simple cysts are relatively common and usually clear on their own. Complex cysts are more likely to need treatment.

Most ovarian cysts are benign, meaning that they are noncancerous.

In this article, we take a close look at complex ovarian cysts, including their causes, symptoms, and treatments.

Ovarian cysts are small sacs that form in or on an ovary. Ovarian cysts can be simple or complex, depending on the substances that are inside them.

Simple cysts are filled with fluid. Monthly ovulation will often include the formation of cysts, and they are not usually a cause for concern. When they cause no problems, they are called functional cysts.

Complex cysts are less common than simple cysts. Either blood or a hard substance fills complex cysts. Unlike simple cysts, complex cysts are not related to the typical menstrual cycle.

Most cysts are not harmful. According to the Office of Women’s Health (OWH), cancerous cysts are rare and more common in older women.

The different types of complex ovarian cyst include:

• Endometriomas. This type occurs when the cells of the uterine lining grow in or around the ovaries or on the uterus. Endometriomas contain a thick brown fluid.
• Dermoids. Skin, hair, fat, or teeth cells make up dermoid cysts.
• Cystadenomas. These cysts are made of ovarian tissue and contain mucus or fluid.

A person with complex ovarian cysts may not experience any symptoms. People may only discover them during medical exams for other conditions or symptoms.

If complex ovarian cysts do cause symptoms, people may notice the following:

• pressure or bloating in the abdomen
• general pain in the lower abdomen
• vomiting or nausea if the cyst causes the ovaries to bend or twist
• an urgent or frequent need to urinate if the cyst pushes on the bladder
• a severe pain that comes on rapidly if the cyst bursts

If a person has endometriomas, they may have additional symptoms that include:

• constipation
• diarrhea
• fatigue
• nausea
• pain during sex
• pain during periods
• issues with fertility
• pain during bowel movements or urination

People should see their doctor if they experience severe pain in the abdomen, a fever, and vomiting.

In many cases, medical experts do not know what causes complex ovarian cysts.

A condition called endometriosis causes endometriomas. Endometriosis is when the cells of the uterine lining grow outside of the uterus.

Women who ovulate are most at risk for developing an ovarian cyst. Meanwhile, after menopause, ovarian cysts are more likely to develop into ovarian cancer.

In many cases, a cyst will clear on its own without treatment. However, if a doctor suspects that someone has an ovarian cyst, they will typically conduct a pelvic examination.

A doctor may perform an ultrasound scan to identify the type and location of any cysts. They may take blood samples to look for proteins that might indicate if a person has cancer.

Most complications from complex ovarian cysts are minor, but some may be more severe.

Complications of complex ovarian cysts may include the following:

• If a cyst grows too large, it can press against the bladder, causing a frequent need to urinate.
• An enlarged cyst may also push the ovary out of its usual position in the body.
• An ovarian cyst can cause ovarian torsion, where the ovary twists. This action may be very painful.
• A person may develop fertility issues because of cysts on the ovaries.
• In rare cases, ovarian cysts can develop into ovarian cancer.

If a cyst ruptures or hemorrhages, a person may experience severe symptoms, including:

• nausea and vomiting
• severe pain
• fast breathing
• abnormal vaginal bleeding
• fever
• dizziness

Complex cysts are more likely to need treatment than simple cysts.

According to the OWH, between 5–10 percent of women with ovarian cysts will have surgery. Of that number, between 13–21 percent are cancerous.

A doctor may recommend surgery when a cyst is becoming too large, interfering with the ovary or other organs, or is painful.

A surgeon will often use laparoscopy to remove an ovarian cyst. Here, the medical team places the individual under general anesthesia, and the surgeon performs keyhole surgery, using small entry points, to remove the cyst.

Most complex ovarian cysts are benign and may not cause any symptoms. A person may experience pain or discomfort if the cyst grows too large.

An enlarged cyst may push against the bladder, cause abdominal pain, or interfere with fertility. Full recovery is usual when a person requires surgery.

If someone suspects that they have an ovarian cyst, they should speak to their doctor to find out the best course of action.

Ovarian cyst, diagnosis and treatment

The doctor chooses treatment depending on the woman’s age, her plans for childbearing, the type of cystic formation.

Conservative treatment

As mentioned above, the corpus luteum cyst and follicular cyst resolve themselves in a few months. To prevent their recurrence, prescribe oral contraceptives that prevent ovulation. These drugs act on the substrate of a probable cystic formation – the corpus luteum or follicle, preventing their formation.

Conservative treatment is also prescribed for cyst rupture and slight intra-abdominal bleeding (in a situation where the general condition of the woman is not affected, and the anemia is not progressing). In such a situation, the doctor prescribes drugs that increase blood clotting (hemostatics), and in some cases non-steroidal anti-inflammatory drugs.

With partial torsion of the cyst, conservative therapy is primarily used, and if it is ineffective, surgical intervention is used. Use infusions, antiplatelet agents, antispasmodics. If the woman’s condition returns to normal, then surgical treatment is not prescribed.

If an endometrioid cyst is diagnosed, surgery is performed. But such cystoid formations can be quite large, and therefore hormones are prescribed before surgical treatment to reduce the size of the cyst – as a result, the risk of traumatizing healthy tissues is reduced, and the intervention itself is technically easier to perform.

Surgical treatment

This type of treatment is performed in the following situations:

• A cyst is suspected to be malignant.

• Endometrioid cystic formation.

• Dermoid cystic formation (with this type of cyst, drug treatment in principle does not give the desired effect).

• Large cystic masses.

• Torsion of the pedicle of a cystic neoplasm when therapeutic methods have failed.

• Intra-abdominal bleeding resulting from rupture of a cystic mass.

• Chronic pelvic pain (implies pain in the lower abdomen for a period of six months or longer) with symptomatic cysts.

Today, when prescribing surgical treatment, gynecologists prefer the laparoscopic method. Its essence is the introduction of instruments into the abdominal cavity through three small punctures on the anterior abdominal wall. The advantages of such interventions are fast recovery after them, an almost imperceptible scar, and minimal tissue trauma. Open laparotomy surgical interventions through the anterior abdominal wall are now performed very rarely.

During the operation, the doctor strives to preserve as much as possible the tissues that are not affected by the pathological process. It is for this reason that, if there are appropriate conditions, the gynecologist excised only a cystic formation, preserving the uterine tube and ovary. If the ovary or tube is pathologically changed, the cystic formation is large, the appendages are removed entirely.

Complicated course of ovarian cysts in the fetus and their ultrasound diagnosis » Obstetrics and Gynecology

Purpose of the study: to establish echographic signs characteristic of various types of complicated ovarian cysts and to choose the most rational tactics for managing pregnancy and newborns, taking into account the identified pathology.
Material and methods: 16 cases of ultrasound diagnosis of complicated course of ovarian cysts in the fetus, detected in the period of 33-38 weeks of pregnancy, are presented. In 10 cases, intrauterine torsion of the ovarian cyst occurred, in 1 case – ovarian apoplexy, in 1 case – rupture of the ovarian cyst, in 4 cases – hemorrhage into the ovarian cyst. When a volumetric formation was detected in the fetus, its localization and size were determined, and the internal structure was evaluated. We also performed dynamic ultrasound monitoring of the fetus to assess changes in the size and structure of the formation during the entire remaining period of gestation and after the birth of the child.
Results of the study: Echographic signs of this pathology are described. Emergency delivery at 33 weeks of gestation was required in 1 case with ovarian apoplexy and intra-abdominal bleeding, in the remaining 15 cases, delivery occurred on time. Surgical treatment after birth was performed in 11 cases (intrauterine torsion of an ovarian cyst, apoplexy), in 5 cases (cyst rupture, hemorrhage into the cyst), the pathological formation spontaneously disappeared. Survival of newborns was 100%.
Conclusion: sonography is a valuable method, the use of which makes it possible to diagnose such a complex pathology as complicated fetal ovarian cysts in utero, and, based on the data obtained, decide on the choice of the most rational way to manage pregnancy and treat newborns.

Ovarian cysts are the most common fetal abdominal mass. Their population frequency averages 1:2500 [1].

Mostly – these are follicular cysts, the occurrence of which occurs due to the accumulation of fluid in the cavity of the follicle as a result of stimulation of the fetal ovaries by mother’s hormones [2]. In isolated cases, cystic teratomas and cystadenomas also occur [3, 4]. Spontaneous regression of ovarian cysts is observed in 25–50% of newborns [2, 5].

Ultrasound data indicate that the size of cysts in the fetus varies widely – from 1 to 12 cm [6]. On scans, they are mainly depicted as unilateral, single-chamber, rounded liquid formations with smooth walls, located in the lower parts of the fetal abdominal cavity [7]. M.V. Medvedev [8] identifies completely anechoic cysts by echostructure, which occur in 81.4% of cases, cysts with internal septa – 14.5%, and cysts containing an echogenic component – 4.1%.

A distinctive feature of ovarian cysts in the fetus is their appearance after the 26th week of pregnancy, more often in the last 2-6 weeks. The tactics of management and treatment of fetuses and newborns with tumor-like formations of the ovaries depends on their size, structure, and the presence of complications [5, 9].

When uncomplicated cysts are detected, surgical treatment is not required, since they disappear within 1-6 months after the birth of a child [3].

The most frequently complicated cysts are 4-5 cm or more. These are torsion of the cyst leg, ovarian apoplexy, hemorrhage into the cyst, rupture of the cyst with the formation of hemoperitoneum. The large size of the cyst can cause obstruction of the intestines, urinary tract, the development of polyhydramnios [10] and, in extremely rare cases, pulmonary hypoplasia [11].

Torsion of the ovarian pedicle is an indication for surgical treatment. Ultrasound diagnosis of this complication is based on a sharp increase in the size of a previously detected cystic formation, the presence of hyperechoic inclusions in its cavity [12], thickening of the wall and the appearance of an echogenic sediment with the level of separation of the liquid part and suspension [13].

Ovarian apoplexy is understood as a sudden hemorrhage into the ovary, accompanied by a violation of the integrity of its tissue and bleeding into the abdominal cavity. The most common cause of apoplexy is the rupture of the follicular cyst in the presence of a thin wall of the formation, its very rapid growth and excessive accumulation of fluid [9]. In some cases, spontaneous rupture of the wall of the follicular cyst can be observed, which we sometimes saw during ultrasound examinations in adults [14].

The purpose of this study was to establish the echographic signs characteristic of various types of complicated ovarian cysts, and to choose the most rational tactics for managing pregnancy and newborns, taking into account the identified pathology.

Material and methods of research

Given the great clinical significance of this problem, the present study analyzed 16 cases of complicated course of ovarian cysts in the fetus. Of these, intrauterine torsion of the cyst stem occurred in 10 cases, apoplexy in 1 case, rupture of the cyst wall in 1 case, and hemorrhage into the cyst in 4 cases.

Initially, to determine the gestational age, weight and growth of the fetus, the biparietal and fronto-occipital dimensions of the head, the interhemispheric size of the cerebellum, the average size of the abdomen, the average transverse size of the heart, the length of the shoulder, thigh, tibia and foot were measured. Then the location and size of the placenta were determined. Particular attention was paid to the condition of the internal organs and other anatomical formations of the fetus.

When a mass was detected in the fetus, its localization and size were determined, and the internal structure was evaluated.

Dynamic ultrasound monitoring of the fetus was also performed to assess changes in the size and structure of the formation during the entire remaining period of gestation and after the birth of the child.

Ultrasound was performed using a Siemens SONOLINE Elegra (Germany) and Alfa 10, Aloka (Japan) using a 3.5 MHz transabdominal convex probe and a 7.5 MHz linear probe. Along with this, Dopplerography and cardiotocography were performed in all patients using a fully automated cardiac monitor (“Fetal Condition Analyzer”) manufactured by Unikos (Moscow).

Research results and discussion

The gestation period at which cyst torsion occurred in our observations was 33–38 weeks.

Ovarian cysts with torsion of their legs on scans were visualized as a liquid formation of a rounded shape, localized in the lower parts of the abdominal cavity of the fetus. Their diameter varied within 4.5–6.0 cm. The thickness of the cyst wall was 2–3 mm (Fig. 1, see inset).

A characteristic feature of this pathology was the presence of an echogenic sediment with a level of stratification of the liquid part and suspension (Fig. 2, see inset). During the dynamic study, an increase in the size of the volumetric formation and a change in the number of internal echostructures were noted. In one observation, thin echogenic septa were found, which, from our point of view, were fibrin threads and their appearance was a consequence of hemorrhage into the cyst cavity (Fig. 3, see inset).

All neonates were surgically treated after birth. Examination of the abdominal cavity revealed an ovarian cyst with torsion in seven cases (Fig. 1, see inset), bilateral adnexal torsion in one case (Fig. 2, see inset), and in two cases, an ovarian cyst with self-amputation ( Fig. 3, see insert). Due to the obvious non-viability and lack of healthy tissues, the altered appendages were removed.

Pathological examination revealed totally necrotic tissue. Bilateral adnexal torsion was diagnosed with giant corpus luteum cysts with subtotal atrophy of ovarian tissue. In the inner lining of the cyst, luteal cells were determined. Ovarian apoplexy was diagnosed in one fetus at 33 weeks’ gestation. When scanning the fetal abdomen in the abdominal cavity on the right, the formation of increased echogenicity of a spongy structure with clear even contours measuring 4.7 × 3.4 × 3.7 cm was visualized. Along with this, the fetus had a significant accumulation of fluid in the abdominal cavity (Fig. 4, see insert). Based on the data obtained, it was suggested that the fetus had apoplexy of the right ovary, which occurred, apparently, due to a rupture of the cyst wall, as well as a follicular cyst of the left ovary.

During the Doppler ultrasound, the fetus showed “zero” blood flow in the umbilical artery and a pronounced decrease in uteroplacental blood flow. The indicator of the state of the fetus, according to automated antenatal cardiotocography, was 4.0, which indicated a pronounced intrauterine suffering of the fetus.

Due to the current critical situation, an emergency delivery by caesarean section was performed. A live premature girl weighing 2544 g and 46 cm tall was born in a state of severe asphyxia. Apgar score 3/7/8 points. Immediately after birth, laparocentesis was performed, 80 ml of hemorrhagic fluid was removed. On the 15th day of life after stabilization of the condition of the newborn, an operation was performed – laparoscopic cystectomy on the left and resection of the right ovary.

When opening the abdominal cavity, it was found that the right ovary was enlarged in size, a formed blood clot 3.0 × 4.0 × 3.2 cm in size was found in its parenchyma. A cyst 6 cm in diameter was found in the left ovary. conclusions: on the right, fragments of the follicular ovarian cyst with the presence of hemorrhage due to apoplexy are determined; on the left – fragments of ovarian tissue with a sign of a follicular cyst. The child was discharged home on the 25th day of life in a satisfactory condition.

Rupture of the ovarian cyst wall was diagnosed directly during the ultrasound examination of the fetus at 33 weeks of gestation. When scanning the fetal abdomen at 32 weeks 2 days in the lower abdominal cavity on the right, a liquid formation with a homogeneous anechoic content 6.3 × 4.5 × 5.2 cm in size was detected, the wall thickness was 0.14 cm (Fig. 5A, see insert). As a result of the study, a follicular cyst of the right ovary of the fetus was diagnosed. During the second ultrasound examination, performed 5 days later, at a gestational age of 33 weeks, during the examination, a rupture of the cyst wall occurred with the simultaneous appearance of a small amount of homogeneous anechoic fluid in the abdominal cavity. The wall of the collapsed cyst was visualized in the form of thin partitions, which were displaced by the movement of the fetus. The formation itself during this period took an oval shape and significantly decreased in size (4.2 × 0.8 × 2.5 cm; Fig. 5B, see inset). During the subsequent ultrasound examination, carried out at a gestational age of 33 weeks 5 days, a liquid formation with a fine suspension, fragments of a fine mesh structure, with irregularly shaped partitions, which were fibrin threads, was determined in the abdominal cavity of the fetus on the right. All this indicated hemorrhage in the remaining cavity of the cyst. The dimensions of the formation during this period were 4.5×3.2×3.6 cm, and the wall thickness was 0.16 cm. Free fluid in the abdominal cavity was not detected (Fig. 5C, see inset). Dopplerography and automated fetal cardiotocography were performed in dynamics, their parameters remained within the normal range. After birth, a dynamic ultrasound examination of the newborn was performed, during which a gradual decrease in the size of the cyst was noted. After 3 months, the volumetric pathology of the ovary detected earlier was not determined.

Hemorrhage into the ovarian cyst occurred in four fetuses at 30-32 weeks. Echography in the abdominal cavity revealed a round liquid formation of an inhomogeneous mesh structure with a diameter of 4.6–5.2 cm, the wall thickness was 2–2.5 mm (Fig. 6, see inset). Dopplerography and automated cardiotocography were carried out in dynamics, the indicators of these research methods were within the normal range. These formations in all fetuses disappeared by the end of pregnancy.

Fetal ovarian cysts are a fairly common pathology. The dynamics of the development of these ovarian formations is different. In some fetuses, they undergo spontaneous regression (functional cysts), in others they remain unchanged (serous smooth-walled cystadenomas, mature cystic teratomas). Sometimes cysts increase in size or the nature of their contents changes, which is associated with the presence of a complicated course: antenatal torsion, rupture of the ovarian cyst wall, ovarian apoplexy, hemorrhage into the cyst. At present, as our study shows, the use of echography makes it possible to differentiate between uncomplicated and complicated ovarian cysts even in utero with a fairly high accuracy. Uncomplicated ovarian cysts on scans are rounded formations with a thin wall and anechoic contents. Under dynamic observation, they tend to decrease, up to complete disappearance. Complicated ovarian cysts are characterized by heterogeneous contents, a thick wall, a double contour, the presence of partitions, echogenic sediment (sometimes with the level of separation of the liquid part and suspension), an increase in their size during dynamic observation.

From the data presented by us, it follows that the main echographic signs of torsion of the pedicle and self-amputation of the ovarian cyst are the presence of a thickened wall and the appearance of an echogenic sediment with the level of stratification of the liquid part and suspension.

Our study shows that at this stage of the development of ultrasound medical technology, it is usually not possible to establish self-amputation of an ovarian cyst, the presence of this pathology in a significant number of cases may indicate a high location in the abdominal cavity of an ovarian cyst with signs of its torsion.

Ovarian apoplexy on scans is manifested by an increase in the size of the ovary, the presence of a volumetric formation of medium echogenicity, an inhomogeneous or amorphous structure (blood clot), and the appearance of fluid in the abdominal cavity of the fetus, which may indicate the presence of hemiperitoneum.

Cyst rupture on scans is manifested by a significant decrease in the size of a previously detected formation, displacement of its walls during fetal movement and the appearance of free fluid in the abdominal cavity.

An ovarian cyst with hemorrhage in its cavity on a scan is depicted as a rounded formation of an inhomogeneous echostructure with the presence of partitions (fibrin strands) and a wall thickened to 2–2.5 mm. Usually, this formation gradually regresses towards the end of pregnancy.

When choosing the tactics of managing pregnancy with complicated ovarian cysts, first of all, it is necessary to take into account the nature of the complication, as well as the results of Doppler sonography and automated antenatal cardiotocography, which reflect the general condition of the fetus. The deterioration of these indicators may be due to the development of intra-abdominal bleeding, which requires emergency delivery. In other cases, if the general condition of the fetus does not suffer, the issue of surgical treatment of this pathology is decided after the birth of the child. Such pathological changes in the ovary as intrauterine torsion, self-amputation and ovarian apoplexy usually require surgical treatment. Hemorrhage into the cyst and rupture of the wall of the ovarian cyst without bleeding generally ends in self-healing.

Thus, echography is a valuable method, the use of which makes it possible to diagnose such a complex pathology as complicated fetal ovarian cysts in utero, and, based on the data obtained, decide on the choice of the most rational way to manage pregnancy and treat newborns.

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