Ovarian cyst during pregnancy
The content of the article:
- Types of cysts
- The risk of developing cystic formations in pregnant women
- Treatment Approach
-
Surgical removal
- Preoperative preparation
- Features of the operation
- Postoperative period
- Consequences for the body
- Video
During pregnancy, an ovarian cyst can be a consequence of the development of an existing pathology in the history (for example, polycystic disease) or occur against the background of complete health. Most of the cystic neoplasms are detected long before pregnancy during ultrasound of the pelvic organs and, as a rule, do not affect either the body of a pregnant woman or the process of conception and gestation.
Ovarian cysts during pregnancy are rarely dangerous, but urgent surgery is necessary in severe cases
Types of cysts
The neoplasm can develop on the right ovary, the left, or both.
The following types of cystic neoplasms are found in pregnant women:
- follicular;
- corpus luteum cyst (in this case, there is a clear connection with the time of ovulation);
- paraovarian;
- luteal (pregnancy luteoma);
- endometrioid (endometriosis);
- dermoid.
The first two types belong to functional formations. With sizes up to 3-5 cm, the formations are not dangerous, treatment is not required, they are only subject to monthly scheduled examination. In the case of intensive growth, a suspicion of a rupture (manifested by symptoms of an acute abdomen) requires additional observation in a hospital setting and, if necessary, an operation. The exact cause of the appearance cannot be established.
The risk of developing cystic formations in pregnant women
During pregnancy, cysts in the course and risks practically do not differ from those in non-pregnant women. The prognosis for all benign lesions is favorable. Timely treatment allows you to prolong pregnancy until the required period (gestation until the end of the third trimester - 38-40 weeks), preserve the life and health of both the mother and the child.
If a malignant tumor of the ovary is suspected, which may be a consequence of the malignancy of some types of benign neoplasms, the treatment tactics changes, and the prognosis becomes unfavorable. The phenomenon of malignancy threatens with termination of pregnancy, but it is extremely rare.
Treatment Approach
During early pregnancy, the ovarian cyst is subject to observation, in most cases, over time, it disappears independently. The goal is not to miss malignant disease of the ovaries and pelvic organs. Indications for hospitalization:
- formations persist up to 4-6 months;
- formations increase in size with observation;
- the impossibility of carrying out differential diagnosis on an outpatient basis with other diseases (appendicitis, peritonitis, adhesive disease);
- the appearance of pronounced clinical signs of the disease (it begins to hurt in the lower abdomen, discharge appears).
Surgical removal
If surgical removal of the cyst is necessary, an operation is performed for a period of 15-17 weeks. The gold standard is laparoscopy - a minimally invasive type of intervention, which represents the most compatible treatment option for the expectant mother and child, safe for both.
If surgery is necessary in the third trimester, the removal of the cyst is carried out by the method of midline laparotomy, in this case, if possible, doctors try to wait 38-39 weeks and at the same time perform a cesarean section.
| Indications for laparoscopy | Contraindications to laparoscopy |
|
Only benign formations. Size no more than 12 cm. Bilateral defeat. Risk of tearing and twisting during pregnancy. There is a high risk of torsion of the pedicle in the postpartum period. |
Malignant form of education. The neoplasm is more than 12 cm. The gestation period is more than 18 weeks. Obesity grade 4. Adhesive disease in the abdominal cavity. |
If it is impossible to perform laparoscopic intervention, they resort to laparotomy.
Preoperative preparation
Medical preoperative preparation includes:
- Tocolytic drugs (intravenous administration) - Fenoterol, Verapamil. To prolong pregnancy and prevent complications.
- To prevent miscarriages, 5 ml of Metamizole sodium intravenously.
- Strengthening of uteroplacental blood flow - Curantil, Pentoxifylline.
Features of the operation
The operation is performed under endotracheal anesthesia.
The position is standard. After the creation of the primary pneumoperitoneum, the Trendelenburg position.
The abdominal cavity is entered openly, thereby reducing the risk of injury to the uterus. Above the navel, an incision is made no more than 2-3 cm long. All tissues are cut in layers and at the end the peritoneum is cut, and only then a trocar (a special instrument with a camera) is inserted. In classical laparoscopy, layer-by-layer tissue dissection is not performed, only the skin is cut and then a puncture is made.
Lateral trocars are inserted depending on the gestational age and the location of the cyst itself. In the classic version, there are strict trocar locations.
The cyst is removed through an incision in the anterior abdominal wall.
If necessary, the ovarian cyst is removed laparoscopically
Postoperative period
After the operation, medical support is provided:
- tocolytic drugs (only in tablet form);
- finoptin drugs to eliminate the side effects of tocolytics.
Consequences for the body
This surgical intervention has no effect on the further reproductive health of a woman; it is permissible to become pregnant again.
The following complications rarely occur:
- the risk of termination of pregnancy after surgery;
- fetal growth retardation;
- injury to the uterus when placing a trocar;
- bleeding from the uterus, ovaries;
- insufficient hemostasis at the site of direct removal of the cyst.
In the presence of complications, a laparotomy is indicated (laparoscopy is not repeated).
Video
We offer for viewing a video on the topic of the article.
Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
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