Management of ovarian cysts and cancer in pregnancy

Abstract

The incidence of ovarian cysts in pregnancy appears to be rising, especially with the increased use of routine antenatal ultrasounds. Most of them are benign and tend to resolve spontaneously. It is rare to diagnose malignant ovarian tumours during pregnancy. Evaluating the adnexa during routine antenatal ultrasound is considered opportunistic screening. Even though several factors can make ultrasound less reliable during pregnancy, it is the preferred initial imaging method. MRI is also a safe option during pregnancy for further evaluation of ovarian lesions. Surgery is recommended for larger, symptomatic cysts or those suspected of malignancy. Laparoscopic management of ovarian cysts is possible between 14 and 16 weeks of gestation but requires advanced laparoscopic skills. Due to the risk of adverse fetal and maternal outcomes associated with surgery during pregnancy, conservative management is preferred when it is deemed safe. Multi-disciplinary team approach is recommended for complicated and malignant adnexal masses.