Management of ovarian cysts in pregnancy: A case report

According to recent epidemiological studies on ovarian cysts during pregnancy one out of 600 are, in most cases, benign neoformations. The most frequent histological type reported is mature cystic teratoma (50% of the cases), followed by functional cysts (13%), benign cystadenomas (20%) and ovarian cancer (0.6%). Most adnexal masses are asymptomatic and spontaneously resolve before the 16th week of amenorrhoea. On the other hand, some cases are persistent forms which can cause complications for the mother and fetus. The objective of this work was to review the existing literature from an epidemiological point of view, with an emphasis on diagnostic and therapeutic management. We have paid particular attention in our review to the use of diagnostic techniques and non surgical therapies such as laparoscopy, which in expert hands and adopting particular skills, can be considered as on approach to ovarian cysts in pregnancy. We present the case of a patient with an ovarian cyst during pregnancy that was a successfully treated with laparoscopy.

Pregnancy, Ovarian cysts, Laparoscopy

[1] Booth R.T.: "Ovarian tumor in pregnancy". Obstet. Gynecol., 1963, 21, 189.

[2] Hogston P., Lilford R.J.: "Ultrasound study of ovarian cysts in pregnancy: prevalence and significance". Br. J. Obstet. Gynaecol.,1986, 93, 625.

[3] Bernhard L.M., Klebba P.K., Gray D.L., Mutch D.G.: "Predictors of persistence of adexal masses in pregnancy". Obstet. Gynecol., 1999, 93, 585.

[4] Scheene D.M.: "The adnexal mass in pregnancy". Mo. Med., 2004, 101, 42.

[5] Nowak M., Szpakowski M., Wilczynski J.R.: "Ovarian tumors in pregnancy - proposals of diagnosis and treatment". Gynecol. Pol., 2004, 75, 242.

[6] Liu J.R., Lilja J.F., Johnston C.: "Adnexal masses and ovanan cancer in pregnancy". Cancer Obstet. Gynaecol., 1999, 9, 25.

[7] Sherard G.B., Hodson C.A., Williams H.J., Semer D.A., Hadi H.A., Tait D.L.: "Adnexal masses and pregnancy: a 12 year experience". Am. J. Obstet. Gynecol., 2003, 189, 358.

[8] Romagnolo C., Maggino T., Zola P., Sartori E., Gadducci A., Bandoni F.: "An analysis of different approaches to ovarian cysts in Italy". Eur. J. Gynaecol. Oneal., 2004, 25, 183.

[9] Boulary R., Podczaski E.: "Ovarian cancer complicacatmg pregnanacy". Obstet. Gynecol. Clin. North Am., 1998.

[10] Lachman E., Schienfeld A. et al.: "Pregnancy and laparoscopic surgery". J. Am. Assoc. Gynecol. Laparosc., 1999, 6, 347.

[11] Fatum M., Rojansky N.: "Laparoscopic surgery during pregnancy". Obstet. Gynecol. Surv., 2001, 56, 50.

[12] Soriano D.,Y efetY.: "Laparoscopy versus laparotomy in the management of adnexal masses during pregnancy". Fertil. Steril., 1999, 71, 955.

[13] Andreoli M., Servakov M.: "Laparoscopic surgery dunng pregnancy". J. Reprod. Med., 2000, 45, 599.

[14] Stepp K.J., Tulikangas P.K., Goldberg J.M., Attaran M., Falcone T.: "Laparoscopy for adnexal masses in the second trimester of pregnancy". J. Am. Asssoc. Gynecol. Laparosc., 2003, 10, 55.

[15] Friedman J. et al.: "Pneumoamnion and pregnancy loss after second trimester laparoscopic surgery". Obstet. Gynecol., 2002, 99, 512.

[16] Cruz A.M., Southerland L.C.: "lntraabdominal carbon dioxide insufflation in the pregnant ewe. Uterine blood flow, intraamniotic pressure, and cardiopulmonary effects". Anesthesiology, 1997, 87, 1596.

[17] Hunter J., Swanstorm L.: "Carbon dioxide pneumoperitoneum induces fetal acidosis in a pregnant ewe model". Surg. Endosc., 1995, 9, 272.

[18] Galan H.L., Reedy M.B.: " Maternal and fetal effects of laparoscopic insufflation". Anesthetiology, 1994, 81, 1159.

[19] Barnard J.M.,C haffin D.: "Fetal response to carbon dioxide pneumoperitoneum in the pregnant ewe". Obstet. Gynecol., 1995, 85, 669.

[20] Nezhat C., Seidman D.S.: "The risk of carbon monoxide poisoning after prolonged laparoscopic surgery". Obstet. Gynecol., 1996, 88, 771.

[21] Ott D.E.: "Carboxyhemoglobinemia due to peritoneal smoke absorption from laser tissue combustion at laparoscopy". J. Clin Laser. Med. Surg., 1998, 16, 309.

[22] Nagao K., Reichert J.: "Carbon dioxide embolism dunng laparoscopy: effect of insufflation pressure in pigs". JSLS, 1999, 3, 91.

[23] Mundell E.W.: "Primary ovarian cancer associated whith pregnancy". Clin. Obstet. Gynecol., 1963, 54, 136.

[24] Boughinaze S.,N aifer R.,H afsa A.,C haiba A.,H idar S.: "Laparoscopic management of adnexal tumor after the first trimester of pregnancy". J. Gynecol. Obstet. Biol. Reprod., 2004, 33, 319.