-An ovarian cyst in pregnant women may undergo torsion or may bleed.
-The pregnant women with an ovarian cyst is a special case because of the risk of surgery to the fetus.
- Thus if the patient present with acute pain due to torsion or haemorrhage into an ovarian cyst or if appendicitis is a possibility, the correct course is to undertake a laparotomy regardless the stage of the pregnancy.
-The operation should be covered with by tocolytic drugs and performed in a center with intensive neonatal care.
-If asymptomatic cyst is discovered during the 1 st trimester , it is prudent to wait until after 14 weeks ’ gestation before removing it.
-This avoids the risk of removing a corpus luteal cyst upon which the pregnancy might still be dependent.
-In the 2 nd and 3 rd trimesters , the management of an asymptomatic ovarian cyst may be either conservative or surgical.
-Cysts < 10cm , which have simple appearance on U/S , are unlikely to be malignant or to result in cyst accident and may therefore be followed by U/S.
-Many may resolve spontaneously .
-If the cyst unresolved 6 weeks postpartum , surgery indicated.
-Malignancy is uncommon in pregnancy occurring in less than 3% of the cysts.
-However a cyst with a features suggestive of malignancy on
U/S , or one that is growing, should be removed surgically.
-The tumour marker C 125 is not useful in pregnancy since it may be
elevated in normal pregnancies.
-Ovarian cysts are uncommon and often benign.
-Teratoma and follicular cysts are the most common.
-Presentation may be abdominal pain, distension or precocious puberty.
-Management depends on:
-relief of symptoms.
-exclusion of malignancy and
-conservation of maximum ovarian tissue without depressing fertility.
Types of surgery for apparently benign ovarian tumours:
For young women less than 35 years:
1.Cystectomy ( removal of the cyst only).
2.Oophorectomy( removal of the ovary with the cyst).
For woman more than 45 years with ovarian cyst more than 6cm in diameter it is advisable to do total abdominal hysterectomy and bilateral salpingo-oopgorectomy.
-Surgery is the mainstay of both the diagnosis and the treatment of ovarian cancer.
-A vertical incision is required for an adequate exploration of the upper abdomen.
-A sample of ascitic fluid or peritoneal washings with normal saline should be taken for cytology.
-The pelvis and upper abdomen are explored carefully to identify metastatic disease.
-The therapeutic objective of surgery for ovarian cancer is the removal of all tumour tissues.
-This is usually possible in the majority of stage I and stage II, but impossible in advanced cases.
To resect all visible tumour requires a total hysterectomy, bilateral salpingo-oophorectomy and infra-colic omentectomy.
-However , in a young , nulliparous woman with unilateral tumour and no ascites ( stage Ia ), unilateral salpingo-oophorectomy may be done after careful exploration to exclude metastatic disease , and curettage of the uterine cavity to exclude a synchronous endometrial tumour.
-If the is subsequently found to be poorly differentiated or if the washings are positive, a second operation to clear the pelvis will be necessary.