Introduction

This chapter discusses the management of a number of gynecologic problems in association with pregnancy that are not covered elsewhere in the book.

The management of the following is discussed elsewhere:

Ovarian Cysts in Pregnancy

Introduction

Incidental detection of an ovarian cyst has become more common with the increasing availability of prenatal ultrasound scanning. In a retrospective audit, 4.8% of women having a scan before 10 weeks had an ovarian cyst of 3 cm or more. Larger ovarian cysts, _6 cm, are estimated to occur much less frequently, in 0.5–2 per 1000 pregnancies. Most unilocular and anechoic ovarian cysts with thin borders that are seen during the first trimester are corpus luteum cysts. These cysts do not usually persist beyond the end of the first trimester. Although the majority of ovarian cysts in pregnancy are asymptomatic, and resolve spontaneously, some can present with torsion or pain.

A review of incidentally detected ovarian cysts reported the following proportions:

In general, further evaluation and surgical management of cysts detected in early pregnancy is usually left until the second trimester.

Maternal and Fetal Risks

The major risks of ovarian cysts in pregnancy are to the mother, namely pain from torsion, rupture, or hemorrhage into the cyst. A large cyst late in pregnancy may predispose to malpresentation or obstructed labor. The overall rate of torsion is approximately 15%, with ovarian masses between 6 and 8 cm having almost twice the risk of torsion compared to other sizes. The majority of torsions tend to occur in the second trimester.

Most ovarian cysts are asymptomatic and resolve spontaneously, and ovarian carcinoma developing de novo during pregnancy is uncommon, with malignancy being found in approximately 1–6% of cases.