Ovarian Cysts – Columbus OBGYN

Ovarian cysts are one of the most common complaints from women of childbearing age. These painful afflictions can range anywhere from being a mild annoyance to a serious problem. This wide range of possible degrees of severity can oftentimes make it difficult for women to take the appropriate action for their type of cysts and to find suitable information that applies to them. This informational page is meant to answer your questions about ovarian cysts, whether big or small, and to help you decide what is right for your condition.

WHAT DO OVARIES DO?

Ovaries are the two small, walnut-sized organs that are located on either side of your uterus. Every month during your menstrual cycle, one of your two ovaries produces an egg, which grows inside a small cyst inside your ovary. On the 14th day of your cycle, hormones signal that this egg should be released to be fertilized. This process is called ovulation, and allows for the possibility of a pregnancy if the egg is fertilized.

WHAT ARE OVARIAN CYSTS, AND HOW DO THEY FORM?

Ovarian cysts are amounts of fluid surrounded by sac, which oftentimes grow inside your ovaries. Ovarian cysts can cause severe abdominal pain and even bleeding when they burst. These cysts can range anywhere from being the size of a pea to the size of an orange. Most cysts are minor and not life threatening, aside from causing a fair amount of pain. However, some larger cysts can be dangerous, as they may be malignant (cancerous). This is why all ovarian cysts should be checked out by your doctor.

There are several different types of ovarian cysts that are categorized by your doctor:

• Functional cysts: These are the most common types of cysts. There are two different types of functional cysts- follicle and corpus luteum. Both types of functional cysts develop from tissues during the menstrual cycle. Usually functional cysts are very minor and have no symptoms and they disappear within a few months.
• Dermoid cysts: These are made up of different kinds of bodily tissues such as hair, fat, skin, and teeth. They are usually small and asymptomatic, but they can sometimes become very large and painful.
• Cystadenomas: They are formed on the outside of the ovary. Cystadenomas have the possibility to become quite large and painful, oftentimes interfering with the functions of other organs. However, usually they remain benign.
• Endometriomas: They are usually caused by sudden change in hormones, resulting in endometrial tissue building up in the ovary. They can become quite large and very painful.

WHAT ARE THE SYMPTOMS OF OVARIAN CYSTS?

Although the majority of ovarian cysts are small and do not end up causing problems, others can be quite painful. They may cause a consistent pain the lower abdomen from bursting, bleeding, or becoming twisted. Also, sexual intercourse may further exacerbate painful symptoms. If you are experiencing pain like this and believe you may have ovarian cysts, it is important to see your gynecologist because they can help determine the course necessary to relieve the pain. Also, it is important to make sure that these cysts are early forms of cancer.

HOW ARE DOCTORS ABLE TO DIAGNOSE MY OVARIAN CYSTS?

Ovarian cysts are oftentimes found during routine pelvic exams. Your doctor may also use an ultrasound to create a better picture of the cysts, or run blood tests to find certain compounds that will indicate your condition. Sometimes, doctors will use laparoscopies to look directly into your body for a better diagnosis. This surgical procedure will allow your doctor to not only diagnose your cysts, but also to treat them.

HOW CAN MY OVARIAN CYSTS BE TREATED?

For cysts that are larger and more painful, treatment for the symptoms is necessary. Depending on your age, symptoms, size and type of cyst, and future family planning, your doctor will be able to decide what treatment plan is best for you.

• Oral Contraceptives: Sometimes, birth control pills can help regulate your menstrual cycle and ovarian cysts. The birth control pills work by adjusting estrogen and progesterone levels to mimic pregnancy, your ovaries will not ovulate; reducing follicles and fluid buildup.
• Surgery: For more serious cysts, your doctor may recommend surgery. Depending on your type of cyst, your doctor will either be able to simply remove just the cyst, or he or she may need to remove the entire ovary. Oftentimes it is very difficult to predict which type of surgery will be needed.

IN CONCLUSION

Ovarian cysts are a very common affliction of women during the years they have a menstrual cycle. Although many cysts are benign and will usually get rid of themselves, it is important to talk to your doctor about any concerns you have about their painful symptoms. Your doctor will then be able to advise you in the appropriate action to take in order to rid yourself of the symptoms and feel your best.

A Primary Ovarian Pregnancy with a Contralateral Ruptured Corpus Luteum: A Case Report

J Clin Diagn Res. 2012 Dec; 6(10): 1772–1774.

Farah Ziyauddin

¹ Assistant Professor, Department of Obstetrics & Gynaecology, JN Medical College, Aligarh, India.

Tamkin Khan

² Associate Professor, Department of Obstetrics & Gynaecology, JN Medical College, Aligarh, India.

Dalia Rafat

³ Resident, Department of Obstetrics & Gynaecology, JN Medical College, Aligarh, India.

Meher Aziz

⁴ Professor, Department of Pathology, JN Medical College, Aligarh, India.

Nazima Haider

⁵ Nazima Haider, Senior resident, Department of Pathology, JN Medical College, Aligarh, India.

¹ Assistant Professor, Department of Obstetrics & Gynaecology, JN Medical College, Aligarh, India.

² Associate Professor, Department of Obstetrics & Gynaecology, JN Medical College, Aligarh, India.

³ Resident, Department of Obstetrics & Gynaecology, JN Medical College, Aligarh, India.

⁴ Professor, Department of Pathology, JN Medical College, Aligarh, India.

⁵ Nazima Haider, Senior resident, Department of Pathology, JN Medical College, Aligarh, India.

NAME, ADDRESS, E-MAIL ID OF THE CORRESPONDING AUTHOR: Dr. Farah Ziyauddin, Near M.U College, Hadi Nagar, Dhorra, Aligarh, India. Phone: 08410640521 E-mail: moc.liamffider@rdayizharaf

Received 2012 Jul 12; Revisions requested 2012 Jul 30; Accepted 2012 Aug 4.

Copyright © 2012 Journal of Clinical and Diagnostic ResearchThis article has been cited by other articles in PMC.

Abstract

A primary ovarian pregnancy is one of the rarest varieties of ectopic pregnancies. The conditions which are most commonly confused with an ovarian pregnancy are, a ruptured corpus luteal cyst, a haemorrhagic corpus luteum and a ruptured endometriotic cyst. This case presents the clinical and the histological findings of a ruptured ovarian pregnancy, along with a ruptured corpus luteal cyst in the contralateral ovary.

Keywords: Primary ovarian pregnancy

INTRODUCTION

An ectopic pregnancy is an important health problem and it accounts for 10% of all the maternal mortalities [1]. A primary ovarian pregnancy is even rarer, accounting for 0.15%-3% of all the ectopic gestations [2]. The diagnosis of an ovarian ectopic pregnancy is seldom made before the surgery [3]. Pelvic pain, amenorrhoea and vaginal bleeding are the foremost classical symptoms which are found in these cases. Here, we are reporting a case of a ruptured primary ovarian pregnancy with a ruptured corpus luteum in the contralateral ovary.

CASE

A 20-year old primigravida presented to the emergency department with amenorrhoea of 6 weeks duration, acute pain in the abdomen, dizziness, vomiting and bleeding per vaginum for 1 day. On examination, her general condition was found to be very poor. She was severely anaemic, with a pulse rate of 120/minute and a blood pressure of 90/60 mm of Hg. There was severe tenderness all over her abdomen, more so in the pelvic region. On per vaginal examination, her uterus was found to be bulky, with a mass of 4 × 5 cm which was felt in the right fornix and a mass of 5 × 6 cm which was felt in the left fornix, with cervical motion tenderness and slight bleeding. The patient had come with a sonography which was done elsewhere and the finding was bilateral adnexal masses with a large amount of free fluid in the peritoneal cavity.

She underwent an emergency Laparotomy under general anaesthesia. Two litres of blood and clots were removed from the peritoneal cavity. The uterus was normal sized, with bilateral normal fallopian tubes.

The right ovary was enlarged and haemorrhagic, approximately 4 × 4cm, which showed rupture of the tunica albuginea, with active bleeding and a trophoblast like tissue which was adhered to the ovary. A wedge resection was done and haemostasis was achieved. The maximum amount of normal ovarian tissue was conserved.

The left ovary was enlarged (5 × 6cm), with 3 cystic structures on its surface, one of which was profusely bleeding. A left sided partial oophorectomy was done and haemostasis was achieved. She was transfused 3 units of whole blood. Post-operatively, she recovered well and was discharged on day 9 after the stitch removal.

On histopathology, the right ovarian tissue showed ovarian stroma, multiple chorionic villi which were covered by trophoblastic cells and decidua with fibrin and polymorphs – which were diagnostic of an ovarian pregnany. The left ovarian tissue showed a ruptured corpus luteal cyst and corpus haemorrhagicum.

In this case, both the ruptured right ovarian pregnancy and the ruptured left corpus luteal cyst were the causes of the massive haemoperitoneum and shock [],[],[] and [].

Clinical photograph showing ruptured ovarian pregnancy in right ovary and ruptured corpus luteum in left ovary.

Clinical photograph showing ruptured ovarian pregnancy in right ovary and ruptured corpus luteum in left ovary and bilateral intact Fallopian tubes.

Right ovary showing ectopic pregnancy with villi, hemorrhage and fibrin. (H&E X 100)

Left ovary showing hemorrhagic corpus luteum with vascularised ovarian stroma. (H&E X 100)

DISCUSSION

Primary ovarian pregnancy is a rare entity. The reported incidence is 0.15%-3% of all the ectopic gestations [2]. It can be classified as primary and secondary. It is called as primary when the ovum is fertilized while it is still within the follicle. It is called as secondary when the fertilization takes place in the tube and when the conceptus is later regurgitated to be implanted in the ovarian stroma. Such pregnancies can be intra-follicular or extrafollicular. An intra-follicular pregnancy is invariably primary and an extrafollicular one may be primary or secondary when the ovarian tissue is usually absent in the gestational sac [4].

Spiegelburg (1878) suggested four criteria to distinguish a primary ovarian pregnancy from a distal tubal pregnancy which secondarily involved the uterus. They are:

1. The fallopian tube with its fimbriae should be intact and separate from the ovary.

2. The gestational sac should occupy the normal position of the ovary.

3. The gestational sac should be connected to the uterus by the ovarian ligament.

4. A histologically proven ovarian tissue should be located in the sac wall [5].

The conditions which are most commonly confused with an ectopic ovarian pregnancy, both clinically and pathologically, are a ruptured haemorrhagic corpus luteal cyst, “chocolate” cysts and a ruptured distal tubal ectopic pregnancy.

Risk factors such as PID and prior pelvic surgery may not play significant roles in its aetiology in contrast to those in patients with tubal pregnancies. The only risk factor which is associated with the development of an ovarian pregnancy is the current use of an intrauterine device. An intra-uterine device is effective in preventing intrauterine and tubal pregnancies in 99.5% and 95% women respectively. However, it has little effect on the prevention of an ovarian pregnancy [6]. Ultrasound, especially TVS, has proven to be an invaluable tool in its diagnosis, where the hyper echoic appearance of a trophoblast, which is surrounded by thickened hypo echoic ovarian tissue, is the only indication of an ovarian ectopic gestation [7].

Even then, it can be mistaken for a haemorrhagic corpus luteum or an ovarian cyst. Ovarian pregnancies usually terminate in rupture during the first trimester in 91% of the cases, in 5.3% cases in the second trimester and in 3.7% cases in the third trimester [1].

A conservative treatment is preferred if the patient is young and if she desires to bear again. Methotrexate is an effective therapeutic option in the management of an unruptured ovarian ectopic pregnancy. It permits the avoidance of more invasive interventional surgeries with possible complications such as haemorrhage, ovariectomy or later, pelvic adhesions [8]. An ovarian pregnancy can be treated conservatively with a single dose of Methotrexate. However, the preferred mode of treatment is oophorectomy by either Laparotomy or Laparoscopy [9]. In the past, ovarian pregnancy had been treated by ipsilateral oophorectomy, but the trend has since shifted towards conservative surgeries such as cystectomy or wedge resection, which are performed during either laparotomy or laparoscopy. Currently, laparoscopic surgery is the treatment of choice [10]. Fertility after an ovarian pregnancy has been reported to be unmodified [9].

In this case, a ruptured right ovarian pregnancy and a left ruptured corpus luteal cyst were profusely bleeding, causing a severe haemoperitoneum. Both these are rare and their co- existence in the same patient is still very rare.

Notes

Financial or Other Competing Interests

None.

REFERENCES

[1] Das S, Kalyani R, Lakshmi M, et al. Ovarian pregnancy. Indian J Path Microbiol. 2008;51(1):37–38. [PubMed] [Google Scholar][3] Nadarjah S, Sim LN, Loh SF. The laparoscopic management of an ovarian pregnancy – a case report. Singapore Med J. 2002;43(2):95–96. [Google Scholar][4] Gon S, Majumdar B, Ghosal T, Sengupta M. Two cases of primary ectopic ovarian pregnancies. Online J Health Allied Scs. 2011;10(1):26. [Google Scholar][5] Spiegelberg O. Zurcasuistik der ovarial schwanger schaft. Arch Gynaecol. 1878;13:73–75. [Google Scholar][6] Lehfeldt H, Tietle C, Gorstein F. Ovarian pregnancies and intrauterine devices. Am J Obstet Gynaecol. 1970;108:1005–08. [PubMed] [Google Scholar][7] Bouyer J, Coste J, Fernandez H, et al. The sites of an ectopic pregnancy: A 10 year population based study of 1800 cases. Human Reproduction. 2002;17(12):3224–30. [PubMed] [Google Scholar][8] Mittal S, Dadhwal V, Baurasi P. The succesful medical management of an ovarian pregnancy. Int J Gynaecol Obstet. 2003;80:309–10. [PubMed] [Google Scholar][9] Panda S, Darlong LM, Singh S, Borah T. A case report of a primary ovarian pregnancy in a primigravida. J Hum Reprod sci. 2009;2:90–92. [PMC free article] [PubMed] [Google Scholar][10] Rashmi B, Vanita S, Preeti V, Seema C, Jasvinder K. A failed medical management in an ovarian pregnancy despite the presence of favourable prognostic factors – A case report. Med Gen Med. 2006;8(2):35. [PMC free article] [PubMed] [Google Scholar]

Ovarian Cyst | Cedars-Sinai

Not what you’re looking for?

What is an ovarian cyst?

An ovarian cyst is a fluid-filled
sac that forms on or inside an ovary. The ovaries are a pair of small, oval-shaped
organs in the lower part of a woman’s belly (abdomen). About once a month, one of
the
ovaries releases an egg. The ovaries also make the hormones estrogen and progesterone.
These play roles in pregnancy, the menstrual cycle, and breast growth.

There are different kinds of
ovarian cysts. They can occur for various reasons, and they may need different
treatments. A cyst can vary in size from half an inch to 4 inches, and sometimes be
even
much larger.

Ovarian cysts are very common in
women of childbearing age, but uncommon in women after menopause. Young girls can
also
get them, but this is less common.

What causes an ovarian cyst?

Different types of ovarian cysts
have different causes. The most common type of ovarian cyst is known as a
functional cyst. Functional ovarian cysts
only happen in women who have started their menstrual cycles, but haven’t gone through
menopause. There are two types of functional cysts:

• Follicular cyst. This cyst happens
  when an egg isn’t released. It keeps growing inside the ovary. 
• Corpus luteum cyst. This type of cyst occurs when the sac around
  the egg doesn’t dissolve after the egg is released.

Other types and causes of cysts include:

• Endometrioma. This cyst is filled with old blood and tissue that
  resembles the lining of the uterus. They are often called chocolate cysts because
  of
  the dark color of the fluid within them. They can happen in women with
  endometriosis. 
• Dermoid. This cyst develops from ovarian cells and eggs. They may
  have hair, skin, teeth, bone, or fat in them. These cysts are common in women of
  childbearing age.

Cysts can also be caused by:

• Polycystic ovary syndrome (PCOS), a condition that causes multiple cysts on the
  ovaries
• Pregnancy
• Severe pelvic infection such as
  chlamydia. This type of cyst may be called an abscess.
• Noncancerous growths
• Cancer (rare)

Who is at risk of having an ovarian cyst?

Certain things may increase your risk of having an ovarian cyst. 

• Endometriosis
• Polycystic ovarian syndrome (PCOS)
• Pregnancy
• Using fertility medicines such as
  clomiphene

What are the symptoms of an ovarian cyst?

Many women don’t have any symptoms from the cyst. In women with symptoms, the most
common is pain or pressure in your lower belly on the side of the cyst. This pain
may be
dull or sharp, and it may come and go. A cyst that breaks open (ruptures) may lead
to
sudden, sharp pain.

Other symptoms of an ovarian cyst can include:

• Pain in the lower back or thighs
• Trouble emptying your bladder completely
• Pain during sex
• Weight gain
• Pain during your period
• Breast tenderness
• Abnormal vaginal bleeding (rare)

How is an ovarian cyst diagnosed?

Your primary care provider, an
obstetrics and gynecology (OB/GYN) doctor, or certified nurse midwife may diagnose
the
condition. Your healthcare provider will ask about your health history and your
symptoms. You will also have a physical exam. This will likely include a pelvic exam.
During the pelvic exam, your healthcare provider may feel the swelling on your ovary.
In
women with no symptoms, this is often the first sign of a cyst.

If your healthcare provider thinks
you may have an ovarian cyst, you may need tests. These can help your healthcare
provider learn the type of cyst. Tests can also help rule out other problems, such
as an
ectopic pregnancy. The tests may include:

• Ultrasound. This test uses sound waves to view the size, shape, and
  location of the cyst. The test can also show if the growth is solid or filled with
  fluid.
• MRI. This uses large magnets and a computer to create a detailed
  picture of the area.
• Pregnancy test. This is done to check if pregnancy may be the cause
  of the cyst.
• Blood tests. These check for hormone problems and cancer. They also
  check if the cyst is bleeding.
• Biopsy. This is a test where a tiny piece of the ovary is taken.
  The piece is examined in a lab for cancer cells. This may be done if an ultrasound
  shows a certain type of growth on the ovary.  Biopsy of the ovary is usually not done
  if cancer is suspected. 

How is an ovarian cyst treated?

Treatment for an ovarian cyst will depend on the type of cyst, your age, and your
general health. Most women will not need treatment. You may be told to watch your
symptoms over time. An ovarian cyst will often go away with no treatment in a few
weeks
or months.

In some cases, you may need to have follow-up ultrasound tests. These are to check
if
your cyst has gone away or is not growing. You may not need any other treatment.

If your ultrasound or blood tests
show signs of cancer, your healthcare provider may advise surgery. This is done to
remove part or all of your ovary. Your healthcare provider might also advise surgery
if:

• Your cyst causes ongoing pressure or pain
• Your cyst appears to be growing
• You have a very large cyst
• You have endometriosis and want the cyst removed to help with fertility

Can an ovarian cyst be prevented?

If you have hormone issues, your
healthcare provider may advise taking birth control pills. These may help prevent
ovarian cysts. Taking antibiotics for a pelvic infection may also prevent a cyst.

What are possible complications of an ovarian cyst?

An ovarian cyst can sometimes break open (rupture). This may not cause any symptoms.
Or
it may cause sudden, sharp pain in the lower belly. A ruptured cyst can cause a lot
of
blood and fluid loss. This can lead to low blood pressure. In some cases, surgery
may be
needed.

Rarely, an ovarian cyst can also cause twisting (torsion) of the fallopian tube. This
can block normal blood supply to the ovary. This can lead to sudden pain and sometimes
nausea and vomiting. It may need emergency surgery.

How to manage an ovarian cyst

Work with your healthcare provider
to find a treatment plan that makes sense for you. Keep all of your follow-up
appointments. Tell your healthcare provider right away if you have sudden belly pain
or
other severe symptoms. These may be caused by a ruptured ovarian cyst.

Key points about ovarian cysts

• An ovarian cyst is a fluid-filled sac that forms in or on one of your ovaries.
• Most ovarian cysts are functional
  cysts. These are related to ovulation. They often go away with no treatment.
• Only a small number of ovarian cysts
  are caused by cancer.
• PCOS, endometriosis, and pelvic
  infection are some of the other causes of ovarian cysts.
• A cyst may cause symptoms, such as
  abdominal pain. Or it may cause no symptoms.
• You may need tests to help diagnose
  your cyst. These may include an ultrasound and blood tests.
• You may need no treatment for the
  cyst. Or you may need surgery.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider
  tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines,
  treatments, or tests. Also write down any new instructions your provider gives
  you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also
  know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or
  procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that
  visit.
• Know how you can contact your provider if you have questions.

Medical Reviewer: Irina Burd MD PhD

Medical Reviewer: Donna Freeborn PhD CNM FNP

Medical Reviewer: Heather Trevino

© 2000-2021 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional’s instructions.

Not what you’re looking for?

What Every Woman Should Know About Ovarian Cysts | Methodist Health System

It’s a very common diagnosis with a scary-sounding name: ovarian cysts. Every ovulating woman has them, and most cause no symptoms or problems.

Ovarian cysts are fluid-filled sacs that are formed quite frequently. Each cyst represents a follicle of a potentially maturing egg that will be released by a properly functioning ovary with each menstrual cycle.
 

Risks associated with abnormal ovarian cysts

The ovary produces cysts each month in response to hormones – a normal part of an ovulating woman’s monthly cycle. It’s when there are abnormalities to this monthly process that problems can occur.

Cysts can be dangerous; if they are painful, it can be an indication that the ovary is starting to twist, bleed or become enlarged. They can contribute to difficulty getting pregnant. In addition, cysts that occur with a positive pregnancy test are concerning for an ectopic pregnancy and need emergent evaluation.

When to see your doctor

When it comes to ovarian cysts, there are some symptoms you shouldn’t ignore. It’s likely time to see your OB/GYN if you experience any of the following symptoms:

• Pelvic fullness and bloating
• Dull pain
• Pain with intercourse
• Sharp, stabbing pelvic pain that typically gets worse with movement
• Irregular menstrual cycles
   

Evaluation and treatment

Ultrasound is the best way to evaluate cysts, and this can be done abdominally or vaginally. CT scans and MRIs may also be used. Depending on the size and characteristics of the cyst, along with the patient’s symptoms, repeat imaging may be needed in six to 12 weeks. Upon further evaluation, your provider may drain or remove the cyst, remove the whole ovary, or suppress ovulation with hormones.

In addition to normal monthly cysts, there are many other types that can develop frequently. While benign types are more common, very rare forms of ovarian cysts can be malignant.

It’s important to know that most cysts are not and will never become cancerous. The malignant ones, however, need to be treated surgically.

While there is no sure way to prevent all ovarian cysts, hormonal birth control may help. It stops the development of monthly follicular cysts and reduces the likelihood that other benign cysts will form.

If you have questions about symptoms you are experiencing, talk to your Methodist Physicians Clinic OB/GYN about treatment options.

More information:

Dr. Abigail Delaney, a reproductive health specialist at Methodist Women’s Hospital gives more information about the condition known as “Polycystic Ovarian Syndrome in this video:

Ovarian Cancer or Pregnancy – Symptoms of Ovarian Cancer

NYRVAH, 34, art-gallery owner

I’ve always been into eating right and exercising, so I was surprised when I developed a little potbelly. I also started getting the urge to urinate so often that I began to feel that if I was going to drink something, I’d be smart to do it in the bathroom. But I didn’t think it was anything serious until my abdomen—slightly to the left of my belly button—really ballooned within a month. It was like I was four-months pregnant. At the same time, I developed intense abdominal pain—like bad menstrual cramps—and I felt exhausted. I got my period and passed large blood clots, which scared me. My partner and I wondered if I was pregnant and something was wrong with the baby.

A pregnancy test at the clinic turned out positive, and I started to get excited that maybe the baby could hold on. But five minutes after the gynecologist did an exam, her face dropped: My uterus was big enough for a 20-week pregnancy, she said, but I’d had a period the previous month. She sent me right to a hospital, which performed ultrasounds that showed no baby. A week of sonograms, CAT scans, MRIs, and exams brought no diagnosis. Even so, I figured it was fibroids, which run in my family, so I wasn’t too worried—except about how I’d pay for all this, since I didn’t have insurance.

The hospital thought I had an unviable pregnancy, gave me a drug to expel the fetus, and sent me home. The medicine caused unbelievable cramping and bleeding, which hadn’t yet subsided several days later. I contacted numerous doctors, but without insurance, none would see me. So my partner and I took a 10-hour train ride to Canada, where emergency care is free. I was still bleeding, and to make myself look even worse, I ran up and down stairs to get my temperature up. Then I called an ambulance from a friend’s house in Montreal. Two days later, a doctor reading a new sonogram found a melon-size tumor on my left ovary.

I was shocked—and later, angry— that all the doctors I’d seen during the previous month had gambled with my life by missing this. But I’ve learned that because ovarian cancer often doesn’t strike women under 60, most doctors just don’t think it’s a possibility. Plus, everyone I’d seen was looking for a pregnancy and may not have considered a tumor.

My cancer was advanced—stage IIIC—but luckily, it was a type called dysgerminoma, which responds well to chemo and has a higher cure rate than the more typical epithelial cancer (often very invasive). It produces the same hormones that pregnancy does, which is why everyone thought I was pregnant.

Even though I had cancer, I kept focusing on the fact that my prospects were so good: I was told that if I didn’t have a recurrence within two years, the cancer would probably never come back. I had surgery to remove the tumor and the affected lymph nodes, plus four months of grueling chemo. Fortunately, the weight of it being cancer didn’t really strike me until later, and by then, I was in remission. I may not be able to have children, but I don’t feel sorry for myself. Now, I’m trying to help other women recognize the disease and push for a diagnosis.

SERENA, 27, nursing student

In the middle of my senior year of college, I began to feel tired all the time. My strength was so zapped that I had to quit my beloved crew team— I just couldn’t keep up. I also became constipated. I went to several team and school doctors, most of whom initially thought I was pregnant (I wasn’t), or prescribed laxatives, which didn’t help much. A few months later, my waistline began expanding. I’d always been fit and thin, so it upset me that my clothes didn’t fit. I went to more doctors—six during the year—but none gave me a diagnosis other than constipation. I didn’t think the problem was serious, but I was completely frustrated that doctors couldn’t find the cause of my fatigue and bloating.

After graduation, despite my fatigue and four-inch-thicker abdomen, I pushed myself to accompany friends to a Wyoming ranch for the summer. Within a few weeks, I felt like I had to urinate constantly; I’d get up numerous times at night to use the bathroom, and I’d still feel the urge when I got back to bed. One late- June morning, it became painful to swallow. I went to another doctor, who diagnosed mononucleosis. Yet I knew something else was wrong. I was so frustrated that I told him I wasn’t leaving until he figured it out. He was the first to do a pelvic exam, during which he thought my uterus was enlarged. He sent me for a sonogram: It revealed an ovarian tumor the size of a cantaloupe. The doctor told me most tumors are benign, so I didn’t think the worst—I was just pissed off that this was ruining my summer fun. On top of it all, I really did have mono.

I went home and got another ultrasound. This time, the radiologist thought I had a stage I, grade I tumor. I can’t remember anything between the pronouncement that I might have cancer and my surgery five days later, except that I was completely stunned.

The surgeon said he would try to preserve my fertility but that I might need a full hysterectomy, and that he would only know once he performed the surgery. It terrified me that I might never have children, but I knew it was important to remove the tumor. Thankfully, the fact that I could have died from the cancer didn’t cross my mind.

The type of cancer I had—stage I germ-cell immature teratoma—doesn’t spread as quickly as the more common epithelial cancer, so he just removed my right ovary. I expected to need chemo and radiation, but the cancer hadn’t spread , so I was spared that. I was lucky, but I was also determined. Not taking “we don’t know” for an answer got me a diagnosis that was crucial to my beating the disease.

3 NEW WAYS TO SPOT OVARIAN CANCER EARLY

For years, women and their doctors have considered ovarian cancer a silent disease, showing no symptoms until the cancer is already advanced. By then, survival rates are disturbingly low: 20 percent for cancers found in stage III or later. But if the tumor is caught early, a woman’s chances of surviving the disease are 95 percent.

A study published last June in the Journal of the American Medical Association, sponsored by the Ovarian Cancer Research Fund, indicates that ovarian cancer often does have identifiable symptoms that arise more quickly and more frequently than anyone realized. In the study, 43 percent of the women with cancer had a combination of certain symptoms—severe bloating, increased abdominal size, and urinary urgency—that occurred approximately 20 to 30 times a month.

“Everyone has occasional bloating and abdominal pain, but when it occurs almost daily and isn’t tied to your period or the foods you eat, go to see your doctor,” says Barbara Goff, M.D., codirector of the division of gynecologic oncology at the University of Washington School of Medicine.

If you have these symptoms, ask your doctor to perform some or all of the following:

1. Pelvic exam

Doctors will feel for a hard mass or other irregularity on your ovaries. This is the same manual exam you get when you go to the gynecologist (you should get one every year if you’re over 18).

2. Transvaginal ultrasound

This test, done by inserting a probe into the vagina, is the primary tool used for diagnosis. The caveat: It can’t always distinguish between a cancerous and noncancerous tumor.

3. Surgery

Sometimes, surgeons have to remove the tumor in order to examine its cells for cancer (removing the tissue with a needle could spread cancerous cells).

OVARIAN CANCER: WHAT’S YOUR RISK?

One in 58 women will get ovarian cancer—that’s about 25,000 a year. So far, dietary habits and exercise haven’t been shown to have much influence, but other factors do.

WHAT RAISES YOUR RISK:

• A mother, sister, or grandmother who has or had breast or ovarian cancer. Women with a family history are two to three times more prone to get the disease than other women are. • Getting your first period before age 12. • A history of endometriosis.

WHAT LOWERS YOUR RISK:

• Being young. Most women with ovarian cancer are age 60-plus. • Having children—especially after age 35, according to a recent study—and breastfeeding them. • Taking the Pill. After five years of use, ovarian-cancer risk drops by 50 percent.

THE NEW SCREENING TESTS: CAN YOU TRUST THEM?

Currently, there is no standard screening test for ovarian cancer. (The Pap test checks for cervical cancer, not ovarian.) But some tests are currently being—or will soon be—marketed to women. They sound like a good idea, but there are reasons to be wary:

1. CA 125 test

Contrary to widely circulated emails, testing your blood for the “tumor marker” CA 125 has not been proven to accurately screen for ovarian cancer, says Andrew Berchuck, M.D., professor of gynecological oncology at Duke University Medical Center. Used to detect recurrence in women who have already had the disease, it yields too many false positives (things other than ovarian cancer can elevate levels of this marker) and false negatives (some research suggests it misses as many as half of all early tumors) to be an effective screening tool. Researchers are aiming to improve the test.

2. OvaCheck

This test may be on the market by the time you read this, but it brings with it serious controversy. OvaCheck uses a breakthrough technology, called proteomics, in which a computer seeks telltale cancer-protein patterns in your blood. In small studies, these “fingerprints” found most early cases of the disease. But the company that makes OvaCheck may sell the test without FDA approval. “We are excited about the premise of proteomics but concerned about a company trying to rush to market before it is fully tested and has proved that it can actually save lives,” says Debbie Saslow, Ph.D., director of breast and gynecologic cancer at the American Cancer Society. False positives are a risk, and could lead thousands of women to unnecessary follow-up procedures, including surgery. Even if this test becomes available, only women with a first-degree relative with breast or ovarian cancer should even consider it, and even then, only after a consultation with a doctor.

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Evaluation of Acute Pelvic Pain in Women

1. Morino M,
Pellegrino L,
Castagna E,
Farinella E,
Mao P.
Acute nonspecific abdominal pain: A randomized, controlled trial comparing early laparoscopy versus clinical observation. Ann Surg.
2006;244(6):881–888….

2. Morishita K,
Gushimiyagi M,
Hashiguchi M,
Stein GH,
Tokuda Y.
Clinical prediction rule to distinguish pelvic inflammatory disease from acute appendicitis in women of childbearing age. Am J Emerg Med.
2007;25(2):152–157.

3. Ding DC,
Hsu S,
Kao SP.
Isolated torsion of the hydrosalpinx in a post-menopausal woman. JSLS.
2007;11(2):252–254.

4. Anteby SO,
Schenker JG,
Polishuk WZ.
The value of laparoscopy in acute pelvic pain. Ann Surg.
1975;181(4):484–486.

5. Gaitán H,
Angel E,
Sánchez J,
Gómez I,
Sánchez L,
Agudelo C.
Laparoscopic diagnosis of acute lower abdominal pain in women of reproductive age. Int J Gynaecol Obstet.
2002;76(2):149–158.

6. Kontoravdis A,
Chryssikopoulos A,
Hassiakos D,
Liapis A,
Zourlas PA.
The diagnostic value of laparoscopy in 2365 patients with acute and chronic pelvic pain. Int J Gynaecol Obstet.
1996;52(3):243–248.

7. Defrances CJ, Lucas CA, Buie VC, Golosinsky A. 2006 national hospital discharge survey. National Health Statistics Reports. Report number 5; July 30, 2008. http://www.cdc.gov/nchs/data/nhsr/nhsr005.pdf. Accessed January 1, 2010.

8. Centers for Disease Control and Prevention.
Ectopic pregnancy—United States, 1990–1992. MMWR Morb Mortal Wkly Rep.
1995;44(3):46–48.

9. Merrill CT, Elixhauser A. Hospitalization in the United States, 2002. Rockville, Md.: Agency for Healthcare Research and Quality; 2005.

10. Vandermeer FQ,
Wong-You-Cheong JJ.
Imaging of acute pelvic pain. Clin Obstet Gynecol.
2009;52(1):2–20.

11. Myers ER, Bastian LA, Havrilesky LJ, et al. Management of adnexal masses. Evidence report/technology assessment no. 130. Rockville, Md.: Agency for Healthcare Research and Quality; 2006. http://www.ahrq.gov/downloads/pub/evidence/pdf/adnexal/adnexal.pdf. Accessed January 2, 2010.

12. Drake J.
Diagnosis and management of the adnexal mass. Am Fam Physician.
1998;57(10):2471–2476.

13. Centers for Disease Control and Prevention,
Workowski KA,
Berman SM.
Sexually transmitted diseases treatment guidelines, 2006 [published correction appears in MMWR Morb Mortal Wkly Rep. 2006;55(36):997]. MMWR Morb Mortal Wkly Rep.
2006;55(RR-11):1–94.

14. Houry D,
Abbott JT.
Ovarian torsion: a fifteen-year review. Ann Emerg Med.
2001;38(2):156–159.

15. Farley TM,
Rosenberg MJ,
Rowe PJ,
Chen JH,
Meirik O.
Intrauterine devices and pelvic inflammatory disease: an international perspective. Lancet.
1992;339(8796):785–788.

16. Padilla LA,
Radosevich DM,
Milad MP.
Accuracy of the pelvic examination in detecting adnexal masses. Obstet Gynecol.
2000;96(4):593–598.

17. Gaitán H,
Angel E,
Diaz R,
Parada A,
Sanchez L,
Vargas C.
Accuracy of five different diagnostic techniques in mild-to-moderate pelvic inflammatory disease. Infect Dis Obstet Gynecol.
2002;10(4):171–180.

18. Simms I,
Warburton F,
Weström L.
Diagnosis of pelvic inflammatory disease: time for a rethink. Sex Transm Infect.
2003;79(6):491–494.

19. Kaplan BC,
Dart RG,
Moskos M,

et al.
Ectopic pregnancy: prospective study with improved diagnostic accuracy. Ann Emerg Med.
1996;28(1):10–17.

20. Frates MC,
Laing FC.
Sonographic evaluation of ectopic pregnancy: an update. AJR Am J Roentgenol.
1995;165(2):251–259.

21. Cartwright SL,
Knudson MP.
Evaluation of acute abdominal pain in adults. Am Fam Physician.
2008;77(7):971–978.

22. Schwartz A. Diagnostic test calculator. http://araw.mede.uic.edu/cgi-bin/testcal.pl. Accessed September 5, 2009.

23. American Academy of Family Physicians. Glossary of evidence-based medicine and statistical terms. https://www.aafp.org/online/en/home/publications/journals/afp/afpebmglossary.html. Accessed December 20, 2009.

24. Close RJ,
Sachs CJ,
Dyne PL.
Reliability of bimanual pelvic examinations performed in emergency departments. West J Med.
2001;175(4):240–245.

25. Chard T.
Pregnancy tests: a review. Hum Reprod.
1992;7(5):701–710.

26. Cook RL,
Hutchison SL,
Østergaard L,
Braithwaite RS,
Ness RB.
Systematic review: noninvasive testing for Chlamydia trachomatis and Neisseriagonorrhoeae Ann Intern Med.
2005;142(11):914–925.

27. Laméris W,
van Randen A,
van Es HW,

et al.;
OPTIMA study group.
Imaging strategies for detection of urgent conditions in patients with acute abdominal pain: diagnostic accuracy study. BMJ.
2009;338:b2431.

28. Lozeau AM,
Potter B.
Diagnosis and management of ectopic pregnancy [published correction appears in Am Fam Physician. 2007;75(3):312]. Am Fam Physician.
2005;72(9):1707–1714.

29. Collins RD. Algorithmic Diagnosis of Symptoms and Signs: A Cost-Effective Approach. 2nd ed. Philadelphia, Pa.: Lippincott Williams & Wilkins; 2003:358–359.

30. McCormack WM.
Pelvic inflammatory disease. N Engl J Med.
1994;330(2):115–119.

31. Chandra A,
Martinez GM,
Mosher WD,
Abma JC,
Jones J.
Fertility, family planning, and reproductive health of U.S. women: data from the 2002 National Survey of Family Growth. Vital Health Stat 23.
2005;(25):1–160.

32. Weinstock H,
Berman S,
Cates W Jr.
Sexually transmitted diseases among American youth: incidence and prevalence estimates, 2000. Perspect Sex Reprod Health.
2004;36(1):6–10.

Diagnosis and management of a giant ovarian cyst in the gravid-puerperium period: a case report | BMC Pregnancy and Childbirth

Ovarian cysts occur to 4.9% of pregnant women [5]. Ovarian cysts of the giant-type are extremely rare in the gravid-puerperium period. They represent less than 1‰ of the set of cysts associated with pregnancy [6] and their symptoms are non-specific. Generally, such symptoms as abdomen discomfort, constipation, back or abdominal pain are attributed to regular manifestations of pregnancy. So, these symptoms may be neglected by both the patient and the physician. The following could help discover the cyst before it became large:

– a complication such as torsion. This torsion often occurs when the cyst has between 6 and 8 cm diameter, with almost 60% of instances happening during 10–17 weeks of gestation.

– a systematic ultrasound carried out for the monitoring of the pregnancy. However, the place where our patient resided, no ultrasound was available.

Imaging plays a big role in diagnosis. Compared to ultrasound, Computed tomography (CT) and magnetic resonance imaging (MRI) (which is better than CT) are the best means of analysis of the cyst [7, 8]. In the present case, CT was used because MRI was too expensive for our patient. The majority of the cysts are asymptomatic and regress spontaneously [9]. When the cyst is large, it can compress the gravid uterus, slow the fetus intra-uterine growth, cause premature delivery or abnormal presentation of the fetus. In the postpartum, the giant cyst is a risk factor for haemorrage. In our case, vaginal delivery has been possible with no complications.

The differential diagnosis of an abdominal mass includes benign and malignant gynecologic and non-gynecologic etiologies. A giant ovarian cyst can provoke a differential diagnostic problem with another fluid abdominal mass. In the present case, imaging had evoked both a giant ovarian cyst and a huge mesenteric cyst. Correct preoperative diagnosis is quite difficult due to the rare occurrence or the lack of specific clinical presentation of the giant ovarian cyst. Common symptoms, due to compressive effect such as abdominal pain, distension, bloating, constipation and vomiting can arise. Before surgery, two main arguments made us to think of a giant ovarian cyst rather than a huge mesenteric cyst: the female sex of our patient, and the rarity of mesenteric cysts. In fact, mesenteric cysts are often found among the paediatric population with an annual incidence of 1 for 20,000 and are very rare in the adult population with an annual incidence of only 1 for 100,000 [10].

The management approach depends on the size of cyst, equipment, and level of surgeon’s experience. According to many authors, aspiration of the contents of the cyst should be avoided because of complications such as infection, bleeding, rupture of the cyst, increased risk of peritoneal adhesion [11,12,13]. Yet, surgery can be done laparoscopically. In so doing, after the introduction of the trocars, an aspiration of the contents of the cyst is made before its removal [14]. But this laparoscopy is not recommended when the cyst is suspected of malignancy because of the risk of spreading cancer cells [13, 14]. In our case, we preferred a laparotomy because we were not sure of the benign nature of the cyst preoperatively. Furthermore, laparoscopy surgery was not possible due to the large size of the cyst.

An immediate complication to be feared when removing a giant ovarian cyst is the vacuum shock requiring a good preventive vascular filling [15]. In the literature, cases of giant ovarian cysts during pregnancy or postpartum have rarely been reported. Qublan et al. [16] in 2002 removed a 6 kg ovarian mucinous cyst after caesarean section. Petros et al. [17] removed a 30 × 25 mm bilateral mucinous benign ovarian cyst in 2005. As for Noreen et al. [18], in 2011, they reported a giant ovarian cyst discovered at 32 weeks of gestation and which was removed at 38 weeks of gestation through an oophorectomy. In 2017 Baradwan et al. [19] removed a 16.5 × 26.3 × 22.4 cm ovarian serous cystadenoma laparoscopically in the postpartum. All these cysts in the gravid-puerperium period did not have the size of our cyst, which measured 42 cm long-axis and weighed 19.7 kg. Except its large size, the cyst in our patient had no other malignancy. Worth noting is that, ultrasound features that increase the suspicion of malignancy are loss of any normal ovarian tissue surrounding the cyst and the existence of solid areas or papillary projections within the cyst. However, borderline tumors can be difficult to differentiate from benign tumors on the basis of ultrasound image characteristics.

Most cysts in the gravid-puerperium period are functional and therefore benign. It is often a luteoma of pregnancy. The other ovarian cysts encountered during pregnancy are, in order of frequency, benign teratomas, mucosal adenomas, rete ovarii tumors and endometriotic cysts [20]. A serous cystadenoma is a commonest benign ovarian cyst and accounts for approximately 60–75% of ovarian cysts. They are the benign epithelial tumors and are usually unilateral and uni-locular. Their incidence tends to peak at 20–40 years. But the aetiology of serous cysts is unknow, although they may be associated with other ovarian tumors such as mature cystic teratomas. Cheng et al. [21] demonstrated that mutations in BRAF and KRAS that characterize serous borderline tumors and low-grade serous carcinomas are absent in serous cystadenomas. They speculated that a small proportion of these cystadenomas become clonal and that mutations of KRAS or BRAF in some of these clonal cystadenomas lead to the development of serous borderline tumors, which are the precursors of low-grad serous carcinoma.

After surgery, because our patient’s cyst was benign, the long-term risks were supposed to be very reduced. Those risks are related to surgery rather than pathology. Indeed, it can be argued that the occurrence of adhesions of intra-abdominal organs is possible after surgery. Also, the ovariectomy performed may slightly reduce fertility and decrease the age of onset of menopause.

This case report proves that vaginal delivery is possible in the association of giant ovarian cyst and pregnancy. Surgical management of a giant cyst was performed in the postpartum with satisfaction. This cyst, histologically, was known as benign. Indeed, for early diagnosis, a better evaluation through both clinical and systematic ultrasound, during antenatal period and intrapartum, should be encouraged even in low-resource countries.

90,000 symptoms and treatment of cysts in the ovary in a woman in Izhevsk

Definition of disease

Ovarian cyst is a tumor-like formation that has a benign character. It is a cavity filled with liquid contents. The causes of the appearance are considered hormonal disorders, inflammatory processes, abortion, diseases of the endocrine organs. Symptoms of an ovarian cyst occur in women of all ages, but treatment is not always required.

Symptoms of an ovarian cyst in a woman

A small neoplasm may occur without clinical signs.With an increase in size, the following symptoms of an ovarian cyst appear:

• failure of the menstrual cycle;
• delay in menstruation, after which there is profuse bleeding;
• periodic spotting;
• engorgement of the mammary glands;
• pain in the lower abdomen;
• the appearance of pain during sex.

Some types of cysts appear only after the addition of complications or torsion of the legs on which they are located.In this case, acute pain below the navel on the side, weakness, tachycardia are disturbing.

Classification of ovarian cysts

There are two main types of cysts:

• functional – are a consequence of ovarian dysfunction, require diagnosis and treatment, but can disappear on their own;
• organic – pathological neoplasms that can degenerate into malignant tumors.

The following types of ovarian cysts are most often diagnosed:

• follicular – formed from a follicle that has not ruptured during ovulation, appears in young women and is accompanied by a cycle failure, can increase up to 6 cm in diameter;
• corpus luteum cyst is a benign neoplasm with a diameter greater than 25 mm, manifested by a delay in menstruation and can mimic pregnancy symptoms;
• endometrioid – overgrowth of the endometrium on the surface of the ovary, called “chocolate cyst”, can periodically empty into the pelvic cavity and leads to chronic pelvic pain;
• paraovarial – formation from the remnants of an embryonic organ – a mesonephral duct, asymptomatic until the moment of spontaneous torsion of the base of the cyst.

Diagnostic methods

Before prescribing treatment, the doctor will collect anamnesis, conduct a gynecological examination. Diagnostic methods are selected depending on the results of the initial examination. It could be:

• vaginal and cervical swab;
• PAP test – cytological examination of a smear in which tumor cells can be found;
• Ultrasound of the small pelvis;
• hysteroscopy – examination of the uterine cavity using a flexible endoscope, combined with separate diagnostic curettage;
• MRI;
• laparoscopy – examination of the pelvic organs through a video camera inserted into the abdominal cavity through small punctures on the body.

Depending on the woman’s condition, additional laboratory tests may be prescribed:

• study for hormones – it is necessary to determine estrogens, progesterone, cortisol, prolactin, LH, FSH, testosterone, thyroid hormones;
• blood test for tumor markers – CA-125, CA-199, hCG, alpha-fetoprotein are important.

Treatment of ovarian cysts in women

There are various methods of treatment of ovarian cysts in women, which are selected individually:

• hormone therapy;
• drug symptomatic treatment to reduce pain, bleeding;
• surgical removal.

Treatment of cysts on their own or using traditional medicine can lead to disastrous consequences and complications. With neoplasms of the ovaries, there is always a risk of transformation into an oncological process.

Benefits of treatment in the clinic of Elena Malysheva

Obstetrician-gynecologists of the highest category work in Elena Malysheva’s clinic in Izhevsk. They have extensive experience in the diagnosis and treatment of ovarian cysts. Specialists individually select the optimal examination methods that are necessary to obtain a complete picture of the disease.All procedures are performed using expert equipment. An individual treatment regimen is selected for each woman.

You can make an appointment with a gynecologist by phone (3412) 52-50-50 or fill out the feedback form on the website, the clinic administrator will contact you to find a convenient time to visit the doctor.

90,000 13-16 weeks of gestation

Baby’s thirteenth week

The beginning of the week is characterized by a fetal length of 6-7 cm, and by its end it already reaches 10 cm, the mass of the unborn child at the moment is 20-30 grams.

This week starts the second trimester of pregnancy. The fruit grows intensively, its legs and arms are lengthened. There is also a change in the proportions of the body, the head no longer looks as big as it was before. The future baby already knows how to reach his mouth with his finger and suck it, which is often seen by specialists during ultrasound diagnostics. Thus, the sucking reflex, which is so important for the baby in the first time after birth, finds its manifestation.

There is an intense muscle growth, especially noticeable in the area of ​​the legs.The future baby becomes more active, his movements are now smoother. At this time, the woman is not able to feel the child, since he, being in the uterus, floats freely and does not actually touch its walls. In the fetus, at this stage, the formation of the rudiments of all milk teeth ends. The rudiments are located in the mucous membrane of both jaws.

The gastrointestinal tract is also in the stage of active growth and development. Fitting into the loops, the intestine completely fills the abdominal cavity. On the inner surface of the intestine, its mucous membrane, the formation of villi occurs, which should cover the entire internal area.After birth, these villi will help the baby absorb all the nutrients from the food in the intestinal cavity. The undulating movements that the fetus’s intestines make help it push through the amniotic fluid, which the future baby constantly swallows. These waters do not contain useful substances, they only help the intestines to train and form the necessary muscular system.

Thirteenth week for a mother-to-be

A woman at the thirteenth week begins to feel much better, she finally manages to feel only positive emotions associated with the expectation of a baby.Malaise, toxicosis and the desire to sleep are a thing of the past. The emotional background is also undergoing changes. A woman becomes calmer and more peaceful, frequent mood swings and irritability also remain in the past. This is due to the end of the critical stages of pregnancy and a more stable hormonal background.

This period for most expectant mothers is associated with a change in the shape of the abdomen. Such changes are not yet noticeable to those around her, but the woman herself clearly sees the resulting roundness, feels discomfort when wearing ordinary things.It’s time to pay attention to the selection of special clothes that can create comfortable conditions for the woman and the unborn baby.

Fourteenth week for a baby

At this stage, the weight of the fetus is 40-45 grams, its length is 13 cm.

A distinct formation of the face leads to a change in the appearance of the fetus. The bridge of the nose becomes more pronounced, the eyebrows are outlined, the cheeks are rounded. The child moves, he feels himself for the tummy and cheeks, holds on to the umbilical cord. The embryonic fluff, which covers the entire body, adheres tightly to the skin of the fetus.This gun has a protective function – it retains a special lubricant, which will allow the baby to easily pass the birth canal during the birth process. Over time, the almost transparent generic fluff will be replaced by thicker hairs.

Important processes occur in the respiratory organs of the fetus precisely at the fourteenth week. Also, muscle tissues develop not only in the motor system, but also in the respiratory system. The fetus begins to imitate breathing with its movements. Such training is of great importance for the future baby, since he must take his first breath immediately after birth.His respiratory organs, under the action of signals from the brain, should open and begin to function fully. At this time, a partial opening of the glottis occurs, so the amniotic fluid penetrates into the respiratory system while inhaling. Then there is an intense exhalation, and they are pushed out of the body of the unborn child. Flushing of the lung tissue with amniotic fluid contributes to their proper maturation.

There are changes in the structure of the genitals. In boys, intensive formation of the prostate begins, in girls, the ovaries, which were previously located in the abdominal cavity, move to the pelvic area.Differentiation of the external genital organs occurs, but when examining with ultrasound at this stage, it is not always possible to establish the sex of the unborn child.

The organs of the endocrine system are also developing. An important event is the beginning of the work of the pancreas. Also, insulin begins to be produced – an important hormone that regulates glucose levels in the body. This week, the pituitary gland begins to function, regulating the work of all the glands of the body, responsible for their coherence, interaction, as well as the process of growth of the fetus and the child in the future.The pituitary gland is located in the most protected part – surrounded by the bones of the skull, in the thickness of the brain.

Fourteenth week for a mother-to-be

In a woman, the uterus is intensively enlarged, it becomes possible to independently palpate its uppermost part through the anterior abdominal wall – the bottom, which will be 10-15 cm above the pubis. It’s time for a woman to purchase special care products that will help nourish the skin and make it able to calmly tolerate the upcoming changes.

Stretch marks – stretch marks on the skin, which occur in many women, are the result of microcracks, that is, ruptures of the connective fibers. The elasticity and firmness of the skin is significantly reduced, so even a small increase in weight can cause microcracks. There is a redistribution of subcutaneous fat, edema may occur, so special care is simply necessary. Creams, lotions and other products for pregnant women are characterized by nourishing safe formulations, they will help the skin restore elasticity and firmness, and prevent the appearance of stretch marks.Even if striae arise due to excessive weight gain, their number will be minimal.

Fifteenth week for baby

At the end of the fifteenth week, the weight of the fetus is already about 50-70 grams, its length is 14-15 cm. The limbs grow, they can outstrip the size of the head due to the intensive development of the bones of the legs and arms. The future baby begins to actively bend the fingers and elbows, a unique skin pattern appears on the palms and fingers, and the process of nail formation begins.

At this stage, the cardiovascular system is being improved. The number of heart beats per minute is twice as high as my mother’s and is 140-160. 20 liters of blood a day pumps a tiny heart, contributing to the intensive development of the body. The fetus is actively growing veins and arteries, there is a general improvement of the circulatory system. Each internal organ forms its own systems of veins and arteries – kidneys, lungs, heart, brain, etc. The fetus acquires an unusual red color instead of pink, because it has very thin skin, and the circulatory system, as it develops, affects its color.

The nervous system at this time is undergoing important stages of formation. The mass of the brain increases, its grooves and convolutions increase. All muscles, internal organs and bones are intertwined with nerve fibers. A strong and stable connection is being established between the central nervous system and the peripheral. The impulses begin to flow in both directions: from the brain to the organs and vice versa. A system of “reverse response”, which is important for the human body, is emerging.

If, before the fifteenth week, red blood cells (erythrocytes) were produced by the bile sac and the liver, then after this stage, the red bone marrow located inside the bones begins to perform this function.

It is already possible to determine the blood group and the Rh factor in the future baby. The laying of the group and the rhesus occurs at the time of the conception of the baby, but this information is realized only at the fifteenth week. There is the formation of special proteins-antigens, which appear on the surface of erythrocytes.

Fifteenth week for a mother-to-be

A woman has a fairly smooth growth of the abdomen, it increases gradually and does not cause discomfort in everyday life.The fundus of the uterus is already felt through the anterior abdominal cavity at a height of 15-20 cm from the pubis.

In the body, there is an intensive production of the pigment melanin, which is deposited in the skin. This process is due to the hormonal background and causes the appearance of age spots on the surface of the skin, which can form in completely different places. Often a dark stripe appears on the abdomen, which has a brown tint and goes from the navel to the pubis. Rarely, the cause of increased melanin synthesis is a lack of vitamins in the body.

Pigmented spots should appear without any sensation. If their occurrence is accompanied by swelling, redness or discomfort, you should see a doctor. Such reactions can be the result of allergies or dermatosis of pregnant women – a common skin disease. Pigmented spots can have a different shade – from light beige to dark brown. Almost always, such manifestations disappear on their own after the appearance of the baby. The use of whitening creams during pregnancy is possible only after consulting a doctor, i.e.because they can be unsafe for the fetus.

Sixteenth week for a baby

There is a formation of facial muscles in the fetus, he begins to develop them, which is expressed in frowning, opening and closing the mouth. The fetus gets the opportunity to open its eyes for the first time, which until this moment were tightly covered by the eyelids, it begins to learn to blink. In place of eyelashes and eyebrows, you can see thin vellus hairs. If the auricles before this stage were not in their place, closer to the neck, now they are already placed as in an adult.Although there is a pronounced reaction of the fetus to loud sounds, at this stage, its middle ear is not yet able to hear. The reaction is due to such a way of perception as bone conduction. It turns out that the fetus hears through the dense parts of the body (bones).

The future baby has already completed the formation of all joints and bones. The process of ossification, that is, the compaction of bone tissue, will continue not only during the entire remaining period, but also after birth, almost until puberty.

When conducting an ultrasound examination, it is already possible to reliably determine the sex of the child, since his external genitals are fully formed. It is at this time or a little later (depending on the time of the prescribed diagnosis) that the mother gets the opportunity to find out who will be born to her.

The kidneys are working intensively in the fetus. Now they begin to perform a partial excretory function, slightly reducing the load that lies on the placenta. The urinary canal is formed, the fetus swallows 300-500 mm of amniotic fluid daily, they pass through its intestines and are excreted by the kidneys.Urination is performed in small portions every hour, urine enters the amniotic fluid.

Sixteenth week for a mother-to-be

At this stage, the woman feels a significant improvement in well-being. A gradual weight gain begins, and appetite normalizes. At the moment, a set of 2.5-3 kg is considered the norm.

At the moment, there is an active growth of the unborn baby, and a significant accumulation of amniotic fluid. Both of these factors affect the growth of the abdomen, its increasing volumes still do not cause discomfort.However, it’s time to make changes in your habits, such as changing your body position while you sleep. Sleeping on the back is not shown as well as sleeping on the stomach. When sleeping on the back, the uterus can press on large veins, which will lead to a violation of the outflow of blood, provoke the occurrence of puffiness, cramps and varicose veins. The most comfortable sleeping position is the position on your side, in which both the unborn child and the mother will feel as comfortable as possible.

90,000 Causes of ovarian apoplexy, symptoms, treatment, recovery

Causes of ovarian apoplexy, symptoms, treatment

Ovarian apoplexy is a condition in which it suddenly ruptures, accompanied by extensive bleeding and acute pain.Most often, pathology is diagnosed in women of reproductive age, but some causes of ovarian apoplexy can provoke pathology in other periods of life.

Clinical picture

The pathology under consideration is most often acute, the clinical picture develops rapidly, and therefore the symptomatology is always pronounced:

• a woman feels a sharp dagger pain in the lower abdomen with a clear localization – if the patient is conscious, she can point to the place of pain;
• marked the spread of pain in the lower back, buttocks, anus, perineum;
• there is a sudden weakness (the woman literally falls), blood pressure drops sharply, which causes a pronounced pallor of the skin of the face and hands, blue discoloration of the nail plates and lips;
• possible fainting;
• heart rate increases dramatically;
• there is nausea, often vomiting.

Symptoms of a ruptured ovarian follicular cyst often mimic those of apoplexy, therefore additional diagnostics will be required to clarify the diagnosis. Often, doctors are forced to abandon the appointment of a full-fledged examination, since the patient’s condition is critical and requires immediate medical action, otherwise a fatal outcome may occur.

If apoplexy is mild (it is characterized by low blood loss – no more than 150 ml), then the woman’s well-being worsens slightly.In this case, the doctor determines the signs of ovarian rupture by ultrasound – this is a mandatory examination with complaints characteristic of ovarian apoplexy. Pain and fever after apoplexy may persist.

Medical care for ovarian apoplexy

In case of unexpressed symptoms, a mild form of apoplexy is diagnosed, with it, conservative treatment is prescribed: hemostatic drugs, cold on the stomach (hot water bottle with ice). As soon as the bleeding stops and the patient’s condition stabilizes, fortifying agents are prescribed that will support the body and speed up recovery.Treatment of the ovary after apoplexy can be quite long and depends on what caused it.

All other forms involve surgical intervention, and urgent – a large blood loss is fraught with the death of a woman. The operation is performed in such a way as to preserve the ovary – this is especially important for women who are planning to give birth. If the ovary with the fallopian (fallopian) tube or part of these organs is removed, then the resulting biological material is sent for research to the laboratory.This is primarily done to identify malignant cells.

Operation for painful form of ovarian apoplexy is performed urgently.

Recovery period

After surgery, a woman will need some time to recover. Doctors monitor the menstrual cycle – menstruation after apoplexy can be disrupted. In this case, hormone therapy may be prescribed. Within 2 months, you must follow the recommendations:

• give up sports and other physical activities;
• eat well;
• do not drink alcohol;
• not to have sex;
• do not use hygienic tampons;
• do not visit the sauna, bathhouse, do not take hot baths.