From the Guidelines
Ovarian cysts during pregnancy are common and typically don't require treatment as most resolve on their own, with expectant management usually recommended for cysts smaller than 5-6 cm that are asymptomatic and appear benign on imaging. Most functional cysts (like corpus luteum cysts) discovered in early pregnancy will disappear by the second trimester 1. Your healthcare provider will likely monitor the cyst through ultrasound to track its size and characteristics. If the cyst is smaller than 5-6 cm, asymptomatic, and appears benign on imaging, expectant management is usually recommended with follow-up ultrasounds. Larger cysts (>5-10 cm) or those with concerning features may require closer monitoring. Surgical intervention during pregnancy is rare and generally only considered if there are complications like torsion (twisting of the ovary), rupture, or if cancer is suspected 1. You may experience mild pelvic discomfort, but severe pain, fever, vomiting, or dizziness warrant immediate medical attention as these could indicate complications. The presence of an ovarian cyst typically doesn't affect pregnancy outcomes or delivery methods, and most women with ovarian cysts have normal pregnancies and healthy babies.
Some key points to consider:
- The incidence of adnexal masses in pregnancy ranges from 1% to 6%, with up to 70% of all lesions resolving spontaneously 1.
- The most common types of adnexal masses in pregnancy requiring surgical management are dermoid cysts, endometriomas, functional cysts, serous cystadenomas, and mucinous cystadenomas 1.
- Ultrasound is the mainstay of evaluation of adnexal masses in pregnancy because of accuracy, safety, and availability 1.
- Approximately 2% of adnexal masses in pregnancy are malignant, with most ovarian cancers diagnosed during pregnancy being stage I and having more favorable outcomes 1.
It's essential to follow the guidance of your healthcare provider and attend all scheduled ultrasound appointments to monitor the cyst's size and characteristics. In general, the approach to managing ovarian cysts during pregnancy prioritizes expectant management with close monitoring, reserving surgical intervention for cases with complications or suspected malignancy 1.
From the Research
Ovarian Cyst in Pregnancy Expectation
- The association of an ovarian cyst with pregnancy is relatively rare, but it may result in serious maternal and fetal complications 2.
- Management options for ovarian cysts during pregnancy include conservative management, elective laparoscopic surgery, and emergency surgery 3, 4, 5.
- Elective laparoscopic surgery may be considered for benign ovarian cysts found early in pregnancy, with adequate informed consent 3.
- The ideal period for scheduled surgery is probably the beginning of the second trimester, as the probability of operating on a functional cyst becomes small and the rate of abortion is minimized 5.
- Laparoscopy can be widely used until the 2nd quarter of pregnancy 4.
- Ovarian torsion in pregnancy is a serious complication that requires immediate attention and laparoscopic management 6.
- The size of the ovarian cyst is an important factor in determining the risk of complications, with cysts larger than 6cm being at higher risk 4, 5.
- The type of ovarian cyst is also an important factor, with organic cysts such as dermoid cysts being more common after 16 weeks of amenorrhea 5.
- Corpus luteum cysts are generally not present after the end of the first trimester and do not require intervention unless complications occur 5.