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Pregnancy cyst: Management of ovarian cysts and cancer in pregnancy

by alexxlab

What It Is and How to Treat

When you’re pregnant, it’s only natural to worry about every little thing that goes on in your body. After all, you want to ensure that everything is just right for that growing baby! So if you’ve been diagnosed with a corpus luteum cyst, you’re probably wondering what it is and what it means for baby. But rest assured that it’s a common condition that many women experience, whether they’re pregnant or not.

In this article:
What is a corpus luteum cyst?
Is a corpus luteum cyst dangerous?
Corpus luteum cyst symptoms
Corpus luteum cyst treatment

What Is a Corpus Luteum Cyst?

A corpus luteum cyst is simply a cyst that forms inside the corpus luteum. What’s that, you ask? Let’s review how ovulation works.

Every cycle, your body produces hormones that cause follicles—aka tiny fluid-filled sacs, each containing an immature egg—in one of your ovaries to start maturing. However, only one of the developing follicles will go on to form and then release a fully mature egg. Once it has released the egg, the empty follicle then transforms into the corpus luteum, a ball of cells that’s responsible for producing the hormone progesterone, explains Melissa R. Peskin-Stolze, MD, an ob-gyn and assistant professor of obstetrics and gynecology and women’s health at Montefiore Health System and Albert Einstein College of Medicine.

If an egg is fertilized and you become pregnant, hormones stimulate the corpus luteum to secrete progesterone until the placenta develops and takes over progesterone production for the remainder of the pregnancy, says Camaryn Chrisman Robbins, MD, a Washington University ob-gyn at the Women & Infants Center in St. Louis, Missouri.

If you don’t become pregnant that cycle, the corpus luteum breaks down and is shed along with the lining of your uterus in your next period.

Sometimes, a cyst can form in the corpus luteum, filled with fluid or blood. They can happen whether you become pregnant during the cycle or not, and happens when the corpus luteum fails to break down and instead continues to grow larger after it’s released the egg, Peskin-Stolze says.

If you’ve been diagnosed with a corpus luteum cyst, know that in the vast majority of cases, they’re completely benign and will resolve on their own. That’s the case even if you’re dealing with a corpus luteum cyst during pregnancy; they’re rarely harmful to the fetus.

Is a Corpus Luteum Cyst Dangerous During Pregnancy?

A luteal cyst is generally harmless and will usually go away on its own. “The corpus luteum works to support the early pregnancy, but if a cyst is still present on the corpus luteum by the end of the first trimester or early part of the second trimester, it usually resolves itself,” Peskin-Stolze says.

If that’s not the case, your doctor will likely just keep an eye on it and ask you questions at your regularly scheduled appointments about whether you’re experiencing any pain or discomfort. They may order an extra ultrasound now and then to monitor its size and make sure the cyst isn’t causing any issues for your ovary.

However, it’s possible (though unlikely) for a corpus luteum cyst to rupture or twist on the ovary’s blood supply, which could cause pain and, in rare cases, endanger your ovary, says Peskin-Stolze. Read on to learn more.

Corpus Luteum Cyst Rupture During Pregnancy

Though uncommon, a corpus luteum cyst can burst open, either spontaneously or because of an external factor like a pelvic exam, sex or exercise, says Robbins. In these cases, the greatest concern isn’t the impact on baby, but rather on the mom-to-be. “Usually the amount of bleeding is small, but in rare cases the cyst rupture can cause internal bleeding, requiring surgery.”

Corpus Luteum Cyst Torsion During Pregnancy

Even rarer than a corpus luteum cyst rupture is an event called torsion. This happens when an ovary with a cyst gets twisted around the artery and vein that make up its blood supply. “The heavy weight of the cyst swings around the blood supply, kind of like a tether ball game,” Peskin-Stolze explains. It’s more common in the early second trimester, as the uterus grows out of the pelvis. A torsion would also call for surgery.

Symptoms of a Corpus Luteum Cyst in Pregnancy

In many cases, there aren’t any corpus luteum cyst symptoms. In fact, most pregnant women don’t even know they have a corpus luteum cyst, especially if they skip that early ultrasound that doctors use to confirm a pregnancy. Other times they show up as part of a routine pregnancy ultrasound.

If you do experience corpus luteum cyst symptoms, the most common is typically a dull ache in your lower abdomen, says Robbins.

When to worry? If your pain suddenly becomes intense. According to Peskin-Stolze, the following are some symptoms you might experience if, in the unlikely event, you’ve had a corpus luteum cyst rupture or become twisted:

  • One-sided, sharp lower abdominal/pelvic pain
  • Moderate to severe pain that comes on quickly
  • Shoulder pain
  • Fainting and/or dizziness

If you experience any of the symptoms above, it’s important to seek medical attention. If your regular doctor is unavailable, or you experience these symptoms during off hours, it’s best to head to the Emergency Room to get checked out.

Corpus Luteum Cyst Treatment During Pregnancy

The best corpus luteum cyst treatment is often simply time, Pskin-Stolze says. Since most corpus luteum cysts resolve on their own, it doesn’t make sense to subject yourself to unnecessary medical procedures to get rid of the cyst.

If you’re experiencing minor corpus luteum cyst pain, it’s fine to take over-the-counter medication like Tylenol (ibuprofen, like Motrin and Advil, isn’t recommended during pregnancy). Heating pads and warm (not piping hot) baths can also be effective ways to reduce pain naturally. If you have a large corpus luteum cyst or take any medication that increases your likelihood of bleeding, your doctor may recommend abstaining from sex, Robbins says. But most women have no pain and don’t need to restrict their activities.

In the event of corpus luteum cyst torsion, you’d likely undergo laparoscopic surgery—but don’t worry, it can be performed safely and effectively in pregnant women. “Sometimes the ovary needs to be untwisted, with or without removal of the cyst that caused it to twist in the first place,” says Robbins. “In some cases, the blood supply has been pinched off too long and the ovary needs to be removed.” But rest assured, those cases are rare.

Updated February 2020

Expert bios:

Melissa R. Peskin-Stolze, MD, is an ob-gyn and assistant professor of obstetrics and gynecology and women’s health at Montefiore Health System and Albert Einstein College of Medicine. She earned her medical degree from Albany Medical College.

Camaryn Chrisman Robbins, MD, MPH, is a Washington University ob-gyn at the Women & Infants Center in St. Louis, Missouri. She received her medical degree from Wake Forest University in 2004.

Please note: The Bump and the materials and information it contains are not intended to, and do not constitute, medical or other health advice or diagnosis and should not be used as such. You should always consult with a qualified physician or health professional about your specific circumstances.

Plus, more from The Bump:

What Causes Abdominal Pain During Pregnancy (and How to Find Relief)

What to Do About Dizziness During Pregnancy

The Truth About Taking Baths During Pregnancy

HEMORRHAGE INTO AN OVARIAN CYST SIMULATING ECTOPIC PREGNANCY | JAMA

HEMORRHAGE INTO AN OVARIAN CYST SIMULATING ECTOPIC PREGNANCY | JAMA | JAMA Network










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Article

February 2, 1918


CHESTER H. WATERS, M.D.

Author Affiliations

From the surgical and pathological departments, University of Nebraska College of Medicine.


JAMA. 1918;70(5):295-296. doi:10.1001/jama.1918.02600050017008

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Abstract

The attention of a small group of observers has been attracted to the clinical resemblance of certain ovarian conditions to ectopic pregnancy. The majority of cases recorded have dealt with the formation of a pelvic hematocele of ovarian origin, usually due to rupture and subsequent hemorrhage from a corpus luteum cyst.

The most important ovarian conditions that may suggest ectopic pregnancy are: (1) a corpus luteum or follicular cyst; (2) torsion of the pedicle of a cyst; (3) rupture of a cyst with or without intra-abdominal hemorrhage; (4) ovarian hemorrhage, and (5) hemorrhage into a cyst. Judging from the literature, the last is infrequent, especially as regards its giving rise to symptoms suggestive of ectopic pregnancy.

The exceedingly close simulation of ectopic pregnancy is well shown in the following instance:

History. 
—Mrs. D., aged 28, secundipara, whose labors had been normal, the last one occurring fourteen months before, consulted me,

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Ovarian cyst during pregnancy.

What is an ovarian cyst during pregnancy?

IMPORTANT
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

An ovarian cyst during pregnancy is a volumetric neoplasm in the form of a cavity with liquid contents that can exist before fertilization or form after the conception of a child. With a small size of cysts, an asymptomatic course is possible, as the fetus grows, pains appear in the suprapubic region of varying intensity, radiating to the groin or sacrum, urination disorders, and constipation. For diagnosis, ultrasound of the pelvic organs is used, which is supplemented by color Doppler mapping. Conservative therapy is aimed at maintaining pregnancy and alleviating the condition. Removal of cysts is performed after the maturation of the placenta.

    ICD-10

    D27 Benign neoplasm of ovary

    • Causes
    • Pathogenesis
    • Classification
    • Symptoms
    • Complications
    • Diagnostics
    • Treatment

      • Conservative therapy
      • Surgical treatment
    • Prognosis and prevention
    • Prices for treatment

    General

    An ovarian cyst is more often detected in patients of late reproductive age, usually exists even before conception, due to hormonal and immune changes during gestation, it increases in volume. Cystic formations are diagnosed in 0.02-0.46% of women bearing a child. A direct relationship between the appearance of cysts and pregnancy has not been established. In adolescents and patients over 45 years of age, there is a risk of malignancy of the neoplasm under the influence of endocrine factors.

    ovarian cyst during pregnancy

    Causes

    The exact causes of ovarian cysts during pregnancy are unknown. The most popular theory suggests the influence of endocrine disorders, which can be provoked by external or internal factors, or a combination of them. The development of the disease is facilitated by:

    • Sexual infections. Chronic inflammatory diseases of the ovaries can cause disruption of proliferation processes in organ tissues. During pregnancy, the immune system weakens, the infection enters the active phase, which provokes the growth of the cyst.
    • Hormonal changes. Associated with a decrease in estrogen production and an increase in the stimulating effect of FSH. They cause diffuse and then focal hyperplasia and proliferation of ovarian cells.
    • Abortions. Termination of pregnancy causes fluctuations in the endocrine status, increases the risk of infection of the genital organs. This leads to a violation of the hormonal regulation of the sex glands and proliferative processes.
    • Heredity. The likelihood of developing the disease is increased in women who have a maternal history of ovarian cysts.
    • Prolonged absence of pregnancy. Regular ovulation is considered a damaging factor for ovarian tissue. If the patient does not become pregnant and does not take oral contraceptives that inhibit the ovaries and the maturation of the follicles, the risk of cyst formation increases.

    Pathogenesis

    The development of ovarian cysts often begins before pregnancy. Violation of neuroendocrine regulation leads to a weakening of the function of the sex glands. The stimulating effect of FSH triggers proliferation processes. The source of focal hyperplasia can be normal cells that form ovarian tissues, or the remains of embryonic rudiments. In the latter case, cysts prone to malignancy appear.

    With regular ovulation, ovarian tissue is damaged at the time of rupture of the follicle. The spilled liquid contains a large amount of estrogens, which increase cell proliferation. In older women, along with conventional estrogens, altered phenol steroids appear that can cause malignancy of cysts, so malignant tumors are often diagnosed in premenopausal pregnant women.

    Ovarian cysts found during pregnancy can also be due to endometriosis. The pathogenesis of endometrioid cysts is associated with retrograde reflux of menstrual blood or with the remnants of embryonic tissue in the gonads. Under the influence of hormonal fluctuations, the epithelium in the cyst cavity is rejected, but does not go beyond the capsule and forms its contents.

    Classification

    Ovarian cysts during pregnancy are classified according to the histological structure, less often – according to the mechanism of origin. The division into types is the same as for neoplasms that have arisen outside the period of gestation. Histological classification includes:

    • Epithelial. Serous, endometrioid, clear cell and mixed cysts, Brenner’s tumor.
    • From the stroma of the sex cord. Thecoma, fibroma.
    • Germinogenic. Dermoid cysts, chorionepitheliomas and ovarian struma.
    • Tumor-like processes. Endometriosis, pregnancy luteoma, superficial epithelial and paraovarian cysts, polycystic, hyperthecosis.

    Symptoms

    Clinical manifestations do not depend on the histological structure of the ovarian cyst during pregnancy. At an early stage, there are no signs of the disease, the duration of the asymptomatic course can reach several years. Subsequently, aching dull pains in the lower abdomen are periodically disturbed, which can radiate to the groin, perineum, and lumbosacral region. Sometimes, before conception, the patient does not know about the existence of a neoplasm, the diagnosis is made during registration and a routine examination.

    For the first trimester, the progression of symptoms is uncharacteristic. From 12-13 weeks, the uterus increases in size, changes the location of the appendages, can compress the cyst and cause tension in its capsule. Pain in the lower abdomen intensifies, especially with a change in body position. Acute pain indicates the development of complications – torsion of the legs of the ovarian cyst.

    Complications

    An ovarian cyst in 18% of cases causes a short-term abortion, the likelihood of complications is determined by the hormonal activity of the neoplasm and the existing risk factors for spontaneous miscarriage. In 12% of pregnant women, serous or dermoid cysts twist at the base. Torsion is accompanied by compression of the vessels supplying the tumor and tissue necrosis. Need emergency care and hospitalization in the gynecological department.

    In the 2-3 trimester, with neoplasms of a significant size, the fetus occupies the wrong position – oblique or transverse, which makes it difficult to give birth through the natural birth canal and becomes an indication for caesarean section. If the patient gives birth on her own, at the end of the 1st stage of labor, with the appearance of attempts, there is a possibility of rupture of the cyst capsule and the addition of an acute abdomen clinic.

    Large and inactive cystic masses can interfere with the advancement of the fetal head, so the preservation of the tumor before delivery increases the risk of labor anomalies and injuries in the newborn. Malignant degeneration of an ovarian cyst during pregnancy occurs in 25% of women with this pathology.

    Diagnostics

    Suspicion of an ovarian cyst may occur during examination or routine examination of a pregnant woman. The diagnosis is established in cooperation with an oncogynecologist or oncologist, who exclude the malignant nature of the tumor. The following diagnostic methods are used:

    • Gynecological examination. In a bimanual study over the Douglas space, a mobile tugoelastic formation is determined. The shape of a benign cyst is round or oval, the surface is smooth.
    • Gynecological ultrasound. A benign ovarian cyst during pregnancy looks like a smooth-walled single-chamber formation of a rounded shape with even contours. The contents are hypoechoic or anechoic.
    • CDC. Ovarian cysts are characterized by blood flow in single vessels located in the capsule. A large number of tortuous and irregularly shaped vessels testifies in favor of malignancy.
    • SA-125, SA 19-9. Tumor markers are determined for differential diagnosis with a malignant tumor. The analysis is highly specific, with an increase in the rate of more than 35 mU / ml, 78-100% of pregnant women are diagnosed with ovarian cancer.

    Treatment

    If an ovarian cyst is detected at the conception planning stage, surgical treatment is recommended before pregnancy. In other cases, tactics depend on the type of neoplasia. With follicular and luteal cysts, treatment is not always required, since in most women the formations disappear on their own within 2-3 cycles. For other types of cysts, hormonal therapy is used at the initial stage, with ineffectiveness, laparoscopic removal.

    Conservative therapy

    Treatment of ovarian cysts in early pregnancy is carried out by conservative methods, aimed at preserving the fetus and reducing unpleasant symptoms. A complete cure by medical methods is impossible. Hospitalization in the gynecology department is necessary in the first trimester when there is a threat of interruption of gestation. From the second trimester, women are sent to the department of pathology of pregnant women. The following groups of drugs are used:

    • Gestagens. Oral or vaginal progesterone tablets are indicated to maintain corpus luteum function and maintain pregnancy.
    • Antispasmodics. They are prescribed to reduce the tone of the myometrium. Pregnant women are allowed to take drugs based on drotaverine or papaverine in the form of tablets, rectal suppositories or injections.
    • β-blockers. They are used to reduce the tone of the uterus after 24 weeks. In the early stages, they are ineffective due to the lack of appropriate receptors.

    Surgical treatment

    In most patients, cysts up to 10 cm in diameter accidentally discovered in the 1st trimester are luteal and regress independently after the final formation of the placenta. For other tumors, surgery is indicated. If the ovarian cyst at the beginning of pregnancy proceeds without complications, the intervention is refrained until 16 weeks of gestation. With elevated tumor markers, surgical treatment is carried out as early as possible.

    Laparoscopic access is used, which reduces the risk of complications and shortens the rehabilitation period. When carrying out the operation at a later date, a laparotomy is performed. The volume of intervention is determined intraoperatively based on the results of an urgent histological examination, varies from cyst removal to ovarian resection. In severe cases, an oophorectomy is performed, which does not affect the bearing of the fetus.

    Prognosis and prevention

    The prognosis of ovarian cysts during pregnancy is usually favorable. Timely removal of the neoplasm allows you to bear the child and give birth on time. The reproductive function does not suffer, there are no contraindications for subsequent pregnancies. In order not to increase the risk of complications during the gestation period, cystic formations must be treated at the conception planning stage.

    Specific prevention of the disease has not been developed. Unprotected sex should be abandoned, timely treatment of inflammatory diseases of the genital organs should be carried out, and abortions should be avoided. Patients who do not plan pregnancy and do not have contraindications to hormonal therapy are recommended to use oral contraceptives to prevent hyperplastic processes of the reproductive organs.

    You can share your medical history, what helped you in the treatment of ovarian cysts during pregnancy.

    Sources

    1. Obstetrics. National leadership / ed. Ailamazyan E.K., Kulakov V.I., Radzinsky V.E., Savelieva G.M. – 2009.
    2. Ovarian tumors in pregnant women / Bakhidze E.V. / / Journal of Obstetrics and Women’s Diseases – 2011 – T. LX, No. 3.
    3. Tumors and tumor-like formations of the ovaries. Guidelines for doctors / Belskikh O.L., Kuzmenko G.Yu., Klyuchnikova T.N., Kozlova N.F. – 2017.
    4. This article was prepared based on the site materials: https://www.krasotaimedicina.ru/

    IMPORTANT
    The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

    Ovarian cyst: is pregnancy possible? Diagnosis and treatment of ovarian cysts

    Tumors and tumor-like formations of the ovaries are a common diagnosis in the practice of an obstetrician-gynecologist. Depending on their type of such formations, there are various types of therapy. However, everything is not so simple when such a pathology occurs during gestation.

    This article is not to be used for diagnosis, treatment, and is not a substitute for a doctor’s appointment.